What are the common symptoms of lymphoma in adults, particularly those over 60 years old?

Lymphoma Symptoms in Adults Over 60

The most common presenting symptoms of lymphoma in adults over 60 are painless lymphadenopathy (swollen lymph nodes), followed by constitutional "B symptoms" including unexplained fever >38°C, drenching night sweats, and unintentional weight loss >10% of body weight within 6 months. 1

Primary Presenting Symptoms

Lymphadenopathy

• Painless, progressive lymph node enlargement is the hallmark presentation, most commonly affecting cervical, supraclavicular, axillary, or inguinal regions 1, 2
• Nodes may be described as firm, rubbery, and non-tender on examination 3
• Supraclavicular and epitrochlear node involvement should raise particular concern for malignancy 3

Constitutional "B Symptoms"

The presence of any of these three symptoms significantly impacts staging and prognosis 1:

• Unexplained fever >38°C (>101°F) without identifiable infection 1
• Drenching night sweats that require changing clothes or bedding 1
• Weight loss >10% of body weight within the preceding 6 months 1

Secondary Symptoms

Common Additional Presentations

• Fatigue and lethargy are frequently reported, often severe enough to impact daily activities 1, 2, 4
• Pruritus (itching) can be generalized and severe, sometimes preceding other symptoms by months 1, 4
• Alcohol-induced pain at sites of lymph node involvement, though less common, is relatively specific for Hodgkin lymphoma 1

Organ-Specific Symptoms

• Splenomegaly and hepatomegaly may cause abdominal fullness or early satiety 1
• Dyspnea from mediastinal mass compression or pleural effusions 1, 2
• Cough or chest discomfort from intrathoracic involvement 2

Age-Specific Considerations in Patients Over 60

Elderly patients often present with more advanced disease and atypical symptoms 5:

• Constitutional symptoms may be more pronounced in older adults 5
• Median overall survival is significantly shorter in patients over 90 (7.2 months), with aggressive lymphomas having worse outcomes than indolent subtypes 5
• Hypoalbuminemia is a strong independent negative prognostic factor in elderly patients with aggressive lymphoma 5

Critical Symptoms Requiring Urgent Evaluation

Red Flag Presentations

• Rapidly enlarging lymph nodes, particularly if >2 cm, hard, or matted/fused to surrounding structures 3
• Persistent lymphadenopathy >4 weeks without obvious infectious cause 3
• Generalized lymphadenopathy (involvement of multiple non-contiguous nodal regions) suggests systemic disease 6, 3

Extranodal Involvement

• Neurologic symptoms including cranial nerve involvement (chin numbness), headache, or seizures may indicate CNS involvement 1, 7
• Bone pain can occur with marrow involvement 4
• Gastrointestinal symptoms including abdominal masses are more suggestive of mature B-cell lymphomas 1

Symptom Patterns and Interrelationships

Symptoms in lymphoma frequently co-occur and have synergistic effects on patient distress 4:

• Lack of energy, night sweats, and sleeping difficulties often cluster together 4
• Weight loss may result from combination of decreased appetite, night sweats, and hypermetabolic state 4
• Co-occurring pre-diagnosis symptoms typically prompt patients to seek medical attention 4

Common Diagnostic Pitfalls

• Do not rely on physical examination alone; lymphadenopathy may not be palpable despite significant disease burden on imaging 8
• Constitutional symptoms can mimic infectious processes, particularly tuberculosis, which can rarely coexist with lymphoma 9
• Fine-needle aspiration is inadequate for initial diagnosis; excisional or core needle biopsy with adequate tissue for immunohistochemistry is essential 1
• In elderly patients, symptoms may be attributed to aging or comorbidities, leading to delayed diagnosis 5