Hodgkin's lymphoma presents typically with non-tender cervical and/or supraclavicular lymphadenopathy. Lymphadenopathy can also present at other sites. The natural history is long (months). Only a minority of patients have systemic symptoms (itching, night sweats, fever). Non-Hodgkin's lymphoma typically shows a more rapid progression of symptoms, and may present with lymphadenopathy, breathlessness, superior vena-caval obstruction or abdominal distension.

• Lymphadenopathy is more frequently benign in younger children but urgent referral is advised if one or more of the following characteristics are present, particularly if there is no evidence of local infection: (C)
• Lymph nodes are non-tender, firm or hard
• Lymph nodes are greater than 2 cm in size
• Lymph nodes are progressively enlarging
• Other features of general ill-health, fever or weight loss
• The axillary nodes are involved (in the absence of local infection or dermatitis)
• The supraclavicular nodes are involved
• The presence of hepatosplenomegaly requires immediate referral (C).
• Shortness of breath is a symptom that can indicate chest involvement but may be confused with other conditions such as asthma. Shortness of breath in association with the above signs, particularly if not responding to bronchodilators, is an indication for urgent referral (C).
• A child or young person with a mediastinal or hilar mass on chest X-ray should be referred immediately (C).