What are the symptoms of lymphoma?

Lymphoma Symptoms

Lymphoma most commonly presents as painless enlarged lymph nodes, particularly in the cervical region, with over 60% of Hodgkin lymphoma patients presenting this way. 1

Primary Presenting Symptoms

Lymphadenopathy

• Painless lymph node enlargement is the hallmark symptom, occurring in the majority of lymphoma cases 1, 2
• Cervical (neck) lymph nodes are most frequently affected, especially in Hodgkin lymphoma 1
• The lymphadenopathy typically develops insidiously and is often discovered incidentally 3
• Nodes may be accompanied by mediastinal masses that are initially asymptomatic 3

Constitutional "B Symptoms"

• B symptoms include fever >38°C, drenching night sweats requiring clothing/bedding changes, and unexplained weight loss >10% of body weight over 6 months 4
• These symptoms indicate systemic involvement and more advanced disease 4, 2
• B symptoms are critical for staging—their presence denotes "B" staging (e.g., Stage IIB), while absence denotes "A" staging 4
• In follicular lymphoma specifically, development of B symptoms mandates treatment initiation 4

Additional Common Symptoms

• Fatigue is frequently reported across lymphoma types 1
• Pruritus (generalized itching) occurs commonly 1, 3
• Alcohol-induced pain in lymph node regions after consuming alcohol is a characteristic but less common symptom 1
• Irritability may be prominent, particularly in pediatric patients 1

Site-Specific Manifestations

Abdominal Involvement

• Abdominal pain and swelling 1
• Poor appetite, early satiety, constipation, nausea, and vomiting 1

Thoracic/Mediastinal Involvement

• Cough (may be chronic and dry), dyspnea, wheezing or stridor 1, 3
• Chest pain (including pleuritic pain) and reduced physical endurance 1, 3
• Respiratory symptoms are particularly common when mediastinal lymphadenopathy is present 3

Head and Neck Involvement

• Swelling in the neck, jaw, gingival area, or maxilla 1
• Difficulty swallowing, choking sensation, and vision changes 1

Central Nervous System Involvement

• Headaches 1
• Bladder or bowel dysfunction and lower extremity weakness 1

Oncologic Emergency Presentations

Lymphoma may present acutely with life-threatening complications requiring immediate intervention: 1

• Tumor lysis syndrome
• Superior vena cava syndrome
• Respiratory compromise from airway compression
• Spinal cord compression

Clinical Pearls

• Any lymph node >2 cm, hard consistency, or matted/fused to surrounding structures should raise concern for malignancy or granulomatous disease 5
• Epitrochlear or supraclavicular lymphadenopathy is particularly concerning for malignancy 5
• Hodgkin lymphoma has a bimodal age distribution with peaks in young adults (20-40 years) and older adults (>55 years) 1
• Definitive diagnosis requires open lymph node biopsy with histological and immunohistochemical analysis 2, 6