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Should I see a specialist in non Hodgkin lymphoma?

Men and women discussing non Hodgkin's lymphoma

This page tells you about the guidelines that GPs have to help them decide who needs to see a specialist for suspected non Hodgkin lymphoma (NHL) and how soon. You can find the following information

 

A quick guide to what's on this page

Should I see a specialist in non Hodgkin lymphoma?

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much more minor. There are guidelines for GPs to help them decide which patients need to be seen urgently by a specialist.

Guidelines for urgent referral

You should ideally get an appointment within 2 weeks for an urgent referral. You should have an urgent referral to a specialist (usually a haematologist) if you have an enlarged spleen that isn’t getting better and your doctor can't explain the cause. You might also need further tests or a referral if you have a swollen lymph node that is

  • Larger than 2 cm wide
  • More than 6 weeks old
  • Getting bigger
  • Accompanied by night sweats, weight loss or an enlarged spleen
  • One of several swollen lymph nodes

The guidelines also say that a GP should do tests and possibly refer anyone with a combination of symptoms that includes tiredness (fatigue), weight loss, a high temperature (fever), night sweats, itching, breathlessness, bruising or bleeding easily, infections that keep coming back or pain.
 

CR PDF Icon You can view and print the quick guides for all the pages in the about NHL section.

 

 

How common is non Hodgkin lymphoma?

There are around 12,300 cases of non Hodgkin lymphoma diagnosed in the UK each year. It is the 5th most common cancer in the UK. 4 out of every 100 cancers diagnosed in the UK (4%) are non Hodgkin lymphoma.

 

About UK referral guidelines

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much less serious that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better, or respond to simple treatments. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed and people needing urgent appointments wouldn't be able to get them.

There are particular symptoms that mean your GP should refer you to a specialist straight away. The National Institute for Health and Clinical Excellence (NICE) and the Scottish Government have produced guidelines for GPs to help them decide which patients need to be seen urgently by a specialist. While reading these guidelines, it is important to remember that

  • About 70 out of every 100 people (70%) diagnosed with non Hodgkin lymphoma are over 60, but you can be diagnosed at any age
  • Symptoms are very similar to those of Hodgkin lymphoma. The most common symptoms are weight loss, tiredness, night sweats, a lump in a lymph gland (often in the armpit or neck) and an enlarged liver or spleen
  • Between 35 and 45 out of every 100 people diagnosed (35 to 45%) have NHL somewhere else in the body other than in the lymph glands
 

Guidelines for urgent referral

You should ideally get an appointment within 2 weeks for an urgent referral. You should have an urgent referral to see a specialist (usually a haematologist) if you have an enlarged spleen that is not getting better, and your doctor can't explain the cause.

You might also need further investigations or a referral if you have a swollen lymph node that is

  • Larger than 2 cm wide
  • More than 6 weeks old
  • Getting bigger
  • Accompanied by night sweats, weight loss or an enlarged spleen
  • One of several swollen lymph nodes

The guidelines say that a GP should do some tests for anyone with some of the following symptoms

  • Tiredness
  • Weight loss
  • A high temperature (fever)
  • Night sweats
  • Itching
  • Breathlessness
  • Bruising easily or bleeding
  • Infections that keep coming back
  • Bone pain or nerve pain
  • Abdominal pain
  • An enlarged spleen or lymph nodes

Depending on the results your GP will decide whether you need to be referred to a specialist. Do bear in mind that many of these symptoms can be caused by other, less serious, medical conditions and do not necessarily mean that you have non Hodgkin lymphoma.

 

Guidelines about referring children

Children need urgent referral to see a specialist if they have

  • Lymph nodes that have become swollen and are firm or hard and not sore to the touch, that are larger than 2cm across and getting bigger, and are in the armpit or just above the collar bone. They may also have signs of general ill health, fever or weight loss
  • Breathlessness with any of the above symptoms
  • An enlarged liver and spleen
  • A lump (mass) in their chest, seen on a chest X-ray

Remember that swollen lymph nodes are usually due to infection and are not serious. But the guidelines advise GPs to refer a child who has the above lymph node symptoms, particularly if there are no signs of an infection.

 

What to do if you are still worried

If you are concerned that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you. Then you can decide together whether you need to see a specialist and if so, how soon.

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Updated: 18 October 2012