LGLs frequently present with symptoms of gradual onset occurring over weeks or months. People can be asymptomatic at diagnosis, with LGL discovered incidentally after imaging or laboratory tests reveal an abnormality.

The following signs and symptoms should be investigated:

• a lump or mass in any organ
• lymphadenopathy, particularly lymphadenopathy lasting more than 2 weeks
• splenomegaly
• one or more of these systemic symptoms even in the absence of lymphadenopathy: fever, drenching night sweats, unexplained weight loss, frequent infections
• unexplained cytopenias
• persistent lymphocytosis.

Indicators of concern that should lead to prompt referral to a specialist include:

• symptoms or results indicating organ dysfunction and low blood counts
• markedly elevated LDH
• marked B symptoms (weight loss > 10%, persistent fevers > 38°C, or persistent drenching night sweats).

Initial investigations by a GP include:

Where there are no indicators of concern (listed above), perform these investigations:

• blood tests to assess organ dysfunction, but no laboratory test can exclude these lymphomas
• imaging of the affected area including ultrasound, chest radiography and CT scan as appropriate
• biopsy or direct specialist referral as appropriate.

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, potential out- of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.

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, Leukaemia Foundation and Lymphoma Australia.

Checklist

• Signs and symptoms recorded
• Supportive care needs assessed and referrals to allied health services actioned as required
• Patient notified of support services such as Cancer Council 13 11 20, Leukaemia Foundation 1800 620 420 and Lymphoma Australia 1800 953 081
• Referral options discussed with the patient and/or carer including cost implications

Timeframe

For patients with indicators of concern, urgent referral to a specialist centre and rapid access to specialist evaluation and review is needed. Where lymphoma is proven by biopsy, or strongly suspected, referral to specialist should occur within 72 hours.

Where there are no indicators of concern, initial investigations should take place and referral to a specialist should occur within 4 weeks.