The following signs and symptoms are common:

• any abnormal lump or mass in any organ
• lymphadenopathy:
  • persistent beyond 2 weeks
  • associated with systemic symptoms (see next bullet point)
  • that does not resolve despite appropriate treatment of infection
  • associated with pain in the lymph nodes following alcohol consumption
• one or more of these symptoms even without lymphadenopathy:
  • persistent unexplained fever, drenching sweats, unintentional weight loss, persistent severe itch and frequent infections.

Initial investigations

If there is a high likelihood of a malignant process, prompt referral to a specialist centre for a tissue diagnosis is appropriate.

For others, further investigations should be completed and may include:

•  full blood examination
• imaging of the affected areas using ultrasound, x-ray and CT, as appropriate
• biopsy, as appropriate
• a period of observation of up to 4 weeks for patients without significant or progressive symptoms.

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.

All patients with suspected lymphoma should be evaluated and cared for by a lymphoma-specific multidisciplinary team. Healthcare providers should provide clear routes of rapid access to specialist evaluation.

Communication

The GP’s responsibilities include:

• explaining to the patient and/or carer who they are being referred to and why
• supporting the patient and/or carer while waiting for specialist appointments
• informing the patient and/or carer that they can contact Cancer Council on 13 11 20.

Checklist

Timeframe

For patients who don’t need a prompt referral, all investigations should be completed, and a path of action decided, within 4 weeks of their first presentation.

Patients should be referred to a specialist:

• within 72 hours if the presence of lymphoma is highly likely
• within 4 weeks if indicators of concern are absent.

If under observation, the patient should be reviewed by their GP within 6 weeks of initial presentation.