Signs and Symptoms of Lymphoma
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
Key Clinical Presentations
Lymphadenopathy Characteristics
- Painless, progressive lymph node enlargement is the most common presentation, particularly affecting cervical nodes in Hodgkin lymphoma 1, 2, 3
- Suspicious features include nodes that are firm, non-tender, fixed/reduced in mobility, and larger than 1.5 cm in cervical locations 2
- Supraclavicular or epitrochlear node involvement should raise high suspicion for malignancy 4
- Mediastinal lymphadenopathy is particularly characteristic of Hodgkin lymphoma, present in over 60% of cases 5
- Nodes larger than 2 cm, hard texture, or matted/fused to surrounding structures suggest malignancy 4, 6
Constitutional "B Symptoms"
These indicate more advanced disease and occur commonly in lymphoma:
- Unexplained fever >38°C (>101°F) 7, 2
- Unexplained weight loss >10% of body weight over 6 months 7, 1, 2
- Drenching night sweats requiring changing of clothes or bedding 7, 2
Additional Common Symptoms
- Persistent fatigue not relieved by rest 2
- Pruritus (generalized or localized itching) without rash 1, 2
- Alcohol-induced pain in lymph node regions after consuming alcohol (specific to some patients) 1
Site-Specific Manifestations
Abdominal Involvement
- Abdominal pain and swelling 1
- Poor appetite and early satiety 1
- Constipation, nausea, and vomiting 1
- Hepatosplenomegaly may be detected on examination 2, 6
Thoracic Involvement
- Coughing and dyspnea (shortness of breath) 1
- Wheezing or stridor 1
- Chest pain and reduced physical endurance 1
- Bilateral pleural effusion may be present 8
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
Subtype-Specific Presentations
Marginal Zone Lymphomas
Extranodal MZL (EMZL):
- Usually remains localized within tissue of origin for prolonged periods 7
- Gastric involvement is multifocal with possible multiple mucosal site involvement 7
- Bone marrow infiltration in 2-20% of cases 7
Splenic MZL (SMZL):
- Symptomatic splenomegaly and cytopenias in advanced stages 7
- Incidental finding of peripheral lymphocytosis in some patients 7
- Autoimmune manifestations in ~20% including autoimmune hemolytic anemia, immune thrombocytopenia, cold agglutinin disease 7
Nodal MZL (NMZL):
- Disseminated lymphadenopathy (mostly cervical and abdominal) 7
- Disease often advanced at presentation 7
- B symptoms in 10-20% of patients 7
- Anemia in ~25% and thrombocytopenia in 10% 7
Mantle Cell Lymphoma
- May present with leukemic manifestation only in rare cases 7
- Gastrointestinal involvement common when systematically analyzed 7
- CNS involvement rare at diagnosis but consider in high-risk cases (blastoid variant, elevated LDH, impaired performance status) 7
Laboratory Findings
- Elevated lactate dehydrogenase (LDH) is a significant marker 7, 2
- Elevated uric acid levels 7, 2
- Anemia and thrombocytopenia may be present 7
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 Pearls
- Hodgkin lymphoma has bimodal age distribution with peaks at 20-40 years and >55 years 1, 2, 5
- Immunocompromised patients (including HIV-infected) are at higher risk and may present with more aggressive disease 2, 8
- Lymphadenopathy persisting beyond 4 weeks or accompanied by systemic symptoms warrants imaging and laboratory evaluation 4
- Excisional biopsy is preferred for diagnosis; fine-needle aspiration alone is insufficient 7, 2, 5