Common Symptoms of Lymphoma
Painless enlarged lymph nodes are the most common presenting symptom, occurring in over 60% of patients with lymphoma, particularly in the cervical (neck) region. 1, 2
Primary Presenting Signs
- Lymphadenopathy (enlarged lymph nodes) is the hallmark presentation, with nodes that are firm, non-tender, and fixed/reduced in mobility being more suspicious for malignancy 1
- Lymph nodes larger than 1.5 cm in any cervical location should raise suspicion for malignancy 1
- Approximately 20% of patients present with splenomegaly (enlarged spleen) and/or hepatomegaly (enlarged liver) on physical examination 3
- Mediastinal masses are particularly common in Hodgkin lymphoma and may be detected on chest imaging 1
Constitutional "B Symptoms"
B symptoms indicate systemic involvement and more advanced disease, consisting of three specific findings: 4
- Unexplained fever >38°C (>101°F) 1, 4
- Drenching night sweats requiring change of clothes or bedding 1, 4
- Unexplained weight loss >10% of body weight within 6 months 1, 4
These B symptoms are critical staging criteria and indicate more aggressive disease requiring treatment initiation. 4
Additional Common Symptoms
- Persistent fatigue not relieved by rest 1, 2
- Pruritus (generalized or localized itching) without rash 1, 2
- Alcohol-induced pain in lymph node regions after consuming alcohol (specific to some patients) 2
- Easy bruising or bleeding 3
- Dyspnea (shortness of breath) and dizziness 3
- Recurrent infections 3
Site-Specific Symptoms by Location
Thoracic involvement: 2
- Coughing, dyspnea, wheezing or stridor
- Chest pain and reduced physical endurance
Abdominal involvement: 2
- Abdominal pain and swelling
- Poor appetite, early satiety, constipation
- Nausea and vomiting
Head and neck involvement: 2
- Swelling in the neck, jaw, or gingival area
- Difficulty swallowing or choking sensation
- Vision changes
- Chin numbness or facial palsy from cranial nerve involvement 3
CNS involvement: 2
- Headaches
- Bladder or bowel dysfunction
- Lower extremity weakness
Pediatric-Specific Presentations
- Pain in the extremities or joints may be the only presenting symptom in children 3
- Irritability is a symptom particularly in pediatric patients 2
Important Clinical Caveats
- Abdominal masses from gastrointestinal involvement are more suggestive of mature B-cell ALL (Burkitt lymphoma) 3
- 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, 2
- Immunocompromised patients are at higher risk for lymphoma development and may present with more aggressive disease 1
- Lymphoma may present with oncologic emergencies requiring immediate intervention, including tumor lysis syndrome, superior vena cava syndrome, respiratory compromise, and spinal cord compression 2