Non-Hodkins Lymphoma Cancer Symptoms

This article describes the symptoms of Non-Hodgkin’s lymphoma.  Non-Hodgkin’s Lymphoma simply refers to any lymphoma that is not Hodgkin’s Lymphoma, thus it describes many different kinds of lymphoma.  Knowledge of all these subtypes is not necessary as many have similar symptoms.  The important point from a public health perspective is to be aware of the “red flag” symptoms and to bring these to the attention of your doctor for further investigation. There are several different types of Non-Hodgkin’s Lymphoma each of those having several sub-types. The classifications have been re-made several times by both the world health organization (WHO) and the revises European-American lymphoma (REAL) organizations.

Lymphoma is a cancer or abnormal growth of one or several parts of the lymphatic system.  Lymphoma is largely a tumor of the lymph nodes.  The granulocyte white blood cells made in the bone marrow can be overproduced and crowd the blood.  This is known as leukemia.  Both leukemia and lymphoma involve overproduction and excessive growth of some aspect of the immune system. Diffuse large B-cell lymphoma is the most common type of non-Hodgkin’s lymphoma.  It makes up about 40% of all lymphomas in adults.  Up to 50% of people with this sub-type can be cured with chemotherapy.  This is encouraging but it still emphasizes the poorer prognosis compared with Hodgkin’s Lymphoma where up to 90% of people are cured with treatment.

Burkitt Lymphoma is another type of NHL.  There are several different types of Burkitt Lymphoma but in general these are more aggressive and have a poorer prognosis.  About 20% of NHL occurs as follicular lymphoma.  This type tends to have a better prognosis than other types of NHL.  A type of NHL that tends to occur mostly in elderly men > 65 years old is mantle cell lymphoma.  This sub-type is also aggressive and usually has a poor prognosis.

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  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.
  • Involvement of places outside of the lymph nodes is common with Non-Hodgkin’s Lymphoma and can affect any bodily organ.  The most common places affected are the bone marrow, gastrointestinal tract, skin and the bone itself.  When the intestines are affected the lymphoma can cause bowel blockage (small bowel obstruction more commonly) from infiltration of the cells.
  • 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.
  • 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.

Any of the above symptoms, particularly when combined with swollen lymph nodes, should be brought to the attention of your doctor immediately.  Early diagnosis and treatment provides the best possible chance for better outcomes and prevention of the more serious complications.

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. Chapter 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.