Lymphoma
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What is Lymphoma?
Lymphoma is a cancer that begins in the lymphocytes, a type of white blood cell that is part of the body's immune system. It mainly affects the lymph nodes, but it can also start in the spleen, bone marrow, tonsils, thymus, and other lymphatic tissue. Because it begins in blood cells, lymphoma is classified as a blood cancer along with leukaemia and myeloma.
There are two broad categories of lymphoma. Hodgkin lymphoma is identified by a specific type of abnormal cell called the Reed-Sternberg cell. Non-Hodgkin lymphoma is a larger and more varied group with many subtypes. The right treatment depends on which type and subtype is diagnosed.
If you have noticed a painless swelling in your neck, armpit or groin that has not gone away in a few weeks, it does not always mean lymphoma. Most lumps are not cancer. But a haemato-oncology consultation is the safest way to be sure.
Types of Lymphoma
Hodgkin Lymphoma
Hodgkin lymphoma is the less common of the two categories. It is characterised by the presence of Reed-Sternberg cells – abnormal large cells visible under the microscope. It is most often diagnosed in young adults aged 20 to 39 and in adults over 65.Non-Hodgkin Lymphoma
- Diffuse Large B-Cell Lymphoma (DLBCL): the most common aggressive lymphoma.
- Mantle cell lymphoma: less common; can be aggressive.
- Burkitt lymphoma: fast-growing; more common in children and young adults.
- Follicular lymphoma: typically slow-growing.
- Marginal zone lymphoma, including MALT lymphoma, which often starts in the stomach.
Non-Hodgkin lymphomas are described as aggressive (fast-growing) or indolent (slow-growing). The exact subtype is identified by a lymph node biopsy with immunohistochemistry and flow cytometry.
Symptoms of Lymphoma
Lymphoma symptoms can develop slowly and are often mistaken for ordinary infections. Common signs include:
- A painless swelling of one or more lymph nodes in the neck, armpit, or groin that does not go away within a few weeks.
- Fever that is unexplained, particularly at night.
- Drenching night sweats.
- Unintentional weight loss of more than 10% over six months.
- Persistent fatigue or weakness.
- Loss of appetite.
- Itching across the body (pruritus).
- Cough, shortness of breath, or chest pain, if lymphoma involves nodes in the chest.
- Abdominal swelling or pain, which may indicate involvement of the spleen or liver.
What are 'B symptoms' in lymphoma?
Three specific symptoms are grouped as 'B symptoms': unexplained fever above 38°C, drenching night sweats, and unintentional weight loss of more than 10% of body weight in six months. The presence of B symptoms is recorded in the staging system because it can affect treatment decisions and prognosis.
If you have noticed any of these signs for more than two to three weeks, please consult a doctor. Most patients with these symptoms do not have lymphoma, but a clinical assessment is the only way to find out.
Where Lymphoma Can Start
Lymphoma can begin in any lymphatic tissue, including:
- Lymph nodes (most common)
- Spleen
- Bone marrow
- Thymus
- Tonsils and adenoids
- Lymphatic tissue in the stomach or intestine (MALT lymphoma)
- Skin (cutaneous T-cell lymphoma)
- Central nervous system (rare; primary CNS lymphoma)
Causes and Risk Factors
The exact cause of most lymphomas is not known. Several factors are linked to an increased risk:
- A weakened immune system, including HIV infection or immunosuppression after an organ transplant.
- Certain infections, particularly Epstein-Barr virus (linked to Hodgkin lymphoma and Burkitt lymphoma), Helicobacter pylori (linked to gastric MALT lymphoma), and Hepatitis C.
- Autoimmune conditions such as rheumatoid arthritis or lupus.
- Previous chemotherapy or radiation therapy for another cancer.
- A family history of lymphoma, in a small proportion of cases.
- Older age for most non-Hodgkin lymphomas; younger adult age for Hodgkin lymphoma.
- Occupational exposure to certain chemicals, including some pesticides and herbicides.
Having one or more of these risk factors does not mean lymphoma will develop. Most people exposed to these factors never get lymphoma.
How Lymphoma is Diagnosed at Onco-Life
A lymphoma diagnosis is built up from several tests, each answering a different question.
- Physical examination: a doctor examines the neck, armpits, groin, and abdomen for swollen lymph nodes or an enlarged spleen.
- Blood tests: a complete blood count (CBC) and lactate dehydrogenase (LDH) level are routinely checked. LDH is often raised in aggressive lymphoma.
- Lymph node biopsy: the central diagnostic test. A tissue sample is taken from the suspicious node and examined to confirm whether lymphoma is present and which subtype.
- Immunohistochemistry, flow cytometry, and molecular tests: laboratory techniques that identify the specific lymphocyte type (B-cell, T-cell, or NK-cell) and look for genetic features that guide treatment.
- Bone marrow biopsy: a small sample of bone marrow is taken from the hip bone to check whether lymphoma has spread there.
- PET-CT scan : whole-body scan combining CT with a tracer that highlights active lymphoma. Standard imaging for staging most lymphomas.
- Other imaging: CT or MRI scans may be used in addition, particularly if the brain or spinal cord needs to be evaluated.
If you have already been diagnosed with lymphoma elsewhere, the haemato-oncologists at Onco-Life offer remote and in-person second opinion consultations. A second pathology review is sometimes recommended because lymphoma subtyping can change treatment.
Staging of Lymphoma
Lymphoma is staged using the Lugano classification (updated from the older Ann Arbor system).
- Stage I: lymphoma in one lymph node area, or one organ outside the lymph nodes.
- Stage II: lymphoma in two or more lymph node areas, all on the same side of the diaphragm.
- Stage III: lymphoma in lymph node areas on both sides of the diaphragm.
- Stage IV: lymphoma has spread widely, including to organs such as the liver, lung, or bone marrow.
Each stage is also recorded with an 'A' or 'B':
- A: no B symptoms.
- B: one or more B symptoms present (fever, drenching night sweats, weight loss).
Other features recorded include 'bulky' disease (a single large mass) and extranodal involvement (cancer outside lymph nodes).
Lymphoma Treatment Options
Lymphoma treatment depends on the subtype, the stage, the patient's age and overall health, and the goals of treatment. At Onco-Life, treatment is planned by a multidisciplinary team that may include a haemato-oncologist, a medical oncologist, a radiation oncologist, a pathologist, and a radiologist.
Chemotherapy
Chemotherapy uses drugs that kill or stop the growth of fast-dividing cells. It is the backbone of lymphoma treatment. Common regimens include:
- ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) for Hodgkin lymphoma.
- CHOP or R-CHOP (Rituximab + Cyclophosphamide + Hydroxydaunorubicin + Vincristine + Prednisolone) for many non-Hodgkin lymphomas.
- Other regimens for specific subtypes; the choice is made by the treating oncologist.
Chemotherapy is given in cycles, typically over three to six months. Most cycles are delivered as daycare admissions.
Immunotherapy uses drugs that recruit the immune system to recognise and kill lymphoma cells. Rituximab, which targets the CD20 protein on B-cells, is part of standard treatment for many B-cell lymphomas. Newer checkpoint inhibitors such as nivolumab and pembrolizumab are used in specific Hodgkin and non-Hodgkin lymphomas.
Targeted drugs attack specific molecular features of certain lymphomas. Examples used in specific subtypes include ibrutinib (a BTK inhibitor for mantle cell lymphoma and certain B-cell lymphomas) and venetoclax (a BCL-2 inhibitor used in some relapsed lymphomas). Your oncologist will recommend a targeted therapy only if your lymphoma subtype is known to respond to it.
Radiation Therapy
Radiation therapy is used in early-stage Hodgkin lymphoma, in localised non-Hodgkin lymphoma, and to treat areas of bulky disease. At Onco-Life Cancer Centre's Talegaon unit, radiation therapy is delivered using TomoTherapy [link to Radiation Oncology service page], an image-guided radiation system that adjusts the beam in real time. This helps deliver a precise dose to lymphoma sites while reducing exposure to surrounding healthy tissue, such as the heart, lungs, and thyroid.
Stem Cell / Bone Marrow Transplant
For some patients with high-risk or relapsed lymphoma, high-dose chemotherapy followed by a stem cell transplant may be recommended. Onco-Life's haemato-oncology team will discuss whether a transplant is appropriate and coordinate referral to a transplant centre when needed.
Supportive Care
Supportive care is part of the treatment plan from the start. This includes nutrition support, management of treatment side effects, antibiotics for infections, blood transfusions where needed, and access to palliative care and psychological support throughout treatment
Prognosis and Follow-Up
Treatment outcomes in lymphoma depend on the subtype, the stage at diagnosis, age, and response to first-line treatment. Many lymphomas respond well to treatment, and long-term remission is achievable for many patients. Hodgkin lymphoma and some aggressive non-Hodgkin lymphomas have particularly favourable response rates with current standard regimens.
Follow-up after lymphoma treatment is structured and includes:
- Regular clinical examinations.
- Periodic blood tests.
- Imaging scans at planned intervals, becoming less frequent over time.
- Long-term monitoring for late effects of treatment and for secondary cancers.
Individual outcomes vary. Your oncologist is the best person to discuss what to expect in your specific case.
Lymphoma in India
The ICMR National Cancer Registry Programme tracks lymphoma incidence across population-based cancer registries in India. Reported risk factors include older age for non-Hodgkin lymphoma, immunosuppression including HIV, and certain viral infections such as Epstein-Barr virus.
Diagnosis of lymphoma in India is sometimes delayed because the early symptoms – painless swollen lymph nodes, low-grade fever, and night sweats – overlap with tuberculosis, which is much more common. If a course of TB treatment has not improved symptoms after six to eight weeks, a lymph node biopsy and a haemato-oncology consultation are recommended.
Onco-Life's mobile cancer screening programme and rural outreach are designed to help patients across Maharashtra access haemato-oncology care earlier in their diagnostic journey.
Lymphoma Treatment Under Government Health Schemes
Lymphoma treatment in India can involve multiple cycles of chemotherapy, immunotherapy, radiation, and follow-up scans over several months. For patients enrolled in government health schemes, Onco-Life Cancer Centre can facilitate cashless or subsidised treatment.
Onco-Life Cancer Centre is empanelled with:
- Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) for eligible Maharashtra residents.
- Ayushman Bharat (PM-JAY) for eligible Indian citizens.
- Central Government Health Scheme (CGHS) for eligible central government employees and pensioners.
- General Insurance Public Sector Association (GIPSA) for cashless processing with empanelled insurers.
Eligibility criteria apply. Please call our TPA desk before your visit to verify your eligibility and the documents required.
Our Lymphoma Specialists at Onco-Life
MBBS, DNB (Med), DNB (Oncology), ESMO-Certified Haemato-Oncologist
Director and Partner, Oncology Care Associates LLP
Based at: Onco-Life Cancer Centre, Chiplun
For appointments or second opinion consultations:
- [Link: Book a haemato-oncology consultation]
- Call: 7378958000 (Chiplun) | 8128124067 (Talegaon and Wagholi) | 7769004343 (Satara)
Book a Haemato-Oncology Consultation at Onco-Life Cancer Centre
If you or someone in your family has been told they may have lymphoma, or you would like a second opinion on an existing diagnosis, our haemato-oncologists can help.
- [Button] Book a Doctor Appointment Online → link to /book-doctor-appointment/
- [Button] Request a Second Opinion → link to /book-doctor-appointment/ with source tag
- Call: 7769004343 (Satara) | 7378958000 (Chiplun) | 8128124067 (Talegaon and Wagholi)
Note: Place this CTA in the body after the Treatment section. Also repeat a shorter version after the Diagnosis section.
Frequently Asked Questions
Lymphoma: Symptoms, Causes, Stages and Treatment in India-FAQS
Is Lymphoma A Type Of Cancer?
Yes. Lymphoma is a cancer that begins in the lymphocytes, a type of white blood cell. It is classified as a blood cancer along with leukaemia and myeloma.
Is Lymphoma Curable?
Many types of lymphoma respond well to treatment. For Hodgkin lymphoma and some aggressive non-Hodgkin lymphomas, long-term remission and what doctors call a cure is achievable for a large proportion of patients. Outcomes depend on subtype, stage, age, and treatment response. Please consult an oncologist for guidance specific to your situation.
Is Lymphoma Treatment Covered Under MJPJAY Or Ayushman Bharat At Onco-Life?
Onco-Life Cancer Centre is empanelled with MJPJAY, Ayushman Bharat (PM-JAY), and CGHS. Eligibility depends on the scheme and your individual situation. Please call our TPA desk before your visit to verify your eligibility and the documents required.
Why Is Lymphoma Sometimes Mistaken For Tuberculosis In India?
Both conditions can cause painless swollen lymph nodes, low-grade fever, night sweats, and weight loss. The standard test to tell them apart is a lymph node biopsy with immunohistochemistry. If TB treatment is not improving symptoms after six to eight weeks, a haemato-oncology consultation and biopsy are recommended.
Where Can I Get Lymphoma Treated Near Pune Or Mumbai?
Onco-Life Cancer Centre's Talegaon unit (off the Mumbai-Pune Expressway, Talegaon Dabhade) and Wagholi unit (east Pune) provide haemato-oncology, medical oncology, and radiation oncology services for lymphoma patients. The Talegaon centre houses TomoTherapy for radiation therapy. Onco-Life does not currently have a Mumbai-city centre.
What Is The Survival Rate For Lymphoma?
Survival rates vary widely by subtype, stage, age, and treatment response. According to the American Cancer Society, the 5-year relative survival rate for early-stage Hodgkin lymphoma is approximately 92%. These are averages; your oncologist can give the most accurate picture for your specific situation.
MBBS, DNB (Med), DNB (Oncology), ESMO-Certified, Haemato-Oncologist
Consultant Medical & Haemato-Oncologist
Onco-Life Cancer Centre, Chiplun Director & Partner – Oncology Care Associates LLP