What are the signs and symptoms of lymphoma?

Signs and Symptoms of Lymphoma

Painless enlarged lymph nodes are the most common presenting sign of lymphoma, occurring in over 60% of patients, particularly affecting cervical nodes in Hodgkin lymphoma. 1, 2

Primary Presenting Signs

• Lymphadenopathy characteristics: Lymph nodes that are firm, non-tender, fixed with reduced mobility, and larger than 1.5 cm in cervical locations are highly suspicious for malignancy 3
• Most common locations: Cervical lymph nodes are most frequently affected, especially in Hodgkin lymphoma, followed by mediastinal involvement (present in over 60% of HL cases) 1, 2
• Generalized lymphadenopathy: Widespread involvement of multiple nodal stations combined with systemic symptoms is highly characteristic of lymphoma 2
• Splenomegaly and hepatomegaly: Enlarged spleen or liver may be detected on physical examination and confirmed by imaging 3

Constitutional "B" Symptoms

These indicate more advanced disease and occur commonly in lymphoma:

• Fever: Unexplained fever >38°C (>101°F) 3
• Weight loss: Unexplained loss of >10% body weight within 6 months 1, 3
• Night sweats: Drenching sweats requiring changing of clothes or bedding 1, 3

Additional Common Symptoms

• Fatigue: Persistent tiredness not relieved by rest 1, 3
• Pruritus: Generalized or localized itching without rash 1, 3
• Alcohol-induced pain: Pain in lymph node regions after consuming alcohol (specific to some patients) 1
• Irritability: Particularly noted in pediatric patients 1

Site-Specific Manifestations

Abdominal Involvement

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

Thoracic/Mediastinal Involvement

• Coughing and dyspnea (shortness of breath) 1
• Wheezing or stridor 1
• Chest pain and reduced physical endurance 1

Head and Neck Involvement

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

Central Nervous System 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

Important Clinical Patterns

• Hodgkin lymphoma has a bimodal age distribution with peaks in young adults (20-40 years) and older adults (>55 years), and more commonly presents with B symptoms 1, 3
• Cervical lymphadenopathy was the most common presenting sign in 44.8% of non-Hodgkin lymphoma cases 4
• Lymphoma typically presents as painless adenopathy, with systemic symptoms occurring in more advanced stages 5

Laboratory Abnormalities

• Elevated lactate dehydrogenase (LDH): A significant marker for lymphoma 3
• Elevated uric acid levels: Associated with lymphoma 3
• Hematologic abnormalities: Anemia, thrombocytopenia, and neutropenia may occur, particularly with bone marrow involvement 4

Critical Diagnostic Considerations

• Excisional lymph node biopsy is required for definitive diagnosis; fine-needle aspiration alone is insufficient 2, 3
• Lymph nodes larger than 2 cm, hard, or matted/fused to surrounding structures may indicate malignancy 6
• Immunocompromised patients are at higher risk for lymphoma development and may present with more aggressive disease 3
• In follicular lymphoma, spontaneous regressions occur in 10-20% of cases 3