Symptoms of non-Hodgkin lymphoma www.lymphomas.org.uk

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Produced 28.02.2011
Revision due 28.02.2013
Symptoms of non-Hodgkin
lymphoma
Lymphoma is a cancer of cells called lymphocytes. These cells are part of our immune
system, which helps us to fight off infections. There are several different kinds of
lymphoma but they are put into two main categories, Hodgkin lymphoma and nonHodgkin lymphoma. In Hodgkin lymphoma a particular abnormal cell is seen under the
microscope (the Reed–Sternberg cell). Non-Hodgkin lymphomas, which are much more
common, are all the lymphomas where this cell is not seen.
When non-Hodgkin lymphomas are looked at under the microscope the pathologist is
able to tell if the cancerous cells are dividing quickly or slowly. If the cells are dividing
quickly the lymphoma is reported as being a ‘high-grade’ (or aggressive) non-Hodgkin
lymphoma. If the cells are dividing slowly it is called a ‘low-grade’ (or indolent)
non-Hodgkin lymphoma.
Non-Hodgkin lymphoma can be tricky to identify compared with other cancers and many
people, looking back, will have had symptoms for weeks or even months before being
diagnosed. A few people will have no symptoms at all and will feel perfectly well before
being diagnosed with non-Hodgkin lymphoma.
There is no one symptom that is unique to non-Hodgkin lymphoma – there are many
potential symptoms, depending on what parts of your body are involved. Another
problem is that many of the symptoms people experience with non-Hodgkin lymphoma
are symptoms that you can have with other illnesses. For example, you can have swollen
glands in your neck after a throat infection. In spite of these difficulties, however, it
is possible to say that certain symptoms – and particularly certain combinations of
symptoms – are common in non-Hodgkin lymphoma.
There is not one set of symptoms that people with high-grade non-Hodgkin lymphoma
get and another set that people with low-grade non-Hodgkin lymphoma experience. They
cause the same types of symptoms. There are a few differences between them in general
terms, however, which we will explain in the next paragraph and we will point out any
other differences between them as we go through the various symptoms.
Low-grade non-Hodgkin lymphomas very often cause few symptoms other than enlarged
lymph nodes in several places in the body. High-grade non-Hodgkin lymphomas tend to
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cause symptoms that develop quickly and are more likely to cause symptoms
that affect the whole body, such as weight loss. These lymphomas are also more likely to
cause symptoms in places other than the lymphatic system, such as the intestines, the skin
and the brain.
In this article we will describe the most common symptoms of non-Hodgkin lymphoma
and explain why they happen. The symptoms you might have can be divided into:
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‘local’ symptoms, which means that they develop around where the lymphoma is
growing, and
‘systemic’ symptoms, which relate to the impact of the lymphoma on your whole body.
Local symptoms of non-Hodgkin lymphoma include:
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lumps – these are enlarged lymph nodes (glands) and are not usually painful
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chest symptoms – cough, breathlessness
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abdominal symptoms – lumps, pain, indigestion, change in bowel habit (eg diarrhoea)
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pain – in bones, abdomen, lymph nodes (though in the lymph nodes this is usually more
of an ache rather than a pain)
brain and nerve symptoms (these are rare) – dizziness, numbness, tingling, weakness in
a limb, visual problems, memory problems
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skin problems – lumps, redness or itchy patches
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lumps in other more unusual places (eg in the breast, testicle, upper chest, jaw, nose).
The systemic symptoms you might experience are:
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fevers
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night sweats
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weight loss – if this is unexplained (eg if you haven’t been on a diet)
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itching
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fatigue (extreme tiredness)
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difficulty fighting off infections
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a tendency to bruise or bleed more easily.
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The first three symptoms in this list – fevers, night sweats and unexplained weight
loss – are called ‘B symptoms’. They often occur together, and whether you have these
B symptoms or not will be taken into consideration when your treatment is being planned.
Local symptoms
Enlarged lymph nodes
Enlarged lymph nodes are sometimes referred to as ‘lymphadenopathy’. Lymphoma
typically starts to grow in the lymph nodes. Lymph nodes enlarge because they contain
lots of cancerous cells. Because cancer cells don’t die in the way that normal cells do, and
because they grow more quickly, they collect to form lumps.
People with non-Hodgkin lymphoma will almost always have enlarged lymph nodes
somewhere in the body. Some lymph nodes are easier to find than others. For example,
an enlarged lymph node in the neck, armpit or groin will be obvious because it is close
to the surface, but other lymph nodes, like those in the abdomen or the chest, are not so
easy to feel from the outside. These can press on other things to cause pain or irritation,
or they might only be detected when you have a scan or an X-ray.
Some people have enlarged lymph nodes in just one area. Other people might have
enlarged lymph nodes all over their body. This is called generalised lymphadenopathy.
Although generalised lymphadenopathy can happen with any lymphoma it is most
common in low-grade non-Hodgkin lymphomas.
People with low-grade non-Hodgkin lymphoma often say that their lumps come and go.
This is because the activity of the disease can vary from time to time. Sometimes it is
active, making lots of cancerous cells that collect and cause the lymph nodes to swell.
Then it will quieten down, some of the cells will die or be absorbed, and the lymph node
will become smaller again.
Some people feel that their enlarged lymph nodes ache a bit, but usually they are not
painful unless they are pressing on something else, such as a nerve.
Chest symptoms – cough and breathlessness
Why might you have a cough? When your body feels like it has something in an airway
that shouldn’t be there – such as mucus – you cough to get rid of it. Enlarged lymph
nodes in the chest can have the same effect. They press on the lung tissue and the
airways, causing irritation and a cough.
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You can be short of breath if:
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enlarged lymph nodes in your chest are pressing on your lungs and airways, preventing
them from expanding and working properly. This makes your lungs work harder to get
enough oxygen and it will make you feel short of breath.
lymphoma in your chest is damaging the lymph node tissue itself or the surrounding
tissues it presses on. In some cases, this damage will result in collections of fluid
forming around your lung (a pleural effusion). This collection of fluid presses on your
lung, causing pain and making it difficult for the lung to expand properly, and this makes
you feel short of breath.
you are anaemic, meaning that you have a shortage of red blood cells. If your body
does not have enough red blood cells, it can’t carry sufficient oxygen. This makes you
breathe harder – your body is compensating by getting more oxygen in. Anaemia
is not a particularly common symptom of lymphoma, but it can happen if there is
lymphoma in the bone marrow.
Abdominal symptoms
It is relatively common for lymphoma to involve the gastrointestinal tract (the gut). This is
the most common site of ‘extranodal’ disease, meaning disease outside the lymph nodes,
which is more frequently seen with high-grade non-Hodgkin lymphoma.
The symptoms will vary, depending on what part of the gut is involved. Lymphoma in the
stomach, for example, can cause inflammation of the stomach lining, pain and bleeding.
Lymphoma in the bowel can cause abdominal pain and change in bowel habit, such as
diarrhoea or constipation.
You might have a feeling of fullness after eating even small amounts of food if the
lymphoma is pressing on the stomach or you might have a feeling of pressure in the
abdomen or pelvis.Your abdomen can be swollen, especially if your spleen or liver are
enlarged, and this can be uncomfortable.
Pain
Although the enlarged lymph nodes themselves aren’t usually painful, lymphoma can put
pressure on the tissues round about the nodes and this can cause pain. For example,
pain in the back and pain in the abdomen are relatively common symptoms of lymphoma,
particularly in high-grade non-Hodgkin lymphomas.
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Lymphoma can involve the bone itself and this would be painful but lymphoma
in the bone is rare. Bones can be painful in some very high-grade lymphomas because
of the pressure of lots of cells collecting in the bone marrow.
Brain and nerve symptoms
Lymphoma starting in the brain or nervous system is very rare, but this can lead to
symptoms of headache, seizures, memory problems, dizziness, vision problems or
numbness, tingling or weakness in a limb.
Skin problems
Although itching is more often a general, systemic symptom (see later), it can also occur
because of lymphoma in the skin. T-cell non-Hodgkin lymphomas are more likely to involve
the skin than other lymphomas. Some of these are low-grade lymphomas that are confined
to the skin. In other cases the lymphoma will be in the skin and in the lymphatic system too.
Lymphoma in the skin can produce redness, dryness, raised patches and scaly texture.
Systemic symptoms
Fevers and night sweats
The precise explanation for fevers and night sweats is not known. It might be that the
presence of cancerous cells in your system causes your immune system to react in a way
that is similar to fighting infection. This can result in your temperature going up and down.
Having a temperature of over 38°C (over 100.4°F) for several days in a row is considered
to be high enough for long enough to be suspicious of what doctors would call ‘fever’.
Night sweats are sweats that are bad enough to make your nightclothes and bedlinen
wet. They might happen because your body detects a rise in temperature and attempts
to cool itself off by sweating, something like perspiration. It might be that night sweats
happen when you are asleep because you are not aware of feeling hot so you don’t do
anything about it.
Fevers and night sweats could also be a response to some of the abnormal hormones and
proteins produced by the cancerous cells – your body is reacting to get rid of something
that is unknown and unwelcome.
Unexplained weight loss
Unexplained weight loss can happen with any lymphoma, but it is more typical of
high-grade non-Hodgkin lymphomas. ‘Unexplained’ means a weight loss of more than a
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tenth of your total body weight over a period of a few months which happens
without you trying to lose weight.
Weight loss occurs because the cancerous cells are placing a heavy demand on
your system. Your body is using up its resources to feed the cancerous cells and to try and
get rid of them. Lymphomas that grow very quickly and place a sudden demand on your
body’s resources are more likely to make this happen.
Itching
Itching is sometimes just felt in the hands and feet, sometimes the lower legs. A few people
feely itchy all over the body. It is usually worse in bed at night. In cutaneous T-cell nonHodgkin lymphoma the itch is felt in the patches where the skin is affected (so it is a local
symptom in this case).
The cause of the itch in non-Hodgkin lymphoma is not known, but it is thought to be due to
chemicals that the immune system releases as it reacts against the malignant lymphoma cells.
These chemicals, which are called ‘cytokines’, irritate nerves in the skin and make it feel itchy.
Fatigue
Fatigue is a very common experience for people with all kinds of lymphoma – before, during
and after treatment. Fatigue is not just feeling a bit tired because you have been busy or
exercising – it means that you feel exhausted for no apparent reason or feel washed out
after doing very little.
The precise reasons for feeling fatigue are not known, but it is thought to be the result
of a combination of factors, including the impact of the disease on your body’s energy
resources, the impact of stress and the effects of the treatment.
Difficulty shaking off infections
Because lymphoma is a disease of your immune system, it can mean that your immune
system doesn’t work as well as it should. The cancerous white cells that make up the
lymphoma are produced at the expense of the good white cells that normally fight
infections. This can make you more prone to pick up infections and they might be more
severe or last for longer than they would normally.
Bruising and bleeding
Occasionally the numbers of special blood cells that help with blood clotting (platelets) are
reduced when you have non-Hodgkin lymphoma, though this is unusual. This can show up as
nosebleeds, heavy periods in women, or tiny blood spots just under the skin.
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If you are worried
Any symptom or combination of symptoms you have will be considered in light of your
individual medical history when you first go to your family doctor or hospital assessment.
If your lymphoma comes back after it has been treated it might show up with the same
symptoms you had the first time, but you can develop new symptoms.You should always
talk to your specialist about any symptom that is worrying you at any stage of your
diagnosis, treatment or follow-up.
More information
This article is based on a Lymphoma Association article, ‘Signs and symptoms of
lymphoma’ and our booklets, High-grade non-Hodgkin lymphoma and Low-grade
non-Hodgkin lymphoma. For more information, or for a copies of these, visit our website
at www.lymphomas.org.uk or telephone the Lymphoma Association’s freephone helpline
0808 808 5555.
Talk to your key worker if you have any concerns about your health or treatment.
The Lymphoma Association cannot provide information about individual diagnosis or
treatment. The information provided by the Lymphoma Association is not a substitute for
advice from your health professionals.
About our publications:
The Lymphoma Association is committed to the provision of high quality information for people with lymphoma, their families
and friends. We produce our information in accordance with nationally recognised guidelines. These include the DISCERN tool for
information about treatments, the NHS Toolkit for producing patient information, and the Campaign for Plain English guidelines.
Our publications are written by experienced medical writers, in close collaboration with medical advisers with expertise in
the appropriate field. Textbooks and professional journals are consulted to ensure that information is as up to date as possible.
References are provided where they have been used. Some publications are written by professionals themselves, acting on guidance
provided by the Lymphoma Association. Our publications are reviewed every two years and updated as necessary.
Our publications are reviewed by a panel of volunteers with experience of lymphoma. Publications are also reviewed by members of
the Lymphoma Association helpline team, who have many years collective experience of supporting those with lymphoma.
In some instances, our publications are funded by educational grants from pharmaceutical companies. These sponsors do not have
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© Lymphoma Association
Views expressed in this publication are those of the contributors.
The Lymphoma Association does not necessarily agree with or endorse the comments included here.
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