Lymphoma Cancer Symptoms

This article describes the symptoms of lymphoma.  This is a difficult task because there are many different kinds of lymphoma.  There are two major categories of lymphoma called Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma.  In each of these categories there are many different sub-types that are classified by their cell types and their behavior.  The classifications have been re-made several times by both the world health organization (WHO) and the revises European-American lymphoma (REAL) organizations.

Fortunately, we do not have to describe a hundred different diseases because most lymphomas share common symptoms.  These symptoms should serve as “red flags” or a warning sign that should prompt some type of investigation.  When symptoms of lymphoma are recognized, the definitive way to establish its presence or absence will involve some type of biopsy.  A biopsy is the taking of a sample of cells from the area of interest.  There are several different ways a biopsy can be obtained.  This might involve removing a few lymph nodes for examination, cutting a piece of one out or taking a large needle to get a core biopsy of that area.  In addition to looking at the cells under the microscope and examining           their architecture; there are many specialized tests can help determine the sub-type of the lymphoma (e.g. flow cytometry).

The general components and functions of the lymphatic system have been previously described in a related article.  A lymphoma refers to a tumor or swelling of a lymph node.  Most lymph node swelling is a part of the normal immune system and not cancer.  For example, when someone gets a sore throat it is common to have swollen and tender lymph nodes in the neck or under the jaw because of the infection and inflammation nearby.  Lymphoma is invasion and expansion of lymphatic tumor cells in the lymph nodes.  It is possible to have cancer cells in lymph nodes that are not lymphoma.  For example, breast cancer cells can spread to adjacent lymph nodes in the armpit and cause swelling of these nodes from infiltration of the cancer.  This represents spread of the breast cancer and not a lymphoma.  Again, the only way to know this for sure would be to take a sample of the cells in the lymph nodes and examine them under a microscope after a biopsy.

The symptoms of lymphoma are quite varied and non-specific.  These symptoms may include:

  • Swollen or enlarged lymph nodes : with Hodgkin’s lymphoma these enlarged nodes tend to occur in patterns.  About 60-70% have enlarged nodes in the left side of the neck.  About 50% have enlarged nodes in the chest, near the heart and lungs (i.e. mediastinal).  About 30% will have enlarged lymph nodes in the armpit (also known as axilla).  About 10% will have enlarged nodes in the inguinal / groin region.  Enlargement of other nodes may not be detectable by physical examination and will require some type of imaging such as a CAT scan, MRI or even surgical exploration.   This type of lymph node enlargement will feel like a bunch of small lumps and do not swell and shrink in the manner of a “reactive” lymph node.
  • Non-tender lymph nodes : The lymph node enlargement seen with lymphoma is different from swollen lymph nodes that seen with infection in that area.  This type of enlargement has a firm and non-tender feel.  The lymph nodes stay swollen and will not seem to go away in a few days as a simple reactive node would.
  • Lymph nodes with a “rubbery” feel : The feel of lymph nodes with lymphoma is different from those with infection.  They generally feel rubbery or firm and are not tender.
  • Cough : The cough from lymphoma is usually due to irritation of the airways from swollen lymph nodes in the chest.  This may also occur from a pneumonia that occurs from partial blockage of the airways by swollen lymph nodes.
  • Night Sweats : Everyone sweats a bit at night but the classic night sweats that occur with lymphoma are drenching sweats that are described as leaving the sheets and pillows soaking wet.
  • Fevers : The fever pattern that occurs with lymphoma is often described as cyclical.  The person will complain of a high fever that seems to occur every day up to 102F or 103F often.  The term “fever” is often very misleading because the average person will say that they took their temperature and unless the dial was precisely on 98.6F they had “fever.”  This of course is inaccurate as we all have normal fluctuations of body temperature throughout the day that are not fever.
  • Weight Loss : The key to identifying weight loss with lymphoma is to realize that it is unexplained weight loss and generally significant in amount being at least 10% of your body weight.  Unexplained weight loss is a common sign of many cancers and should be a red flag to seek medical care and have some type of investigation to exclude the presence of a cancer.
  • Chest pain with alcohol consumption : This is a rare sign of lymphoma and no one knows exactly why it happens.  For some reason, after drinking alcohol the lymph nodes involved with lymphoma ache badly.
  • Pruritus (itching) : Many types of skin reactions, rashes, sores and itching are common with lymphoma.
  • Jaundice : Yellow or orange appearance of the skin, tongue and eyes usually indicate some type of liver disease or problem with bile excretion from the liver.  Enlargement of lymph nodes around the liver and bile ducts can impair bile flow.
  • Swelling and fullness of the head and neck : Swelling of the head and neck can occur for several different reasons with lymphoma.  The lymph nodes of the neck may enlarge causing a full appearance.  This is swelling will probably be asymmetric.  Swelling of the head and neck can also rarely occur as lymph nodes in the chest swell to the point that they partially or complete block the blood return via the veins.  This situation is also known as superior vena cava syndrome.
  • Back pain – Pain in the back from lymphoma can occur for a variety of reasons but is generally related to enlargement of lymph nodes and pressure on adjacent nerves or organs.  Pain from abdominal organs is perceived as vague and difficult to localize.  As the spleen enlarges and stretches it can cause a deep ache under the left rib cage or even possible to the left shoulder.  Similarly, the liver can cause ache under the right rib cage and even to the right shoulder or scapula.

While many of these symptoms are distressing it is important to emphasize that they are also fairly non-specific.  We all have fevers or swollen glands from time to time.  Symptoms that are disturbing or do not seem to go away should prompt one to discuss with their doctor for further investigation.

REFERENCES:

  1. www.cancer.gov/cancertopics/types/hodgkin
  2. www.nlm.nih.gov/medlineplus/lymphoma.html
  3. Lichtman MA. Obesity and the risk for a hematological malignancy: leukemia, lymphoma, or myeloma. Oncologist 2010; 15:1083.
  4. Abeloff, M.D. (2008). Abeloff: Abeloff’sClinical  Oncology, 4th ed. Chapters 111, 112.Philadelphia,PA: Churchill Livingstone – Elsevier
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.