Symptoms of Lymphoma
The most common symptoms of lymphoma include painless enlarged lymph nodes (especially cervical), fever >38.3°C, drenching night sweats, unexplained weight loss >10% of body weight over 6 months, fatigue, pruritus, and alcohol-induced pain. 1
Primary Symptoms
Lymphadenopathy
- Most patients with Hodgkin lymphoma (>60%) initially present with enlarged cervical lymph nodes 2, 1
- Characteristic lymph nodes are:
- Enlarged (>1.5 cm)
- Painless
- Firm in texture
- Reduced mobility
- Persistent (≥2 weeks)
- Often lack signs of infection 1
- Supraclavicular lymphadenopathy carries a high malignancy risk and requires prompt evaluation 1
B Symptoms
B symptoms are formally used in lymphoma staging and indicate more advanced disease:
Other Common Symptoms
- Fatigue
- Pruritus (itching)
- Alcohol-induced pain (pain in lymph nodes after alcohol consumption)
- Sleeping difficulties 1, 4
Subtype-Specific Presentations
Cutaneous Manifestations
- T-cell lymphoma: patches and plaques on the skin, later developing into tumors 1
- B-cell cutaneous lymphoma: multiple red papules, plaques, or nodules 1
- Paraneoplastic skin manifestations may include:
Systemic Involvement
Symptoms related to involvement of other organs:
- Spleen, liver, bone marrow, and lung can be affected 2
- Dry cough (with mediastinal involvement) 6
- Pain (can occur in various locations depending on disease site) 4
- Sadness/emotional symptoms 4
Clinical Pearls and Pitfalls
Important Considerations
- Co-occurring symptoms often lead patients to seek medical attention 4
- Multiple symptoms during treatment have a cumulatively distressing effect 4
- Symptoms are often interrelated, with one symptom leading to others 4
Diagnostic Pitfalls
- Core needle biopsy may be inadequate for proper classification; excisional or incisional biopsy is preferred 1
- Cutaneous manifestations may precede the diagnosis of lymphoma and be mistaken for common skin conditions 6, 5
- Lymphoma should be considered in the differential diagnosis for persistent unexplained symptoms, especially in the presence of risk factors (age >40 years, tobacco use, alcohol abuse, immunocompromised status) 1
When to Suspect Lymphoma
- Persistent lymphadenopathy (≥2 weeks)
- B symptoms without clear infectious cause
- Unexplained pruritus, especially in older adults
- Combination of systemic symptoms with lymphadenopathy 1, 3
Remember that definitive diagnosis always requires a lymph node biopsy 2, and PET-CT is recommended for accurate staging when lymphoma is suspected 1.