Medically reviewed by Dr. N. Kiranmayee, Medical Oncologist · Written by Dr. Basudev Pokhrel, Haematologist · Last reviewed 21 May 2026
The word 'lymphoma' covers one of the most wide-ranging diagnoses in oncology. Two people who have both been told they have lymphoma can have treatments that look completely different — one starting chemotherapy the same week, the other being told no treatment is needed right now. This is not inconsistency; 'lymphoma' is an umbrella for over 60 distinct conditions, each with its own behaviour, treatment approach, and prognosis.
Lymphoma is cancer that develops in the lymphatic system — the network of lymph nodes, vessels, and organs (including the spleen and bone marrow) that forms a central part of the body's immune defences. Lymphoma begins when a white blood cell called a lymphocyte grows abnormally and multiplies out of control.
The critical thing to understand is that 'lymphoma' is not one disease. It is a family of more than 60 distinct cancers that happen to share the same origin — lymphocytes. They range from slow-growing conditions that may not need treatment for years, to aggressive cancers that require urgent treatment within days of diagnosis. The type of lymphoma — confirmed by a lymph node biopsy and detailed laboratory analysis — determines everything about how it is treated.
All lymphomas fall into one of two broad families:
A specific, well-defined lymphoma type characterised by the presence of distinctive abnormal cells (called Reed-Sternberg cells) seen under the microscope. It follows a relatively predictable pattern of spread and is highly curable with chemotherapy. It primarily affects people aged 15 to 35 and those over 55.
Everything else — a diverse group of more than 60 distinct subtypes with very different behaviours, treatments, and outcomes. NHL is far more common than HL, accounting for about 85% of all lymphoma cases.
Approximately 80 to 90% of patients with Hodgkin lymphoma are cured with chemotherapy, often without radiation for early-stage disease. Even advanced-stage Hodgkin lymphoma has 5-year survival rates of 75 to 85% with modern treatment. A Hodgkin lymphoma diagnosis, while frightening, carries a very different prognosis from what most patients initially fear.
Within Non-Hodgkin lymphoma, the most clinically important distinction is between indolent (slow-growing) and aggressive (fast-growing) subtypes. Understanding this distinction is why two patients with NHL can have completely different treatment plans.
Indolent lymphomas grow slowly — often over years — and typically do not cause urgent symptoms when first diagnosed. The most common type is follicular lymphoma, accounting for approximately 20% of all NHL cases.
A key characteristic: starting treatment immediately does not improve survival over watchful monitoring. For patients without symptoms and with low disease burden, 'watch and wait' is the evidence-based recommendation. When treatment is eventually needed, indolent lymphomas generally respond well and can often be controlled for many years.
Aggressive lymphomas grow quickly and require prompt treatment. The most common type is diffuse large B-cell lymphoma (DLBCL), accounting for roughly 30 to 35% of all NHL cases.
DLBCL can cause rapidly worsening symptoms — rapidly growing lymph nodes, fever, night sweats, and weight loss — and requires chemotherapy to begin as soon as staging is complete. The paradox: unlike indolent lymphoma, aggressive lymphoma is potentially curable. The same aggressive growth that makes it dangerous also makes it highly sensitive to chemotherapy.
Put simply: indolent lymphoma is often not treated immediately but is rarely cured. Aggressive lymphoma is treated urgently — and often cured.
The most common presenting symptom of lymphoma is painless swollen lymph nodes — usually in the neck, armpit, or groin. Three other symptoms are so characteristic of lymphoma that they are given a specific name — B symptoms:
B symptoms are clinically important because their presence at diagnosis affects staging and, in some cases, the intensity of treatment. Other symptoms include:
Swollen lymph nodes are far more commonly caused by infection than by lymphoma. However, lymph nodes that are persistently swollen for more than 4 to 6 weeks without an obvious infectious cause, that are growing, or that are associated with B symptoms should be evaluated by a specialist.
Most patients with lymphoma have no identifiable risk factor. However, several factors are known to increase the risk of developing lymphoma:
Lymphoma diagnosis depends on getting the type and stage exactly right — because the type determines the treatment, and the stage determines the intensity. The diagnostic workup at CION involves four key steps:
Diagnosis requires a tissue sample from the most accessible enlarged lymph node. This is typically done as an excision biopsy — surgical removal of the entire lymph node under local or general anaesthesia. The sample is examined by a specialist pathologist who identifies the lymphoma type, subtype, and grade. This pathology result is the single most important test in lymphoma management, because it determines the entire treatment plan. In some situations, a core needle biopsy (a thick needle inserted into the node under ultrasound guidance) is used as an alternative.
A sample of bone marrow — taken from the back of the hip under sedation or local anaesthetic — is examined to check whether the lymphoma has spread into the bone marrow. This affects the final stage and, for some lymphoma types, the treatment plan.
A full blood count, kidney and liver function tests, LDH (a marker of tumour bulk and disease activity), and specific proteins associated with certain lymphoma types are measured. These baseline tests guide initial risk assessment and are repeated during treatment to monitor response.
PET-CT is the most important imaging tool in lymphoma management, used both for initial staging and for assessing how well the lymphoma is responding to treatment. A PET-CT combines a CT scan (which shows anatomy) with a PET scan (which shows metabolic activity — cancer cells are far more active than normal cells and 'light up' on PET). This combined scan identifies all active lymphoma sites throughout the body. PET-CT scans are arranged through CION's specialist imaging referral network; cost starts from ₹9,999 to ₹16,000 per scan.
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Lymphoma pathology is among the most specialised in oncology. A second look can confirm — or change — the treatment plan.
Lymphoma is staged using the Ann Arbor staging system, which describes how widely the lymphoma has spread through the lymph nodes and whether other organs are involved.
| Stage | Definition | B Symptoms | 5-Year Survival (HL) | 5-Year Survival (DLBCL) |
|---|---|---|---|---|
| Stage I | Single lymph node region or single organ | A or B | 90–95% | 70–80% |
| Stage II | Two or more regions on the same side of the diaphragm | A or B | 85–90% | 65–75% |
| Stage III | Lymph node regions on both sides of the diaphragm | A or B | 75–85% | 50–65% |
| Stage IV | Spread to organs (bone marrow, liver, lungs) | A or B | 65–80% | 40–60% |
5-year survival figures reflect treatment at specialist centres. 'A' = no B symptoms; 'B' = B symptoms present (fever, night sweats, >10% weight loss). Follicular lymphoma and other indolent NHL types have different, generally more favourable stage-specific survival curves.
Hodgkin lymphoma is one of the great success stories of modern oncology. For a cancer that primarily affects teenagers, young adults, and those in mid-life, it carries cure rates of 80 to 90% across all stages combined — making it one of the most curable cancers in medicine.
The standard chemotherapy for Hodgkin lymphoma is a combination of four medicines given together as an intravenous infusion — known by the acronym ABVD. Each cycle involves infusions on Day 1 and Day 15 of a 28-day cycle. Early-stage Hodgkin lymphoma (Stages I and II without B symptoms and without large lymph node masses) is typically treated with 2 to 4 cycles. Advanced-stage disease (Stages III and IV, or II with B symptoms) receives 6 cycles. Side effects are manageable and well understood; temporary hair loss, nausea, and fatigue are the most common.
After chemotherapy, a PET-CT scan assesses how completely the lymphoma has responded. If any active disease remains, radiation therapy to those sites is added. For patients who achieve a complete response on PET-CT, radiation may be avoided — preserving long-term quality of life by reducing exposure to unnecessary radiation. This PET-CT guided approach to deciding whether radiation is needed is the modern international standard for Hodgkin lymphoma management.
A mid-treatment PET-CT scan — taken after the first 2 to 4 cycles of chemotherapy for Hodgkin lymphoma — can show whether the cancer cells are still active or have been eliminated. When the scan shows a complete response at this early stage, it opens the option of reducing the remaining treatment intensity — protecting patients from unnecessary side effects while still curing the disease. This PET-guided approach is now standard at specialist lymphoma centres and is part of the routine CION management protocol for Hodgkin lymphoma.
For patients newly diagnosed with an indolent (slow-growing) Non-Hodgkin lymphoma — most often follicular lymphoma at Stage III or IV — who have no symptoms and a low disease burden, the recommended approach is often active surveillance, commonly called 'watch and wait.' This is not a compromise or a decision to defer necessary treatment. It is a deliberate, evidence-based strategy.
Multiple large clinical trials have shown that for asymptomatic patients with low-burden indolent NHL, starting chemotherapy immediately does not improve survival compared to beginning treatment only when the lymphoma progresses or causes symptoms. Starting treatment early in indolent lymphoma does not cure it; it does expose patients to side effects they did not yet need to experience.
Watch and wait involves:
When a haematologist recommends watch and wait, patients and families sometimes feel that treatment is being withheld. CION's team explains this approach carefully at the time of diagnosis so that patients and their families fully understand the rationale and feel in control of the monitoring journey.
For patients with aggressive Non-Hodgkin lymphoma — particularly DLBCL, the most common aggressive NHL — treatment begins as soon as staging is complete. The international standard treatment is R-CHOP: a combination of a targeted antibody medicine and four chemotherapy medicines, given together.
R-CHOP works by combining two different attack mechanisms: the antibody medicine (rituximab) specifically attaches to a marker called CD20 found on the surface of B-cell lymphoma cells, flagging them for destruction by the immune system. The four chemotherapy medicines then attack the cancer cells directly through their rapid division. Together, they are significantly more effective than either approach alone.
R-CHOP treatment involves:
R-CHOP cures approximately 60 to 70% of DLBCL patients. For those whose disease does not respond fully to R-CHOP, second-line chemotherapy regimens and stem cell transplant are considered by the specialist haematology team.
One of the most important advances in lymphoma management over the past decade is the use of PET-CT scanning during treatment — not just at the beginning and end, but after the first 2 to 4 cycles of chemotherapy. This mid-treatment scan tells the haematology team something no blood test or CT scan alone can: whether the cancer cells are still metabolically active (still 'alive' despite treatment) or whether they have stopped functioning (killed by chemotherapy).
For Hodgkin lymphoma, a mid-treatment PET-CT result that shows complete metabolic response (no active disease on the scan) allows the team to consider de-escalating treatment — reducing intensity to spare the patient from unnecessary side effects while still curing the disease. A poor mid-treatment response guides escalation to a more intensive approach. For DLBCL, mid-treatment PET-CT response is one of the strongest predictors of long-term outcome.
CION's haematology team uses PET-CT response assessment as standard for Hodgkin lymphoma and aggressive NHL management. PET-CT scans are arranged through CION's specialist imaging referral network.
For patients whose lymphoma does not respond to first-line treatment (refractory) or who relapse after achieving remission, several treatment pathways exist:
Autologous stem cell transplant for eligible relapsed patients is coordinated through CION's specialist referral network.
Lymphoma management requires haematology, medical oncology, pathology, and radiology working together from the time of diagnosis. At CION, every lymphoma case is reviewed by our multidisciplinary tumour board before treatment begins:
Costs depend on the lymphoma type, stage, and treatment duration. Day-care chemotherapy across 7 CION locations reduces travel and time costs significantly for Hyderabad patients.
| Treatment / Investigation | Approx. Cost (INR) | Notes |
|---|---|---|
| Lymph Node Biopsy (excision) | ₹8,000 – ₹30,000 | Under local or general anaesthesia; includes pathology |
| Bone Marrow Examination | ₹5,000 – ₹15,000 | Day procedure; biopsy and aspiration |
| PET-CT Scan (staging / response) | ₹9,999 – ₹16,000 | Arranged through CION's specialist imaging referral network |
| R-CHOP Chemoimmunotherapy (per 21-day cycle) | ₹60,000 – ₹1,50,000 | Includes rituximab + 4 chemotherapy medicines; day-care |
| R-CHOP Full Course (6 cycles, 18 weeks) | ₹3,00,000 – ₹8,00,000 | Standard for DLBCL and aggressive NHL |
| ABVD Chemotherapy (per 28-day cycle) | ₹40,000 – ₹1,00,000 | 2 infusions per cycle; Day 1 and Day 15 |
| ABVD Full Course (6 cycles) | ₹2,00,000 – ₹6,00,000 | For advanced Hodgkin lymphoma |
| Rituximab Maintenance (per infusion) | ₹40,000 – ₹80,000 | Every 2 months for up to 2 years after follicular lymphoma response |
| Radiation Therapy — IMRT (consolidation) | ₹1,20,000 – ₹2,50,000 | If residual disease after chemotherapy; HL or localised NHL |
| Watch & Wait Monitoring (annual) | ₹20,000 – ₹60,000 | Clinic visits, blood tests, imaging; no treatment cost if stable |
Costs are indicative. A personalised cost estimate is provided following your initial haematology/oncology consultation at CION.
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Start Your Story. Book Free Consultation.The most common symptom is painless swollen lymph nodes, usually in the neck, armpit, or groin. Three specific symptoms — called B symptoms — are particularly associated with lymphoma: unexplained fever, night sweats that soak clothing, and unexplained weight loss of more than 10% of body weight over 6 months. Other symptoms include persistent fatigue, itching without a rash, chest tightness or breathlessness (from chest node involvement), and abdominal discomfort (from abdominal nodes or an enlarged spleen). Swollen lymph nodes are far more commonly caused by infections; nodes that persist for more than 4 to 6 weeks without an obvious cause should be evaluated.
Many types of lymphoma are curable, and the overall prognosis is better than most people expect. Hodgkin lymphoma has cure rates of 80 to 90% across all stages. Diffuse large B-cell lymphoma (the most common aggressive NHL) achieves cure in approximately 60 to 70% of patients with R-CHOP treatment. Indolent lymphomas such as follicular lymphoma are rarely curable but are highly controllable — many patients live 15 to 20 years with the disease, managed through periods of treatment and watch-and-wait monitoring. The specific subtype and stage are the most important determinants of outcome.
Hodgkin lymphoma (HL) is a specific, well-defined cancer characterised by the presence of distinctive abnormal cells (Reed-Sternberg cells) seen under the microscope. It primarily affects people aged 15 to 35, follows a predictable spread pattern, and is highly curable with chemotherapy. Non-Hodgkin lymphoma (NHL) is everything else — a diverse group of over 60 distinct subtypes with very different behaviours, from slow-growing (indolent) conditions needing no immediate treatment, to aggressive cancers requiring urgent chemotherapy. NHL accounts for about 85% of all lymphoma diagnoses.
Watch and wait (active surveillance) is the recommended approach for patients with indolent (slow-growing) Non-Hodgkin lymphoma who have no symptoms and low disease burden. Clinical evidence shows that starting treatment immediately in this group does not improve survival — it only adds side effects the patient does not yet need to experience. Instead, the patient is monitored closely with regular blood tests and imaging. Treatment starts only when the lymphoma grows, causes symptoms, or shows signs of change. Most patients on watch and wait eventually require treatment, but many enjoy years of stable, symptom-free disease without any chemotherapy.
R-CHOP is the standard treatment for DLBCL — the most common aggressive Non-Hodgkin lymphoma. It combines a targeted antibody medicine (rituximab) that attaches to a specific marker on B-cell lymphoma cells and flags them for immune destruction, with four chemotherapy medicines given together. Treatment is given as a day-care intravenous infusion, one day every 21 days, for 6 cycles over 18 weeks. Most patients tolerate R-CHOP well enough to continue normal activities between cycles. R-CHOP cures approximately 60 to 70% of DLBCL patients.
Survival varies significantly by type and stage. Hodgkin lymphoma: Stage I–II 90–95%; Stage III 80–85%; Stage IV 65–80%. Diffuse large B-cell lymphoma (aggressive NHL): Stage I–II 70–80%; Stage III–IV 40–65% depending on risk factors. Follicular lymphoma (indolent NHL): median survival exceeds 15 to 20 years even with advanced disease — it is not typically measured the same way as aggressive lymphoma because most patients are not cured but live with the disease for very long periods. T-cell and other NHL subtypes vary widely.
Lymphoma is closely related to blood cancer but not identical to it. Lymphoma begins in lymphocytes — white blood cells that are part of the immune system — and primarily affects the lymph nodes and lymphatic organs. Leukaemia, by contrast, begins in the bone marrow and involves large numbers of abnormal white blood cells circulating in the bloodstream. The two overlap in some areas: lymphomas can sometimes involve the bone marrow and blood, and some leukaemias involve the lymph nodes. Broadly, both are cancers of the blood and immune system, managed by haematology specialists.
PET-CT is a specialised scan that combines two types of imaging: a CT scan showing the structure of the body, and a PET scan showing where cells are metabolically active (using energy rapidly — as cancer cells do). Together, they identify all active lymphoma sites in the body at once, making PET-CT the most accurate staging tool for most lymphoma types. It is also used during treatment — a scan after the first few cycles of chemotherapy shows whether cancer cells are still active or being killed. This mid-treatment assessment can guide decisions about adjusting treatment intensity. PET-CT scans are arranged through CION's specialist imaging referral network, starting from ₹9,999 to ₹16,000.
PET-CT staging scan: ₹9,999 to ₹16,000 (through CION's imaging referral network). R-CHOP chemotherapy per cycle: ₹60,000 to ₹1,50,000; full 6-cycle course ₹3,00,000 to ₹8,00,000. ABVD per cycle: ₹40,000 to ₹1,00,000; full 6-cycle course ₹2,00,000 to ₹6,00,000. Rituximab maintenance per infusion: ₹40,000 to ₹80,000. Radiation therapy (if needed after chemotherapy): ₹1,20,000 to ₹2,50,000. Watch and wait annual monitoring: ₹20,000 to ₹60,000. A personalised cost estimate is provided after your initial consultation at CION. EMI options are available.
Absolutely — and for lymphoma, a second opinion is particularly valuable in three situations: if immediate chemotherapy has been recommended for an indolent lymphoma without discussion of watch and wait (surveillance is often appropriate for asymptomatic low-burden indolent disease); if a subtype diagnosis seems uncertain or unusually complex — lymphoma pathology is among the most specialised in oncology and benefits from expert review; and if treatment has not achieved remission and no second-line options have been discussed. CION's multidisciplinary haematology team offers a dedicated Second Opinion service.
