Signs and Symptoms of Lymphoma
The most common signs and symptoms of lymphoma include painless enlarged lymph nodes, B symptoms (fever >38°C, drenching night sweats, weight loss >10% of body weight within 6 months), fatigue, and pruritus. 1
Common Presenting Signs
- Lymphadenopathy: Painless enlarged lymph nodes are the most common presenting sign, occurring in over 60% of patients with lymphoma, particularly in the cervical region 1, 2
- Firm texture: Lymph nodes that are firm, non-tender, and fixed/reduced in mobility are more suspicious for malignancy 2
- Size >1.5 cm: Lymph nodes larger than 1.5 cm in any cervical location should raise suspicion for malignancy 2
- Splenomegaly/hepatomegaly: Enlarged spleen or liver may be detected on physical examination and confirmed by imaging 2
- Mediastinal mass: May be detected on chest imaging, particularly in Hodgkin lymphoma 2
Common Presenting Symptoms
B Symptoms
- Fever: Unexplained fever >38°C (>101°F) 2, 3
- Night sweats: Drenching sweats that require changing clothes or bedding 3, 4
- Weight loss: Unexplained loss of >10% body weight within 6 months 2, 3
Other Common Symptoms
- Fatigue: Persistent tiredness not relieved by rest 1, 5
- Pruritus: Generalized or localized itching without rash 1, 2
- Alcohol-induced pain: Pain in lymph node regions after consuming alcohol (particularly in Hodgkin lymphoma) 1, 2
Site-Specific Symptoms
Thoracic Involvement
- Respiratory symptoms: Cough, dyspnea, chest pain, reduced physical endurance 1, 6
- Superior vena cava syndrome: Facial swelling, distended neck veins, dyspnea 1
Abdominal Involvement
- Gastrointestinal symptoms: Abdominal pain, swelling, early satiety, nausea, vomiting 1, 2
- Ascites: Fluid accumulation in the peritoneal cavity 2
Head and Neck Involvement
- Swallowing difficulties: Dysphagia, choking sensation 1, 2
- Oropharyngeal symptoms: Tonsil asymmetry, ulceration, or mass 2
Diagnostic Criteria
- Ann Arbor staging system is used for classification, with stages I-IV based on extent of disease 2
- A and B designations: "A" indicates absence of systemic symptoms, while "B" indicates presence of B symptoms 2
- Excisional biopsy is the preferred diagnostic method; fine-needle aspiration alone is insufficient 2, 4
- PET/CT scanning is the standard for assessment and staging in most lymphomas 2
Red Flags for Urgent Evaluation
- B symptoms with progressive lymphadenopathy 3, 4
- Lymphadenopathy persisting >2 weeks without signs of infection 2, 7
- Supraclavicular lymphadenopathy (highest risk for malignancy) 7
- Mediastinal mass with respiratory symptoms 1, 6
- Neurological symptoms suggesting CNS involvement or spinal cord compression 1
Important Clinical Considerations
- Hodgkin vs. Non-Hodgkin lymphoma: Hodgkin lymphoma has a bimodal age distribution (young adults 20-40 years and older adults >55 years) and more commonly presents with B symptoms 1, 8
- Lymphadenopathy differential: Not all lymphadenopathy is lymphoma; infections and other malignancies must be considered 7, 2
- Spontaneous regression: In follicular lymphoma, spontaneous regressions occur in 10-20% of cases 2
- Immunocompromised patients: Higher risk for lymphoma development and may present with more aggressive disease 2
Early recognition of these signs and symptoms is crucial for timely diagnosis and treatment, which can significantly impact prognosis and quality of life.