What are the key clinical features and symptoms that may suggest a diagnosis of Non-Hodgkin Lymphoma in primary care?

Key clinical features and symptoms suggesting Non-Hodgkin Lymphoma (NHL) in primary care include:

• Unexplained lymphadenopathy (swollen lymph nodes), which may be persistent or progressive.
• Unexplained splenomegaly (enlarged spleen).
• Systemic 'B' symptoms such as fever, night sweats, and unexplained weight loss.
• Pruritus (itching) associated with lymphadenopathy or splenomegaly.
• Shortness of breath, which may be related to mediastinal involvement.

These features warrant urgent referral for specialist assessment, with adults typically referred via a suspected cancer pathway aiming for an appointment within 2 weeks, and children and young people (up to 24 years) considered for very urgent referral within 48 hours.

In primary care, unexplained lymphadenopathy or splenomegaly accompanied by any of these symptoms should raise suspicion of NHL and prompt urgent investigation and referral.

Additionally, persistent or unexplained infections, fatigue, or pallor may also be present but are less specific.

Referral decisions should consider the patient's age and local referral pathways.

References: ¹,²,³