What are the symptoms of lymphoma?

Lymphoma Symptoms

The most common symptoms of lymphoma include painless lymphadenopathy (especially cervical lymph nodes), B symptoms (fever >38.3°C, drenching night sweats, unexplained weight loss >10% over 6 months), fatigue, pruritus (itching), and alcohol-induced pain. 1

Primary Symptoms

Lymphadenopathy

• Cervical lymph nodes are most commonly affected (>60% of Hodgkin lymphoma cases) 1
• Characteristic features of lymphomatous nodes:
  • Enlarged (>1.5 cm, especially concerning if >2 cm)
  • Painless
  • Firm in texture
  • Reduced mobility
  • Persistent (≥2 weeks)
  • Lack of signs of infection 1
• Supraclavicular lymphadenopathy has particularly high malignancy risk 1

B Symptoms

These indicate more advanced disease and include:

• Fever >38.3°C (101°F)
• Drenching night sweats
• Unexplained weight loss >10% of body weight over 6 months 1, 2

Other Common Symptoms

• Fatigue or lethargy
• Pruritus (itching)
• Alcohol-induced pain (particularly in affected lymph nodes after alcohol consumption) 2, 1
• Sleeping difficulties 3

Less Common Presentations

• Hepatomegaly and/or splenomegaly (in approximately 20% of patients) 1
• Abdominal masses from gastrointestinal involvement 1
• Pain in extremities or joints 1
• Cranial nerve involvement 1
• Cutaneous manifestations:
  • T-cell lymphoma: patches and plaques on skin, later developing into tumors
  • B-cell cutaneous lymphoma: multiple red papules, plaques, or nodules 1
  • Diffuse hyperpigmentation, prurigo nodularis, acquired ichthyosis 4
  • Eczematous eruptions (can be paraneoplastic) 4

Symptom Patterns

Symptoms often co-occur and may have synergistic effects on patient distress 3. The European Society for Medical Oncology (ESMO) guidelines note that multiple co-occurring symptoms often lead patients to seek medical attention 2, 3.

Clinical Pearls

• Important distinction: B symptoms (fever, night sweats, weight loss) are formally used in lymphoma staging and indicate more advanced disease 2
• Lymphoma symptoms may be subtle initially, with painless lymphadenopathy often being the only presenting sign 5
• Symptoms can precede diagnosis by months, with many patients reporting persistent fatigue and lymphadenopathy before formal diagnosis 3
• Extranodal involvement is less common in follicular lymphoma 6
• Constitutional symptoms are uncommon in follicular lymphoma unless transformation to diffuse large B cell lymphoma has occurred 6

Red Flags Requiring Urgent Evaluation

• Lymph nodes >2 cm, especially when firm and fixed 1
• Supraclavicular lymphadenopathy 1
• Presence of B symptoms (fever, night sweats, weight loss) 2, 1
• Progressive lymphadenopathy without signs of infection 1
• Lymphadenopathy with risk factors (age >40 years, tobacco use history, alcohol abuse, immunocompromised status, history of prior malignancy) 1

The presence of these symptoms should prompt consideration of lymphoma in the differential diagnosis and appropriate diagnostic workup, including excisional or incisional biopsy of the most accessible site for definitive diagnosis 1, 5.