Symptoms of Lymphoma
The most common symptoms of lymphoma include painless, enlarged lymph nodes (>1.5 cm) that persist for more than 2 weeks, accompanied by systemic B symptoms such as fever >38°C, drenching night sweats, and unexplained weight loss >10% of body weight within 6 months. 1
Cardinal Symptoms
Lymph Node Involvement
- Enlarged, painless, firm lymph nodes with reduced mobility 1
- Cervical lymph nodes are most commonly affected (>60% of Hodgkin lymphoma cases) 2, 1
- Supraclavicular lymphadenopathy carries a high risk of malignancy and requires prompt evaluation 1
B Symptoms
These indicate more advanced disease:
- Fever >38.3°C (101°F) 2
- Drenching night sweats 2
- Unexplained weight loss >10% of body weight over 6 months 2
Other Common Symptoms
- Fatigue or lethargy 2, 1, 3
- Pruritus (itching) 2, 1, 3
- Alcohol-induced pain (particularly in Hodgkin lymphoma) 2, 1
- Reduced physical endurance 1
- Pain in extremities or joints (more common in children) 2
- Sleeping difficulties 3
Symptoms of Advanced Disease
Extranodal Manifestations
- Hepatomegaly and/or splenomegaly (in approximately 20% of patients) 2
- Abdominal masses from gastrointestinal involvement 2
- Cranial nerve involvement (may present as chin numbness) 2
Cutaneous Manifestations
- T-cell lymphoma: patches and plaques on skin, later developing into tumors 1
- B-cell cutaneous lymphoma: multiple red papules, plaques, or nodules 1
Symptom Patterns and Relationships
- Co-occurring symptoms often lead patients to seek medical attention 3
- Symptoms frequently appear in clusters with cumulative distressing effects 3
- Symptoms may have interrelationships, with one symptom triggering others 3
When to Suspect Lymphoma
- Lymph nodes >2 cm, especially when firm and fixed 1
- Persistent lymphadenopathy (≥2 weeks) without signs of infection 1
- Presence of B symptoms 2
- Unexplained systemic symptoms in patients with risk factors (age >40 years, tobacco use history, alcohol abuse, immunocompromised status) 1
Diagnostic Approach
When lymphoma is suspected based on symptoms:
- Excisional or incisional biopsy of the most accessible site is preferred for definitive diagnosis 2, 1
- Core needle biopsy may be inadequate for proper classification 2, 1
- PET-CT is recommended for accurate staging 2
It's important to note that many lymphoma symptoms are nonspecific and may overlap with other conditions. The combination of persistent, painless lymphadenopathy with systemic symptoms should raise suspicion for lymphoma and prompt appropriate diagnostic evaluation.