Lymphoma Symptoms and Signs

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Lymphoma may present with any one or more of the following symptoms. Sometimes there may be no symptoms, and sometimes other disease conditions may cause similar symptoms. Therefore, further investigations may be required to confirm the diagnosis.

What are the Signs and Symptoms of Lymphoma?

lymphoma-symptoms

  • Painless swelling of lymph nodes especially those in the neck, under the arm, or in the groin. Often these lymph nodes appear as a lump under the skin which gets bigger over time. Note that some other cancers and infections may also cause swollen lymph nodes.
  • Enlarged spleen and/or liver.
  • B Symptoms: Unexplained weight loss, Fever (>38 degree Celsius), and night sweats occur in many patients with NHL.
  • Fatigue and weakness attributable to anemia, other anemia-related symptoms may include shortness of breath and dizziness.
  • Loss of appetite.
  • Cough or chest pain mainly due to swollen lymph nodes in the chest pressing on the trachea.
  • Swelling in abdomen.
  • Headache, weakness, confusion, mood changes, and seizures may appear when lymphoma affects the brain.
  • Itching and other skin involvement signs may be visible in some NHL types mainly involving skin.

Besides above listed common symptoms, other symptoms may appear depending upon the type of lymphoma and site of disease.

Symptoms of Hodgkin’s Lymphoma

Broadly, it may have any one or more of the symptoms discussed above. But there are some specific symptoms may vary with the type of Hodgkin’s Lymphoma as discussed below.

Nodular Lymphocyte Predominant HL (NLPHL)

  • Accounts for 5% of HL.
  • Median age is mid 30.
  • M:F ratio is 3:1.
  • NLPHL usually involves peripheral LN, with sparing of mediastinum.
  • 80% of cases are stage I or II at diagnosis.
  • > 90% of patients have a complete response to treatment.
  • Cause of death is often transformation to NHL, other cancers, or complications of treatment rather than HL.

Nodular Sclerosis HL

  • Most common type of HL (60-80%)
  • Most common in adolescents & young adults,
  • Males are affected less than females
  • Medistinum and supradiaphragmatic sites are involved commonly

Mixed Cellularity HL

  • MCHL comprises 15-30% of HL
  • May seen at any age (lacks in early adult)
  • Abdominal LN & splenic involvement is more common than mediastinum

Lymphocyte Depleted HL

  • Least common variant of HL, less than 1%.
  • MC in older people, HIV + & non-industrialized countries.
  • Frequently presents as Abdomen LN, spleen, liver, BM involvement without peripheral LN.
  • Usually advanced at diagnosis, however response to treatment is similar to other types.

Lymphocyte Rich HL

  • At presentation clinical features are intermediate between LPHL & cHL.
  • Mostly it presents as an early stage disease  and lacks bulky disease and B symptoms.
  • In contrast to NLPHL, there is lack of mediastinal disease & male predominance.
  • Like MCHL they had older median age.

Symptoms of Non-Hodgkin’s Lymphoma (NHL)

Although NHLs broadly have similar symptoms as discussed above, but there may be some differences depending on the subtype, as discussed below-

  • The distribution of lymphoma types shows a markedly different bias in different sites.
  • Low-grade NHLs usually present with advanced stage of disease
  • High grade NHLs usually present at an early stage.
  • B-symptoms are more commonly seen in high grade NHLs.
  • Extranodal involvement (of tissues-skin, GIT & spleen, etc) is more common in high grade NHLs.
  • Some NHLs (like extranodal, cutaneous, marginal zone, etc) usually produce symptoms depending upon the site of involvement.

What are B symptoms in Lymphoma?

B symptoms are important for prognostic purpose and help in staging of lymphoma. In the absence of any B symptoms, suffix A is added. If one or more symptom is present, suffix B is added in front of stage.

The B symptoms are as follows-

  1. Unexplained weight loss of more than 10% in the past 6 months
  2. Drenching night sweats
  3. Unexplained fever >38°C 

Where does Lymphoma usually start and How does it progress? 

Lymphoma is an uncontrolled proliferation of lymphocytes in the lymphoid organs. It may involve extralymphoid organ also (suffix E should be added with stage in such cases). It usually starts from one or more lymph node region or extranodal site.

Nodal Region

In Hodgkin’s Lymphoma, it usually start from one site and progresses in a contiguous fashion to involve nearby lymph node sites in a predictable manner. Whereas, in a Non-Hodgkin’s lymphoma (NHL) it may progress in a non-contiguous manner to involve distant sites. But the pattern of involvement may differ in low-grade and high-grade NHLs. 

Extranodal Region

In some cases (mostly NHLs and T Cell lymphoma) lymphoma may arise from extranodal sites (primary extranodal lymphoma) like skin, CNS, gastrointestinal tract, eye, thyroid gland etc.

  • Orbit – Follicular Lymphoma, MALT lymphoma
  • Scalp – Follicular Lymphoma
  • Submandibular Gland – Follicular Lymphoma, MALT lymphoma
  • Maxilla – Extranodal NK/T Cell Lymphoma, Plasmablastic Lymphoma, DLBCL
  • Nasal Cavity – Extranodal NK/T Cell Lymphoma, Follicular Lymphoma
  • Parotid Gland – DLBCL
  • Mandible – DLBCL
  • Thyroid – DLBCL
  • Lacrimal Gland – DLBCL

What are the first signs of Lymphoma?

The first signs and symptoms of lymphoma may be due to the local or systemic manifestations.

Local Symptoms/Signs

  • Nodal swellings in neck, axilla and/or groin
  • Abdominal distension or discomfort
  • Back pain
  • Cough, breathlessness, chest discomfort
  • Enlargement of liver and/or spleen
  • Headache, altered sensorium
  • Symptoms due to extranodal site involvement

Systemic or Constitutional Symptoms/Signs

  • Unexplained weight loss
  • Drenching night sweats
  • Unexplained fever >38°C 

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