What are the signs and symptoms of lymphoma?

Lymphoma Signs and Symptoms

Painless enlarged lymph nodes are the hallmark presenting sign of lymphoma, occurring in over 60% of patients, most commonly in the cervical region. 1, 2

Nodal Presentation

Lymph node characteristics:

• Cervical lymph nodes are the most frequently affected site, particularly in Hodgkin lymphoma 3, 1
• Nodes that are firm, non-tender, fixed/reduced in mobility, or larger than 1.5 cm in any cervical location are more suspicious for malignancy 2
• Nodes larger than 2 cm, hard, or matted/fused to surrounding structures suggest malignancy or granulomatous disease 4
• Supraclavicular and epitrochlear nodes are particularly concerning for malignancy 4
• Mediastinal involvement is characteristic of Hodgkin lymphoma, with over 60% presenting with enlarged cervical or mediastinal nodes 5

Constitutional "B Symptoms"

These systemic symptoms indicate more advanced disease:

• Unexplained fever >38°C (>101°F) 2
• Drenching night sweats requiring changing of clothes or bedding 2
• Unexplained weight loss >10% of body weight within 6 months 3, 2

B symptoms are particularly common in Hodgkin lymphoma and indicate unfavorable risk features 5

Additional Common Symptoms

• Persistent fatigue not relieved by rest 1, 2
• Generalized or localized pruritus (itching) without rash 1, 2
• Alcohol-induced pain in lymph node regions after consuming alcohol 1
• Irritability, particularly in pediatric patients 1

Site-Specific Manifestations

Abdominal involvement:

• Abdominal pain and swelling 1
• Poor appetite, early satiety, constipation, nausea, and vomiting 1
• Enlarged spleen or liver detected on physical examination 2

Thoracic involvement:

• Coughing, dyspnea (shortness of breath), wheezing or stridor 1
• Chest pain and reduced physical endurance 1
• Mediastinal mass on chest imaging 2

Head and neck involvement:

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

CNS involvement:

• Headaches 1
• Bladder or bowel dysfunction 1
• Lower extremity weakness 1

Oncologic Emergencies

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

• Tumor lysis syndrome 1
• Superior vena cava syndrome 1
• Respiratory compromise 1
• Spinal cord compression 1

Epidemiologic Considerations

• Hodgkin lymphoma has a bimodal age distribution with peaks in young adults (20-40 years) and older adults (>55 years) 3, 1, 5
• Immunocompromised patients are at higher risk and may present with more aggressive disease 2
• Follicular lymphoma demonstrates spontaneous regressions in 10-20% of cases 2

Critical Diagnostic Pitfall

Fine-needle aspiration alone is insufficient for diagnosis—excisional lymph node biopsy is required to provide adequate tissue for proper classification according to WHO criteria 3, 2, 5