What are the symptoms and treatment options for lymphoma?

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Lymphoma Symptoms and Treatment

Lymphoma presents primarily with painless lymphadenopathy (enlarged lymph nodes), often accompanied by systemic symptoms including fever, night sweats, and unexplained weight loss in advanced stages, with treatment typically involving chemotherapy regimens such as ABVD for Hodgkin lymphoma or R-CHOP for non-Hodgkin lymphoma, depending on lymphoma type and stage. 1, 2

Types of Lymphoma

Lymphoma is broadly classified into two main categories:

  1. Hodgkin Lymphoma (HL)

    • Accounts for approximately 11% of all lymphomas in the US 3
    • Further classified as Classical HL (95%) and Nodular Lymphocyte-Predominant HL (5%) 4
    • Characterized by the presence of Reed-Sternberg cells 4

  2. Non-Hodgkin Lymphoma (NHL)

    • More common than Hodgkin lymphoma
    • Multiple subtypes including follicular lymphoma (second most common subtype in Western Europe) 4
    • Characterized by malignant lymphocytes without Reed-Sternberg cells

Common Symptoms

Primary Symptoms

  • Painless lymphadenopathy (enlarged lymph nodes) - most common presenting sign 2, 5
  • Lymph node enlargement typically occurs in the neck, axilla, or groin
  • Nodes are usually firm, rubbery, and non-tender

Systemic Symptoms (B Symptoms)

  • Fever (>38°C)
  • Night sweats (drenching)
  • Unexplained weight loss (>10% of body weight over 6 months) 4, 2

Other Common Symptoms

  • Fatigue
  • Pruritus (itching)
  • Alcohol-induced pain in lymph nodes (specific to Hodgkin lymphoma) 4
  • Symptoms related to mass effect from enlarged nodes (e.g., cough, dyspnea if mediastinal involvement)

Site-Specific Symptoms

  • Head and neck involvement: May present with tonsillar enlargement, salivary gland swelling, or sinonasal symptoms 5
  • Abdominal involvement: Abdominal pain, early satiety, or bowel obstruction
  • Bone marrow involvement: Anemia, thrombocytopenia, or neutropenia

Diagnostic Approach

Essential Diagnostic Tests

  • Excisional lymph node biopsy: Gold standard for diagnosis 4
    • Core biopsies only for inaccessible nodes
    • Fine needle aspiration is inadequate for diagnosis

Staging Workup

  • Imaging:
    • Contrast-enhanced CT scan of neck, chest, abdomen, and pelvis
    • PET-CT scan (preferred for staging and response assessment) 4, 1
  • Laboratory tests:
    • Complete blood count
    • Erythrocyte sedimentation rate (ESR)
    • Blood chemistry including LDH, liver enzymes, and albumin
    • Hepatitis B, C, and HIV screening 4

Treatment Approaches

Hodgkin Lymphoma Treatment

  1. Limited Stage (I-II):

    • Combined modality therapy: 2-3 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) followed by involved-site radiation therapy (20-30 Gy) 1, 2
    • ABVD regimen carries risks of cardiotoxicity and pulmonary toxicity 6, 7

  2. Advanced Stage (III-IV):

    • For patients <60 years: 6 cycles of ABVD or 4-6 cycles of escalated BEACOPP 1
    • For patients >60 years: 6-8 cycles of ABVD (due to higher toxicity of BEACOPP) 1

Non-Hodgkin Lymphoma Treatment (Follicular Lymphoma)

  1. Limited Stage (I-II):

    • Radiotherapy (involved or extended field, 30-40 Gy) with curative potential 4

  2. Advanced Stage (III-IV):

    • Treatment initiated upon symptoms, bulky disease, or progression 4
    • Standard regimen: Rituximab plus chemotherapy (R-CHOP, R-CVP, or R-FCM) 4
    • Single-agent therapy (rituximab, bendamustine, chlorambucil) for patients with contraindications to intensive therapy 4

Relapsed/Refractory Disease

  • Hodgkin Lymphoma: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) 1
  • Non-Hodgkin Lymphoma: Repeat biopsy recommended to rule out transformation, followed by non-cross-resistant regimens 4

Treatment Complications and Monitoring

Major Treatment Complications

  • Cardiotoxicity: From anthracyclines like doxorubicin 6
  • Pulmonary toxicity: From bleomycin 7
  • Secondary malignancies: Including acute myeloid leukemia and myelodysplastic syndrome 6
  • Infertility: Especially with BEACOPP regimen 1

Follow-up Schedule

  • Physical examination every 3 months for 2 years, then every 4-6 months for 3 years, then annually 4, 1
  • Blood counts at 3,6,12, and 24 months
  • Imaging studies at 6,12, and 24 months after treatment
  • Thyroid function tests for patients who received neck radiation 4

Special Considerations

  • Elderly patients: Require dose modifications due to increased risk of treatment-related toxicity
  • Pregnant patients: Treatment decisions must balance risks to mother and fetus
  • Immunocompromised patients: May require more aggressive supportive care
  • Vaccination: Patients should receive pneumococcal vaccines and age-appropriate vaccinations due to immunosuppression 2

References

1
Guideline

Hodgkin Lymphoma Treatment Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

2
Research

Lymphoma: Diagnosis and Treatment.

American family physician, 2020

3
Research

Hodgkin Lymphoma: Diagnosis and Treatment.

Mayo Clinic proceedings, 2015

4
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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