🫧 Men's Health

Lymphoma — Nigeria Guide

Understanding Hodgkin and non-Hodgkin lymphoma — symptoms, staging, and treatment in Nigeria

Lymphoma — cancer of the lymphatic system — is one of the most common cancers in Nigeria. Burkitt lymphoma (a fast-growing non-Hodgkin lymphoma) is particularly prevalent in the malaria belt and is strongly linked to Epstein-Barr virus — Nigeria has the highest incidence of Burkitt lymphoma in the world. Hodgkin lymphoma is common in young adults. Both are potentially curable with chemotherapy if detected and treated early. This guide explains the types, warning symptoms, and treatment options available in Nigeria.

Signs and Symptoms

✓ Painless lymph node swelling — neck, armpits, or groin — lasting more than 2 weeks

✓ B symptoms (in Hodgkin lymphoma): drenching night sweats, fever >38°C, unintentional weight loss >10% in 6 months

✓ Mediastinal mass — cough, shortness of breath, superior vena cava obstruction (facial swelling)

✓ Abdominal mass — Burkitt lymphoma classically presents as rapidly enlarging jaw or abdominal mass in children

✓ Splenomegaly — enlarged spleen causing left upper abdominal fullness

✓ Itching (pruritus) — without rash — 'Pel-Ebstein fever' pattern in Hodgkin

✓ Fatigue, anaemia, recurrent infections — bone marrow involvement

Risk Factors

HIV infection — dramatically increases risk of high-grade B-cell lymphoma
Epstein-Barr virus (EBV) — strongly linked to Burkitt lymphoma and Hodgkin lymphoma
Malaria — hyperendemic malaria in Nigeria promotes EBV-driven B-cell proliferation (Burkitt lymphoma mechanism)
Helicobacter pylori — gastric MALT lymphoma
Autoimmune diseases — Sjögren syndrome, SLE, RA
Immunosuppressive therapy — post-transplant lymphoproliferative disorder
Age and sex — Hodgkin lymphoma: bimodal peaks 15–35 and >55 years; NHL: increases with age

When to Seek Help

SoonPainless lymph node swelling persisting for more than 2 weeks without obvious infection — lymphoma must be excluded

UrgentB symptoms (night sweats, fever, weight loss) with lymphadenopathy — likely lymphoma, needs urgent biopsy

EmergencySuperior vena cava (SVC) syndrome — facial swelling, arm swelling, distended neck veins with rapidly growing neck/chest mass — oncological emergency

UrgentRapidly enlarging jaw or abdominal mass in a child in malaria-endemic area — Burkitt lymphoma grows 1 cm per day and requires urgent chemotherapy

Tests & Diagnosis

🧪 Lymph node excisional biopsy

The most important test — removes the entire lymph node for histopathological analysis. Core needle biopsy as an alternative. Fine needle aspiration (FNAC) is INSUFFICIENT for lymphoma diagnosis — do not rely on it

🧪 Immunohistochemistry (IHC)

Essential for subtyping lymphoma — determines whether Hodgkin (CD15+, CD30+) or non-Hodgkin (B-cell vs T-cell markers). Guides treatment. Available at LUTH, UCH, and some private pathology labs

🧪 CT scan (chest, abdomen, pelvis)

Staging — identifies all involved lymph nodes and organs. PET-CT (if available) is superior for Hodgkin lymphoma staging

🧪 Bone marrow biopsy

Determines bone marrow involvement — part of staging for most lymphomas

🧪 HIV test

Essential — HIV-related lymphomas are managed differently (HAART plus chemotherapy)

🧪 LDH (lactate dehydrogenase)

Elevated in aggressive lymphomas — correlates with tumour bulk and is a prognostic factor

🧪 Hepatitis B surface antigen

Essential before rituximab (anti-CD20) — can reactivate hepatitis B; antiviral prophylaxis needed if positive

Treatment Options

Burkitt lymphoma — intensive chemotherapy

Highly chemotherapy-sensitive. CODOX-M/IVAC or R-CODOX-M/IVAC regimens. High cure rates (70–90%) with appropriate treatment. Requires intensive supportive care — tumour lysis syndrome prophylaxis (allopurinol, IV fluids, electrolyte monitoring). Available at LUTH, UCH, LASUTH, OAUTH Ile-Ife

Hodgkin lymphoma — ABVD chemotherapy

ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) — 4–6 cycles. >90% cure rate in early disease. Radiotherapy for selected patients. Available at major teaching hospitals with oncology units

Diffuse large B-cell lymphoma (DLBCL) — R-CHOP

R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) — 6 cycles. Cure rate ~60–70%. Rituximab requires hepatitis B screening beforehand

Rituximab availability in Nigeria

Available at LUTH, UCH, National Hospital Abuja, and some private oncology centres. Cost is the major barrier — advocate for inclusion in Nigeria's essential medicines list and health insurance coverage

Stem cell transplantation (SCT)

For relapsed/refractory lymphoma — autologous SCT is the standard. Available at very limited centres in Nigeria — LUTH has performed SCT. Medical evacuation to South Africa or Europe remains common

Palliative chemotherapy

For elderly or frail patients who cannot tolerate intensive regimens — less aggressive regimens. Corticosteroids provide significant symptom relief

Supportive care

Anti-emetics, growth factors (G-CSF for neutropenia), prophylactic antibiotics (cotrimoxazole, fluconazole), blood transfusion and platelet support

Frequently Asked Questions

Is every swollen lymph node lymphoma?

No — the vast majority of swollen lymph nodes are caused by infection (viral throat infections, tuberculosis, bacterial infections). A lymph node is more concerning for lymphoma if it has been present for more than 2–4 weeks, is painless, is growing, or is accompanied by B symptoms (fever, night sweats, weight loss). A biopsy is the only way to confirm the diagnosis.

Is Burkitt lymphoma curable?

Yes — Burkitt lymphoma is one of the most chemotherapy-sensitive tumours. With appropriate intensive chemotherapy, cure rates of 70–90% are achievable even in Nigeria, where it is diagnosed more frequently. The key is early diagnosis and starting chemotherapy promptly at a centre with intensive supportive care.

Can lymphoma come back after treatment?

Yes — relapse occurs in 20–40% of cases depending on subtype. Hodgkin lymphoma has very effective salvage therapy and high cure rates even at relapse. Relapsed DLBCL can be treated with salvage chemotherapy followed by stem cell transplant. Some patients achieve long-term remission after salvage therapy.

Is lymphoma the same as leukaemia?

No. Lymphoma arises from lymphocytes in lymph nodes and lymphatic tissues — causing lymph node swelling. Leukaemia arises from blood cell precursors in the bone marrow — causing abnormal cells in the blood. However, they can overlap — lymphoma can spread to the blood (leukaemic phase), and some leukaemias primarily involve lymph nodes.