General symptoms of lymphoma
Lymphoma is often first noticed as painless enlarged lymph nodes (adenopathy or lymphadenopathy). However, most of the time, enlarged lymph nodes do not mean lymphoma. Only a biopsy and subsequent pathology evaluations of the tissue can determine or exclude the diagnosis of lymphoma.
See Lymphadenopathy: Differential Diagnosis and Evaluation Robert Ferrer, M.D., M.P.H. - American Family Physician for an excellent description of lymphadenopathy, as well as the many benign causes of enlarge lymph nodes.
Symptoms can vary widely depending on the type of lymphoma, and where the lymphoma is actively growing. Symptoms related to bone marrow dysfunction, such as anemia (low red blood cell count), are not as common when the disease is first diagnosed, but are likely to present in later stages of the disease and also as side effect of some treatments. MALT lymphomas may present as an upset stomach; or a change in bowel movement could be caused by an enlarged lymph node.
Reporting symptoms: It can be difficult at times to identify the meaning of a symptom. Some symptoms may be common to certain stages of lymphoma and to specific treatments. But you may have or develop other medical conditions and illnesses that are unrelated to lymphoma, such as flu or an ulcer.
When informing your doctor about a symptom also describe:
the intensity using a scale of 1 to 10,
for visible symptoms, describe the size and appearance
when it started,
how long it has lasted,
if it waxes and wanes,
the medications and supplements you may be taking and when you started taking them,
how the symptom might change when you change position,
if the symptom is associated with meals or specific foods,
the time of day the symptom might be most intense ...
These and other like details can assist your doctor in identifying the possible cause or causes, or if further tests are warranted.
Alphabetical List | B-Symptoms | Systemic Symptoms
Alphabetical list of common symptoms:
Unexplained and persistent:
Anemia - low red blood count*
Appetite loss
Fatigue (see Anemia)
Fever
Flu-like symptoms - aches, fever, chills
Infections associated with low white count
Night sweats - drenching
Pain - depending on the anatomic location that is secondary to pressure to bone or organs, or obstruction of bodily functions
Skin - Itchy skin (purititis); red patches
Skin - Jaundice - yellowish tinge (related to liver function)
Swollen and painless lymph nodes
Swollen spleen or liver
Thrombocytopenia - low platelets*
Weight loss
* secondary to bone marrow involvement that can inhibit blood cell production.
So called "b-symptoms" are common. Onset of b-symptoms may suggest that the lymphoma is progressing.
B-symptoms include unexplained and persistent:
Fever and chills
Drenching night sweats
Fatigue
Pruritus - skin itchiness
Weight loss
Other general symptoms may include:
flu-like symptoms such as aches and pains.
Localized pain, may occur depending on the location of tumors,
and frequent infections resulting from depressed immunity.
Also see Lymphedema swelling in limbs
Since b-symptoms are common to both minor and serious medical conditions, the diagnosis of lymphoma (which requires a biopsy) is often delayed.
So called systemic symptoms, such as fever, night sweats, weight loss in excess of 10%, or asthenia, are infrequent at presentation of the disease but can be observed in later stages. Progression to an intermediate-grade or high-grade lymphoma should be considered when a patient develops systemic symptoms.
Monitoring blood for increasing levels of LDH and Human beta-2 microglublin is
commonly used to monitor progression. See LDH | Human beta-2 microglublin
Resources:
General symptoms: CancerNetwork | MSKCC | Oncology Channel
Disease Direction indications
Disease Direction Indication
Also see: Lab Tests
Return to top Increasing or decreasing lab values may help to gauge progression or response to treatment. However, location of disease can affect interpretation of the indicators provided here. Therefore, it's important to consult with your doctor about questions you may have.
Increased levels: ALT (sSGPT), Alkaline Phosphatase, AST (sGOT), Beta2-microglobulin, BIlirubin, Total Calcium, Creatinine, LD (LDH), Lymphocytes, Monocytes, Sodium, BUN, Uric Acid
Decreased levels: Albumin, Cholesterol, Globulin Iron, Total MCH, MCHC, MCV, Protein
SOURCE: NHL disease-specific disease Lab pattern indications -- CellMate Wellness
Abnormal Blood Counts
Abnormal Blood Counts
Also see
Low Blood Counts
Complete Blood Count Test
Anemia
(low red blood cells)
Neutropenia
(low white cells)
Thrombocytopaenia
(low platelets)
Return to top Blood counts cannot be reliably used to diagnose disease or monitor it, but abnormal counts are sometimes associated with lymphomas, leukemias, disease progression, or the side effects of treatment.
Leukocytosis - emedicine.com
"refers to an increase in the total number of white blood cells (WBCs) from any cause. From a practical point of view, leukocytosis traditionally is classified according to the component of white cells that is contributing to an increase in the total number of white cells. Thus, leukocytosis may be caused by an increase in (1) neutrophil count (ie, neutrophilia), (2) lymphocyte count (ie, lymphocytosis), (3) monocyte count (ie, monocytosis), (4) eosinophilic granulocyte count (ie, eosinophilia), (5) basophilic granulocyte count (ie, basophilia), or (6) immature cells (eg, blasts). A combination of any of the above may be involved."
Leukopenia - Merck Manual
"is usually characterized by a reduced number of blood neutrophils, although a reduced number of lymphocytes, monocytes, eosinophils, or basophils may also contribute to the decreased total cell count. Neutropenia accompanied by monocytopenia and lymphocytopenia is often a more serious disorder than neutropenia alone."
Ascites (not common)
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TOPIC SEARCH: PubMed | Web
Ascites is an excess of fluid in the membrane lining of the abdomen (the peritoneal cavity). Lymphoma might cause ascites by obstructing the lymphatic system. To relieve symptoms and diagnose the cause, a peritoneal fluid tap may be performed. Successful treatment of the lymphoma can resolve this problem.
"Ascites usually can be detected clinically by the presence of fullness in the flanks, shifting dullness, generalized abdominal distention with a fluid wave, and umbilicus eversion. In obese patients, moderate amounts of ascitic fluid may be difficult to detect. Ultrasound typically is performed to confirm the diagnosis in obese patients, because it can detect as little as 100 mL of fluid in the peritoneal cavity. Accumulation of fluid is first detected in Morison's pouch, then in the paracolic gutters; eventually, generalized ascites is noted."
- postgradmed
About Ascites - Medline Plus | postgradmed
"Clinical assessment of likely cause; peritoneal fluid examination may be indicated if cause uncertain or infection suspected. CA 125 may be elevated in any peritoneal disease and is not specific for ovarian cancer." - rcpa.edu.au/pathman
"Chylous ascites is the extravasation of milky chyle into the peritoneal cavity. This can occur de novo as a result of trauma or obstruction of the lymphatic system. Moreover, an existing clear ascitic fluid can turn chylous as a secondary event." - Emedicine
Case Report: Intraperitoneal rituximab: an effective measure to control recurrent abdominal ascites due to non-Hodgkin's lymphoma - Springer-Verlag 2002
Intraperitoneal rituximab: an effective measure to control recurrent abdominal ascites due to non-Hodgkin's lymphoma. Ann Hematol. 2002 Jul;81(7):405-6.
PMID: 12185515 - PubMed
Peritoneal fluid analysis (draining the fluid to relieve discomfort and diagnose cause) - Medline Plus
Cutaneous (skin)
Also See
Cutaneous Lymphoma
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Cutaneous lymphomas can present on anywhere on the skin.
Image of Cutaneous B-Cell Lymphoma - Large Cell Type - Trunk
Click to enlarge
Source: Dermatologic Image Database
Lymphoma - Cutaneous B-Cell
Cutaneous B-Cell Lymphoma Large cell Type - Closeup of Right Scapular Area of Back
Cutaneous B-Cell Lymphoma - Large Cell Type - Right Scapular Area of Back - Detail of 2
Source: Aafp.org:
T-Cell Lymphoma Presenting as Benign Dermatoses - includes images - aafp.org
Itching (Pruritus)
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TOPIC SEARCH: PubMed | Medscape | Web
Pruritus, also known as itch, is a common symptom of lymphoma.
Management of Pruritus (nonspecific) - fpnotebook.com
Pruritus as a manifestation of systemic disorders.
Cutis. 1978 Jun;21(6):873-80. PMID: 657843 - PubMed
Efficacy and safety of naltrexone, an oral opiate receptor antagonist, in the treatment of pruritus in internal and dermatological diseases. J Am Acad Dermatol. 1999 Oct;41(4):533-9. PMID: 10495371 - PubMed
Severe pruritus should be a B-symptom in Hodgkin's disease.
Cancer. 1983 May 15;51(10):1934-6. PMID: 6831358 - PubMed
Itch: scratching more than the surface. QJM. 2003 Jan;96(1):7-26. Review. PMID: 12509645 - PubMed
Night Sweats
Drenching Night Sweats
Return to top TOPIC SEARCH: PubMed
Drenching night sweats is one of the so-called b-symptoms associated with lymphomas. This type usually " involves the entire body and are not confined to a specific hour during the night.
What causes night sweats in lymphoma? There does not appear to be a definitive answer. One possible mechanism behind night sweats is that the progression of lymphoma, and the body's way of fighting infection, have some things in common - both may require the mobilization of immune cells and cytokines (such as interferon, Interleukin); and that these immune activities might account for causing night sweats, fever, and achy muscles. A more optimistic explanation is that your body is fighting back against the lymphoma - as it would an infection - having recognized abnormal antigen expression in the malignant cells.
Resources:
Diagnosing Night Sweats - aafp.org | Stanford.edu
Nosebleed (not common)
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TOPIC SEARCH: PubMed | Web
NHL can present itself in many ways, and the symptoms can have so many other causes. In NHL-info I wrote in response to a question: " I've never heard of nose bleeds associated with NHL, but I suppose it's not out of the question." Then came two quick replies:
"My mother was also just diagnosed with NHL after recurring nosebleeds and a stuffy nose for about 6 months. There were no other symptoms." - Lesli (NHL-info)
"One of the symptoms which lead to my Mother's diagnosis of NHL was reoccurring nosebleeds." - Sandra (NHL-info)
Pleural effusions
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TOPIC SEARCH - PubMed | Medscape | Web
Pleural effusions, or abnormal accumulations of fluid in the pleural space around the lungs, can be caused by a wide variety of diseases, including lymphoma. Sometimes an enlarged lymph node can block drainage of fluid that lubricates the pleural space. In such cases, successfully treating the lymphoma can resolve the condition. To relieve symptoms and diagnose the cause, a Thoracentesis, or pleural tap may be performed.
About - Medline Plus * | Emedicine
Pleural effusions have many causes, not just lymphoma - unmc.edu
In the United States, three fourths of pleural effusions are caused by three conditions: congestive heart failure, pneumonia, and malignancy. The following table, adapted from Light’s text on pleural diseases, estimates the incidence of various types of pleural effusions
How should you go about finding the cause? - Jeffrey B. Rubins, MD; Gene L. Colice, MD
Thoracentesis or pleural tap (draining the fluid to relieve discomfort and diagnose cause) - Medline Plus* | meddean.luc.edu
Restless leg syndrome (not common)
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TOPIC SEARCH: Cachexia - PubMed | Web
This syndrome can make it difficult to get adequate sleep because of pain or sensations experienced in the legs while sleeping. Restless leg syndrome might be related to an iron deficiency, which could be related to anemia.
About - Postgrad Med | NIH
Weight loss - unexplained (Cachexia)
Also see Diet & Exercise
Return to top TOPIC SEARCH: PubMed | Web
A symptom of lymphoma progression is weight loss that cannot be explained by diet. Cachexia, the loss of lean body mass, is most typically associated with advanced progression of the disease.
Is there a difference between weight loss and wasting?
"Yes. As its name implies, weight loss refers to a loss of body weight. Wasting syndrome refers to a loss of body mass or size, most notably muscle mass (sometimes referred to as "lean body mass"). Very often, both occur at the same time. However, this is not always the case. It is possible that someone who is losing weight might not lose muscle mass. It is also possible that someone losing muscle mass might not lose a lot of weight." - beingalivela.org
You should report unexplained weight loss to your doctor or nurse and seek the underlying cause.
Some patients will try alternative diets that severely restrict calories. These diets can make it difficult to determine what is causing the weight loss, and they can be potentially dangerous if they contribute to wasting.
Related articles on weight loss, cachexia, and nutrition:
CNTO 328, a potent antibody to interleukin 6 inhibits human cancer cachexia in nude mice - ASCO 2003
Cancer AND cachexia - Related abstracts
Macrobiotic diet and cachexia- medicine.wustl.edu
Unintentional Weight Loss S. M. Massompoor, M.D. - sums.ac.ir