Leukaemia

• Chronic myeloid leukaemia (CML) (NHS Choices)

• Hairy cell leukaemia (NHS Choices)

Lymphoma

• Hodgkin’s lymphoma can present with night sweats, weight loss and tiredness. Patients usually complain of a painless lump in the neck, axilla or groin which needs further blood tests and biopsy. They may also notice painful lymph nodes after drinking alcohol. 

• Non-Hodgkin lymphoma (NHS Choices), Hodgkin lymphoma (NHS Choices)​

Question

A 30-year-old woman has experienced fatigue, unexplained weight loss and night sweats over the last two months. She describes a puzzling ache of her right shoulder and arm if she has a glass of wine. On examination, she has cervical lymphadenopathy. Petechiae are present over her abdomen and her spleen is enlarged.

What is the SINGLE MOST likely diagnosis?

A. Hodgkin’s lymphoma

B. Chronic lymphocytic leukaemia

C. Acute lymphoblastic leukaemia

D. Acute myeloid leukaemia

E. Chronic myeloid leukaemia

All of these conditions can present with fatigue, unexplained weight loss, fever or night sweats. Signs of a bleeding disorder – bruising or petechiae - are frequently present. Splenomegaly may be found in all. The alcohol-induced pain (not that common) would point towards Hodgkin’s lymphoma.

Hodgkin’s lymphoma has a bi-modal age incidence. The first peak occurs between 15 and 34 years and the second peak occurs after 50 years. 95% of patients present with lymph gland involvement.

Of the acute leukaemias, myeloid accounts for 80% and lymphoblastic for 20%.

Chronic lymphocytic leukaemia is diagnosed most commonly in the elderly, with the median age at diagnosis 65–70 years.

Chronic myeloid leukaemia occurs mainly in middle aged and elderly people.

Resources

• Anthony Nolan (saving the lives of people with blood cancer) (anthonynolan.org), Bloodwise (Formerly Leukaemia & Lymphoma Research)