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Supporting people with non-Hodgkin's lymphoma
Symptoms and diagnosis of non-Hodgkin's lymphoma

Keypoints

  • All of the symptoms seen in non-Hodgkin's lymphoma are also seen in other conditions, making initial diagnosis difficult
  • Typical symptoms include a painless, swollen lymph node that lasts for a long time in the neck, armpit or groin
  • Other symptoms include unexplained fevers, night sweats and unplanned weight loss, along with breathlessness and itchiness

Introduction

All of the symptoms that can be caused by non-Hodgkin's lymphoma can also be caused by other conditions. In other words, no one symptom can be used to guarantee the presence of non-Hodgkin's lymphoma. This is one of the reasons why diagnostic tests are so important in establishing the diagnosis of non-Hodgkin's lymphoma.

Very often, patients have no symptoms when non-Hodgkin's lymphoma is diagnosed. The lymphoma is often first discovered as the result of a physical examination by the doctor or an investigation for some other condition, such as a blood test or a chest X-ray. This is particularly likely to be the case in patients with indolent non-Hodgkin's lymphoma, which grows slowly and often causes no symptoms for a long time.

A painless, swollen lymph node, usually in the neck, the armpit or the groin, is the most common symptom of non-Hodgkin's lymphoma at the time of diagnosis
Swollen lymph node in the neck

Symptoms, when they occur, can be divided into four broad groups:

  • Swelling in one or more lymph nodes
  • Constitutional symptoms (symptoms of being generally unwell)
  • Symptoms that are attributable to lymphoma swellings outside the lymph nodes
  • Symptoms that are attributable to decreased numbers of blood cells

Common symptoms

A painless, swollen lymph node usually more than 1 cm in diameter is the most common symptom of non-Hodgkin's lymphoma at the time of diagnosis. The nodes most likely to be noticed are in the neck, the armpit and the groin. These swellings usually cause no pain or other symptoms, but often steadily increase in size. Many patients with aggressive non-Hodgkin's lymphoma, and some with indolent non-Hodgkin's lymphoma, have swollen lymph nodes at the time of diagnosis.

It must be remembered, of course, that swollen lymph nodes are very common, and the overwhelming majority of people with swollen nodes do not have non-Hodgkin's lymphoma. By far the most common cause of swollen lymph nodes is infection. Swollen lymph nodes in infection usually go down after the infection has cleared up.

Non-lymph node symptoms

While the most common symptom of non-Hodgkin's lymphoma at the time of diagnosis is a swollen lymph node, there are other common symptoms. These include:

  • Constitutional symptoms (symptoms of being generally unwell)
  • Symptoms that are attributable to lymphoma swellings outside the lymph nodes

Constitutional symptoms are non-specific symptoms indicating that a person is unwell. Constitutional symptoms that commonly occur in non-Hodgkin's lymphoma include:

  • Recurrent, unexplained fevers (with body temperature over 38 degrees Centigrade)
  • Night sweats, which may drench nightclothes and sheets
  • Unintended weight loss (defined as losing more than 10% of the body weight in 6 months)
  • Severe and persistent fatigue or tiredness
  • Decreased appetite

The first three of these symptoms - fevers, night sweats and weight loss - are often used in the staging of non-Hodgkin's lymphoma. A person with one or more of these symptoms may have the letter 'B' added to the staging of the lymphoma. So, for example, non-Hodgkin's lymphoma stage IIB indicates that one or more of these three symptoms are present, whereas stage IIA indicates that none of these three symptoms is present. For this reason, these first three symptoms are sometimes called 'B symptoms'.

Other general symptoms that people with non-Hodgkin's lymphoma may experience include:

  • Breathlessness or cough
  • Itchiness that is persistent and may be felt all over the body

Completely different symptoms can occur if the lymphoma is in another part of the body, outside the lymph nodes. For example, lymphoma in the stomach or intestines might cause abdominal pain, indigestion or diarrhoea.

Patients with non-Hodgkin's lymphoma may experience recurrent, unexplained fevers, night sweats and unintended weight loss: the so-called 'B symptoms'
Fevers, night sweats and weight loss

Many people with lymphoma have decreased numbers of blood cells (such as red blood cells, white blood cells and platelets). Sometimes, this occurs because the lymphoma is in the bone marrow, where blood cells are made. However, cell numbers can be decreased even if there is no sign of any bone marrow involvement.

Having low numbers of red blood cells, or anaemia, can make people tired and breathless. In contrast, low numbers of white blood cells make people more prone to infection, while low numbers of platelets makes people more likely to bruise or bleed easily. All of these can occur in non-Hodgkin's lymphoma. For more information, see Symptom management.


 

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