Lymphoma is a type of cancer that, different from many others, is not located in a single organ but throughout an entire system. In lymphoma, cancer invades the lymphatic system, which is an integral part of the immune system, has its own circulation (the lymphatic vessels) and structures called lymph nodes that produce and store lymphocytes and other white blood cells. However, lymphoma is similar to many other cancers in how cells reproduce and mutate to become more aggressive. They start replicating fiercely and modulate the metabolism, interfering with the normal function of the body. Lymphoma affects lymphocytes, and these cells are not located in a single spot of the body. Instead, they circulate throughout the organism.
If you start reading about lymphoma, you will find a term called Hodgkin lymphoma. Hodgkin and non-Hodgkin lymphoma are the two main types of lymphoma, and they have subcategories and many differences when it comes to treating them and following-up. However, regardless of their kind, lymphoma is usually the same when it comes to signs and symptoms.
In this article, we will give you the most important signs and symptoms of lymphoma. If you experience one or two, lymphoma is not necessarily your diagnosis, and you might need to ask your doctor if you want to know the cause of your symptoms.
» Now, let’s discuss the smptoms of lymphoma.
1. Enlarged lymph nodes
Lymph nodes are important structures in the lymphatic system, and enlargement of these lymph nodes is one of the most common symptoms of this disease. These structures are all over the body. They are connected to the lymphatic system, and they store lymphocytes, always on guard when there’s an infection in the surrounding area. When a pathogen (a bacteria or virus) colonizes or infects an area of the body, an antigen-presenting cell takes a sample of the invader and brings it back to the lymph node. In the lymph node, this sample is used to replicate lymphocytes specialized in recognizing and attacking the pathogen. That is why lymph nodes become larger during infections.
In lymphoma, the lymph nodes become larger than usual, not because cells are preparing to attack cancer or microbes, but due to an unrestrained replication of lymphocytes. That is what cancer does: replicating cells uncontrollably. But different than other types of cancer, lymphocytes are capable of moving around to other areas of the body, and there’s not only one lymph node taken but several of them instead.
If you have enlarged lymph nodes, keep in mind this condition is widespread in infectious diseases. Even viral infections may result in swollen lymph nodes. Trying to differentiate infection lymph nodes with lymphoma might be difficult. If you have enlarged lymph nodes that feel very hard, movable and not tender, these are more suspicious, and you should ask your doctor about them. You might notice lymph nodes continuously increasing their size and going back to normal, and this might also raise your suspicion. The most common locations are the neck, groin and the armpit, and the most common size is larger than 2 centimetres.
2. More susceptibility to infections
Lymphoma is an ailment that affects the normal function of the immune system, and higher susceptibility to infections is one of the most prevalent conditions of the disease. It increases the risk of patients to get severe infections, and sometimes bacteria that would not cause problems start doing so as a result of the suppression of the immune system. There are various types of lymphoma, and each one of them makes the patient susceptible to a different range of microorganisms.
For example, B-cell lymphomas affect a type of lymphocyte that reacts against bacteria. Thus, these patients display a higher susceptibility to bacterial infections, and they are usually located in the urinary system and the respiratory tract. When patients with B-cell lymphoma have an infection, it can be very severe and sometimes life-threatening, which is why they need to be very careful and have extra measures to keep safe.
On the other hand, T-cell lymphomas affect a type of lymphocyte that reacts against viruses. These patients would have a higher susceptibility to viral infections, and even mild viruses might become deadly. T-cell lymphoma is also associated with reactivation of latent viruses, as it happens with herpes and tuberculosis.
3. Fever
Lymphocytes are an important part of the immune system, and they are related to the onset of fever during infections. Fever is a normal response our body has to combat pathogens, and it is triggered by inflammatory mediators released by the immune system and received in the brain centers in charge of controlling body temperature. Lymphoma triggers fever independently from a given infection, but if a pathogen has colonized the patient, fever might become more severe still.
In lymphoma, the lymphocytes start releasing inflammatory substances, and the brain interprets that signal as if the body needs to defend against a pathogen. Fever in lymphoma is usually around 38°C, and it is very frequent, even more, when the disease is accompanied by infections. However, it is not necessary to have fever in order to diagnose lymphoma. It is also caused by most infectious diseases, and you will need assistance from your doctor if you want to know the real cause of your fever.
4. Chills and night sweats
There’s a solid reason why people get chills when they have fever, and it is a normal reaction the body has to increase body temperature in the event of fever. After reaching the brain, the inflammatory mediators modulate the temperature threshold of the body. Thus, the brain makes the body feel it is cold and needs to warm up, which is done by initiating small jerking movements in the muscle fibers.
Night sweats are strongly related to fever as well, and this symptom is very common and especially severe in lymphoma. Sometimes, patients report waking up in the middle of the night soaked in their own sweat. Excessive sweating is not necessarily a night symptom, but these patients may also report daytime sweating.
Consider that many health conditions and infections triggering fever would likely cause night sweats. It is also common in menopause, so talk to your doctor about your complaints and don’t think right away it is caused by lymphoma because it is one of the last diagnoses your doctor would consider.
5. Difficulty to breathe
There are lymph nodes all over the body and surrounding various organs and glands. Sometimes a very large lymph node is located near the respiratory tract, and sometimes it might be pressing the lung tissue, making it difficult to breathe. In some cases, there’s an associated infection in the respiratory tract, which is more prevalent in lymphoma patients compared to the rest of the population, and it contributes to a difficulty to breathe and other chest symptoms.
In some cases, patients would also have chest pain, usually described as a pressing pain, and a dry cough. These symptoms should be differentiated from heart attack symptoms, especially when the patient feels fatigued along with other concerning symptoms. If you’re worried or somehow think your symptoms are unusual, talk to your doctor as soon as possible so you can get a proper diagnosis.
6. Swelling in the extremities and the abdomen
The lymphatic system is an alternative circulation to the venous return. It is important to prevent liquid retention, and when there’s a disturbance in the natural return of liquids, you might end up having swelling in the extremities or the abdomen. Additionally, lymphoma sometimes affects the function of the liver, and this organ synthesizes important proteins to maintain the liquid balance in the organism. When this happens, swelling might be accompanied by jaundice, a yellowish coloration of the skin caused by an accumulation of bilirubin in the blood.
When fluid retention becomes a more significant concern, there’s a large fluid collection in the abdominal cavity, which is known as ascites. Other organs might experience swelling as well, as in the case of the spleen. This organ becomes very large in some lymphoma patients, and may even reach the belly button. Take into consideration that each one of these symptoms is not only found in lymphoma. They are actually more common in other diseases, and they should be ruled out before thinking about cancer.
7. Dry skin
This symptom is especially important in Hodgkin lymphoma, and these patients usually display dry patches of skin that becomes sore and itchy. The areas of dry skin are usually located around swollen lymph nodes, and the itching might become especially severe in some cases.
This symptom is caused by an increase in inflammatory substances in the surrounding tissue. They cause irritation to the skin and the nerve terminals. These nerve terminals receive pain sensation, and when they become irritated by inflammatory mediators, they cause a mild pain sensation that’s translated into itching by the brain. When the inflammation is severe, patients may feel soreness instead or a burning sensation instead of itching.
There are many causes of itchy skin, and you will need your doctor’s advice before trying anything to relieve your dry skin problem. Using creams, especially antibiotics, without your doctor’s advice is highly imprudent because it may change the way your skin lesions look like, making it harder to reach an accurate diagnose.
8. Fatigue
This symptom is common in all patients with cancer, and lymphoma is not the exception. It is defined by a type of exhaustion that does not improve after proper rest and interferes with the normal activities of the patient. People with lymphoma experience fatigue for a very long time, and sometimes this symptom becomes prevalent as one of the first signs that something is wrong with your body.
Various factors cause fatigue in lymphoma, and we are going to discuss the most critical: anemia and metabolic stress. Anemia is a reduction of red blood cells, which is common in patients with lymphoma. These cells carry oxygen throughout the body, and a significant reduction would cause patients to feel drowsy and easily tired. At the same time, there’s metabolic stress caused by the excessive replication and the nutrients cancer needs and steals from the blood. This extra consumption of nutrients makes the body run out of energy, which is why patients do not recover after a good night’s sleep.
9. Weight loss
Another symptom that is common in all types of cancer including lymphoma is unplanned weight loss. It is defined by a reduction of 5% of body weight or more in 12 months without planning or doing efforts to lose weight, such as changing your diet or increasing your levels of physical activity. If you have this type of weight loss, it is essential to ask your doctor and trace the reason why, because it is usually associated with an increase in metabolic stress or a wasting syndrome called cachexia, which is seen in cancer and HIV.
Another symptom that is common in all types of cancer including lymphoma is unplanned weight loss. It is defined by a reduction of 5% of body weight or more in 12 months without planning or doing efforts to lose weight, such as changing your diet or increasing your levels of physical activity. If you have this type of weight loss, it is essential to ask your doctor and trace the reason why, because it is usually associated with an increase in metabolic stress or a wasting syndrome called cachexia, which is seen in cancer and HIV.
Even if you have several symptoms in this list, your doctor has the final call after performing a physical exam and diagnostic tests. There are plenty of diseases to rule out before thinking about cancer, and you should not raise your own conclusion. However, do not delay your diagnosis and look for medical assistance if you feel your health condition is worsening all of a sudden or you’re experiencing unusual symptoms that do not seem normal.
References
Abraham, J., Gulley, J. L., & Allegra, C. J. (2012). The Bethesda handbook of clinical oncology. Lippincott Williams & Wilkins.
Cheson, B. D., Fisher, R. I., Barrington, S. F., Cavalli, F., Schwartz, L. H., Zucca, E., & Lister, T. A. (2014). Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. Journal of clinical oncology, 32(27), 3059.
Anthony, P. P., Sarsfield, P., & Clarke, T. (1990). Primary lymphoma of the liver: clinical and pathological features of 10 patients. Journal of clinical pathology, 43(12), 1007-1013.
Grogg, K. L., Miller, R. F., & Dogan, A. (2007). HIV infection and lymphoma. Journal of Clinical Pathology, 60(12), 1365-1372.