Signs of Lymphoma
Lymphoma presents primarily with painless lymphadenopathy (enlarged lymph nodes), often accompanied by systemic symptoms such as fever, night sweats, and unexplained weight loss in advanced stages of the disease. 1
Common Presenting Signs and Symptoms
Lymph Node Involvement
- Enlarged lymph nodes (>1.5 cm) that are:
- Painless
- Firm in texture
- Reduced mobility
- Persistent (≥2 weeks duration)
- May lack signs of infection 2
- Most commonly affected areas:
B Symptoms
These symptoms indicate more advanced disease:
- Fever >38°C (unexplained)
- Drenching night sweats
- Weight loss >10% of body weight within 6 months 2
Other Common Symptoms
- Fatigue
- Pruritus (itching)
- Alcohol-induced pain (in affected lymph nodes)
- Reduced endurance 2
Type-Specific Presentations
Hodgkin Lymphoma
- Bimodal age distribution (peaks in third decade and after age 55)
- Orderly spread through contiguous lymph node groups
- Mediastinal involvement common
- Extranodal disease less common (only ~5% arise in extranodal sites) 4
Non-Hodgkin Lymphoma
- More likely to present with extranodal involvement (~30% of cases)
- Site-specific presentations:
- Ocular adnexa, salivary glands, larynx, thyroid: Marginal-zone lymphoma
- Paranasal sinuses, mandible, maxilla, Waldeyer ring: Diffuse large B-cell lymphoma
- Maxilla and mandible (especially in children/young adults): Burkitt lymphoma 4
Cutaneous Lymphoma Signs
- T-cell lymphoma: Patches and plaques on skin, later developing into tumors
- Mycosis fungoides: Follicular mucinosis, alopecia
- Sézary syndrome: Erythroderma, hyperkeratosis of palms and soles, lymphadenopathy, alopecia 2
- B-cell cutaneous lymphoma: Multiple red papules, plaques or nodules 2
Warning Signs That Increase Suspicion for Malignancy
Patient Factors
- Age >40 years
- Tobacco use history
- Alcohol abuse
- Immunocompromised status
- History of prior head and neck malignancy 2
Associated Symptoms
- Hoarseness
- Otalgia (ear pain)
- Hearing loss
- Oral cavity numbness
- Dysphagia or odynophagia
- Hemoptysis
- Nasal congestion or unilateral epistaxis 2
Diagnostic Approach
When lymphoma is suspected, an excisional or incisional biopsy of the most accessible site is preferred for definitive diagnosis. Core needle biopsy may be insufficient for proper classification of lymphoma subtypes 2.
Pitfalls to Avoid
- Mistaking lymphoma for infectious lymphadenopathy (lymphoma nodes are typically non-tender)
- Overlooking supraclavicular lymphadenopathy, which has high malignancy risk
- Failing to recognize that lymph nodes >2 cm, especially when firm and fixed, require prompt evaluation
- Delaying biopsy in patients with persistent lymphadenopathy and B symptoms 5, 3
Remember that while lymphadenopathy is common and often benign, warning signs such as nodes >2 cm, supraclavicular location, and generalized lymphadenopathy with systemic symptoms should prompt immediate evaluation for lymphoma.