Symptoms and Warning Signs of Lymphoma

Lymphoma is cancer of the lymphocytes, which are white blood cells that primarily exist in the body's lymphatic system, but are also present in blood and other body tissues. There are many different kinds of lymphoma, and many different symptoms are possible, as a result.

Lymphocytes, the affected white blood cells in lymphoma, can be found throughout the lymphatic system – a network of vessels that carry lymph – and in associated structures. Lymphocytes fight off bacterial and viral infections and play an important role in the body's immune system. Lymph nodes, also part of the lymphatic system, are small masses of lymph tissue that are scattered throughout the body, like checkpoints along the system of lymph vessels. Their purpose is to filter the lymph as it passes through them. Oftentimes, lymph nodes become enlarged in lymphoma, and that is what causes the lump that may be felt under the skin.

Under normal circumstances, healthy lymphocytes can move in and out of the lymph nodes to carry out their duties in the immune system. When a lymphoma develops, lymphoma cells can build up in the lymph nodes, as well as in the bone marrow, spleen, and other parts of the body. Though lymphomas typically begin in the lymph nodes, they can arise virtually anywhere.

There are many different kinds of lymphoma, but for historical reasons, lymphoma is essentially divided into two main categories: Hodgkin's lymphoma (HL)—also called Hodgkin's disease—and non-Hodgkin’s lymphoma (NHL), which essentially refers to all other lymphomas.

What Are the Signs of Lymphoma?

The warning signs of lymphoma may be so subtle that it can take years before a person with the disease realizes that there is anything seriously wrong. In addition, most of the symptoms of lymphoma are non-specific, meaning they can also occur in more common and less dangerous, non-cancerous conditions. Therefore, it is important to consult your doctor for an accurate diagnosis.

A painless lump in your neck, armpits, or groin

Doctor examining glands of female patient
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This is the most common symptom, and often it’s the only symptom. These lumps are enlarged lymph nodes. Most people first notice these lumps while bathing or changing, or a spouse or significant other may first feel them. Enlarged nodes are not always a sign of lymphoma.

Usually, the lump from an enlarged node is not painful, but sometimes it may become painful after drinking alcohol, which has been reported in many cases of Hodgkin lymphoma.

If you have a worrisome lump and you are not sure if it is a lymph node or something else, see your doctor. Physicians have detailed knowledge of lymph drainage patterns, along with the typical locations for certain lymph nodes. By seeing you and doing the physical exam, your doctor will often be able to quickly tell the difference between common lumps and bumps, normal lymph node swelling or something more concerning.

Cancers other than lymphoma can also cause swollen lymph nodes. And, it should be noted that most cases of enlarged lymph nodes are actually due to other things, such as infections, rather than cancers. This is especially true in children. Enlarged nodes due to infection generally return to their normal size a couple of weeks or months after the infection clears. 

Unexplained weight loss

Weight loss in the context of lymphoma usually occurs rapidly and it may have various causes. In some cases, it occurs because the cancerous cells are requiring extra energy while the body is working hard to try to eradicate them. This kind of unexplained weight loss is more often a feature of fast-growing lymphomas.

Often a person can lose ten to fifteen pounds over a couple of months. It is important to see your doctor if you lose more than 5 percent of your body weight over the course of a month, or more than 10 percent over the course of six months. 

Many studies have tried to determine the significance of weight loss and body weight, or body mass index (BMI) in lymphoma. It is not clear whether body weight at the time of diagnosis generally has any impact on a person’s prognosis or survival rates. Studies have suggested a higher body weight index may be associated with better survival in some cases, but not others. Several recent studies, for instance, have found that an increased BMI was associated with improved overall survival in patients with non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL); two studies in patients with NHL, however, found that increased BMI was associated with decreased survival, and another found that BMI was not significantly associated with clinical outcomes among patients with diffuse large B-cell lymphoma (DLBCL), HL or follicular lymphoma (FL).

Weight loss is one of the three symptoms known as ‘B symptoms.’ The other two are fever and sweating.

Fever

 

Fever that is continuous or occurs intermittently over a period of time and doesn't seem related to a chest or urinary infection is an important sign that you should let your doctor know about. Fever that is related to node swellings occurs commonly with infections, and many lymphomas are often mistaken for infections in the early stages. Occasionally, in those affected by Hodgkin lymphoma, a characteristic fever called Pel-Ebstein fever occurs. This is a particular pattern of fever that most doctors learn about during there training, but it may be a relatively rare finding in lymphoma.

Fever is one of the three symptoms known as ‘B symptoms.’ The other two are sweating and weight loss.

Excessive sweating at night

Everyone on occasion awakens to find they are sweaty, especially when sleeping under too many blankets or in a warm bedroom without a fan. These types of experiences are usually not considered night sweats and don’t usually indicate a medical problem.

True night sweats are often more impressive. You may wake up at night drenched in sweat without any apparent reason. These night sweats are usually severe enough to require you to change your clothing and bed linens. Your pajamas and bed linens become soaking wet. Of note, night sweats can also sometimes happen during the day.

While it’s true that night sweats may be a sign of lymphoma, it’s also true that a whole slew of items can produce night sweats, including drugs and alcohol, infections like HIV/AIDS, certain sleep disorders, and even anxiety in some cases. And, of course, night sweats and hot flashes are very common among women around the time of menopause.

The preceding three symptoms ­–­ fever, weight loss and sweating ­– are sometimes called ‘B symptoms.’ This is a term that is used in the staging of the disease. In some lymphomas, the presence of B symptoms may be important; in other types of lymphoma, they are less so.

Itchiness

Itching is more common in people with Hodgkin lymphoma than in non-Hodgkin lymphoma. In fact, about one in three people with Hodgkin lymphoma will experience itching, usually without any apparent rash. The itching often affects hands, feet, lower legs, or the entire body. The itching can be distressing, especially in hot weather, and it is usually worse at night while in bed.

The cause of the kind of itching that occurs in lymphoma is not known, but cell signals called cytokines are believed to be responsible, at least in part, for the itching sensation. In types of lymphoma that affect the skin, the itching occurs in the skin patches affected by the disease.

Loss of appetite

As lymphomas spread within the body and grow, many people feel a considerable loss of appetite, further accelerating weight loss. There may be different reasons for the loss of appetite that can occur in lymphoma.

In some cases, lymphomas that start or grow in the abdomen can cause swelling or pain in the belly area. This might be from lymph nodes that have become large, or from organs such as the spleen or liver that have become involved with disease. Fullness in the abdomen can also result from a build-up of large amounts of fluid in the abdomen. An enlarged spleen might press on the stomach, which can cause a loss of appetite and feeling full after only a small meal. Lymphomas in the stomach or intestines can also cause abdominal pain, nausea, or vomiting.

A feeling of weakness

As cancer cells are always growing, they use up more of the body's nutrients, leaving the body with less. This one of the many processes that can make a person with lymphoma feel weaker. The weakness may also be caused by anemia if the lymphoma is occupying the bone marrow where red blood cells are produced. Anemia essentially means the body does not have enough healthy red blood cells in the circulation to do the job of delivering oxygen to the tissues – including the muscles and the brain. So, anemia can produce a sense of weakness, but also a sense of fatigue or tiredness in a person with lymphoma.

Breathlessness along with swelling of the face and neck

Less commonly, when a lymphoma in the neck or chest area grows very large, it may block the flow of some vessels and lead to a swelling of the face and neck along with a feeling of breathlessness. Shortness of breath and cough can also be symptoms when the lymphoma grows in the mediastinum, an area of the chest that houses the heart and is bordered by the lungs and anatomical structures both above and below.

As lymphomas can occur in any organ, they may give rise to some unusual symptoms as well. A lymphoma in the stomach can cause pain in the abdomen, and a lymphoma in the brain can cause headaches or leg weakness, etc.

If you experience several of these symptoms or feel at all concerned that you might have lymphoma, see your doctor. Only a medical professional can properly diagnose the cause of your symptoms.

Sources

Li Y-J, Yi P-Y, Li J-W, et al. Increased body mass index is associated with improved overall survival in extranodal natural killer/T-cell lymphoma, nasal type. Oncotarget. 2017;8(3):4245-4256.

American Cancer Society, 2017. Signs and symptoms of non-Hodgkin lymphoma.

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