Referral guidance for suspected childhood lymphoma

Non-Hodgkin's lymphoma in children and young people

• consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for non-Hodgkin's lymphoma in children and young people presenting with unexplained lymphadenopathy or splenomegaly. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss

Hodgkin's lymphoma in children and young people

• consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for Hodgkin's lymphoma in children and young people presenting with unexplained lymphadenopathy. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss

Previous NICE guidance was more specific about possible clinical presentation and investigation of possible lymphoma (2)

Referral for suspected lymphoma:

• refer immediately children or young people with either:
  • hepatosplenomegaly, or mediastinal or hilar mass on chest X-ray.

Refer urgently children or young people:

• with one or more of the following (particularly if there is no evidence of local infection):
  • non-tender, firm or hard lymph nodes
  • lymph nodes greater than 2 cm in size
  • lymph nodes progressively enlarging
  • other features of general ill-health, fever or weight loss
  • axillary node involvement (in the absence of local infection or dermatitis)
  • supraclavicular node involvement
• with shortness of breath and unexplained petechiae or hepatosplenomegaly (particularly if not responding to bronchodilators)

Notes:

• investigate with full blood count and blood film any child with one or more of the following symptoms and signs:
  • pallor
  • persistent or recurrent upper respiratory tract infections
  • fatigue - generalised lymphadenopathy
  • unexplained irritability
  • persistent or unexplained bone pain
  • unexplained fever - unexplained bruising
  • if the blood film or full blood count indicates leukaemia, make an urgent referral
• Hodgkin's disease (3):
  • usually presents with non-tender cervical /supraclavicular lymphadenopathy.
  • natural history is long (months). Only a minority have systemic symptoms
• Non-Hodgkin's lymphoma (3):
  • lymphadenopathy and/or disease in mediastinum or abdomen
  • rapid progression of symptoms

Reference:

1. NICE (June 2015). Suspected cancer: recognition and referral.
2. NICE (June 2005). Referral Guidelines for Suspected Cancer.
3. Referral Guidelines for Suspected Cancer (April 2000). NHS Executive.