Lymphoma Symptoms and Treatment Options
Lymphoma presents with painless lymphadenopathy as the most common symptom, with B symptoms (fever, night sweats, unexplained weight loss >10% of body weight over 6 months) occurring in more advanced stages, and treatment varies by subtype with chemotherapy regimens like ABVD for Hodgkin lymphoma and R-CHOP for non-Hodgkin lymphoma being the standard approaches. 1, 2
Common Symptoms of Lymphoma
Primary Symptoms
- Painless, enlarged lymph nodes (most commonly cervical - 44.8% of cases) 3
- B symptoms (occur in advanced disease):
- Fever (unexplained)
- Drenching night sweats
- Unexplained weight loss (>10% of total body weight over 6 months) 1
Other Common Symptoms
- Fatigue/lack of energy
- Pruritus (itching)
- Pain (particularly in affected areas)
- Alcohol-induced pain (specific to Hodgkin lymphoma)
- Sleeping difficulties 4
Symptoms by Subtype
Hodgkin Lymphoma
- Typically presents with enlarged cervical lymph nodes (>60% of cases)
- More likely to present with localized disease
- B symptoms occur in approximately 25-30% of patients
- Pruritus is more common than in NHL 1
Non-Hodgkin Lymphoma (NHL)
- More varied presentation depending on subtype
- Follicular lymphoma often presents with:
- Diffuse lymphadenopathy
- Bone marrow involvement
- Splenomegaly 5
- Extranodal involvement is common in certain subtypes
- Cytopenias may occur, especially with bone marrow involvement 1
Complications
- Hematologic abnormalities (anemia, thrombocytopenia)
- Bone marrow infiltration
- Neurologic involvement
- Organ compression by tumor
- Pleural or peritoneal effusion 1, 3
Diagnosis
Essential Diagnostic Steps
Excisional lymph node biopsy - gold standard for diagnosis 1
- Core biopsies only if excisional biopsy not possible
- Fine needle aspirations are inadequate for diagnosis
Imaging studies:
- CT scan of neck, chest, abdomen, and pelvis
- PET/CT scan (particularly valuable for staging) 1
Laboratory tests:
Bone marrow biopsy - if PET/CT not available or in specific subtypes 1
Treatment Options
Hodgkin Lymphoma Treatment
Early-Stage Disease (Stages I-II)
- Standard approach: 2-3 cycles of ABVD (adriamycin/bleomycin/vinblastine/dacarbazine) followed by involved-field radiotherapy (IFRT) 1
- ABVD regimen is the backbone of treatment
- Radiation dose typically 20-30 Gy
Advanced Disease (Stages III-IV)
- 6-8 cycles of ABVD or more intensive regimens like BEACOPP for high-risk patients 1
- PET-guided approach to determine treatment duration
Non-Hodgkin Lymphoma Treatment
Aggressive NHL (DLBCL)
- Standard approach: R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) 6, 7
- 6-8 cycles depending on stage and risk factors
- CNS prophylaxis for high-risk patients
Indolent NHL (Follicular Lymphoma)
- Asymptomatic, low tumor burden: Observation ("watch and wait") 1
- Symptomatic or high tumor burden:
Treatment Decision Factors
- Lymphoma subtype
- Disease stage
- Patient age and comorbidities
- Presence of B symptoms
- Tumor burden
- Specific risk factors (FLIPI score for follicular lymphoma) 1
Follow-up and Monitoring
- Regular clinical examinations every 3-4 months for first 2 years
- CT scans at 6,12, and 24 months after treatment
- PET/CT if there is suspicion of relapse
- Monitoring for late effects of treatment (secondary malignancies, cardiac toxicity) 1
Important Considerations
- Early diagnosis is critical for optimal outcomes
- Treatment should not be delayed for symptomatic patients
- For indolent lymphomas, not all patients require immediate treatment
- Long-term follow-up is essential due to risk of relapse and treatment-related complications
- Vaccination against pneumococcal disease is recommended for lymphoma patients 2