Signs and symptoms
The signs and symptoms of lymphoma are almost the same in both types, with minor variants. Here’s a list of the clinical manifestations of both Hodgkin and non-Hodgkin lymphoma:
- Swollen lymph nodes: This is often the initial manifestation of the disease in both categories. In Hodgkin lymphoma, swollen lymph nodes are found in the upper body, including the thoracic area, the upper limbs, the armpits, and the neck. In this type, swollen lymph nodes can be adjacent or nearby. In contrast, non-Hodgkin lymphoma can be found in any part of the body, including the upper or lower body. The distribution of swollen lymph nodes does not follow a pattern.
- Hepatosplenomegaly: This is the clinical name of an increase in the liver’s size and the spleen. It is a significant finding in both Hodgkin and non-Hodgkin lymphoma but more relevant in the physical exam of the latter. The spleen is a part of the lymphatic system and often grows very large.
- Compression or obstruction symptoms: Swollen lymph nodes are often close to blood vessels, nerves, and other structures inside of the body. As they keep growing, they will potentially cause compression or obstruction symptoms. For example, when causing compression in the superior vena cava, the blood return to the heart is compromised, and the patient can develop facial edema and shortness of breath. If the biliary tree is compromised, the patient will have jaundice. In case of bowel obstruction, symptoms will be constipation and vomiting. When the lymph drainage is compromised, the patient will develop fluid retention in the lower extremities. Nerve compression is also possible, causing sensory or motor disturbances such as tingling or muscle weakness.
- Abdominal pain: This symptom is often reported when the liver and the spleen are very large. They activate nearby nerve terminals and cause diffuse abdominal pain. It can also be a part of the compression symptoms listed above.
- Fever and chills: Lymphocytes taken by the disease are a part of the immune system, and fever is an immune system function. As a part of the illness, aberrant B and T cells can release substances into the blood, similar to what happens during an infection. This triggers fever as a defense mechanism, and chills are reported when we reach the peak of high temperature.
- Weight loss: This symptom is the same as many other types of cancer. These cells have an accelerated metabolism and consume our resources and calories very fast. Even patients with adequate nutrition can potentially experience weight loss.
- Fatigue: The extra consumption of energy and nutrients by cancer also leads to the sensation of tiredness or fatigue in these patients. This symptom is more prevalent in patients with anemia, which is also possible in Hodgkin and non-Hodgkin lymphoma.
- Itching: This symptom is significant to differentiate the main categories of lymphoma. Only Hodgkin’s lymphoma causes itching, known by doctors as pruritus.
- Skin manifestations: They are particularly common in non-Hodgkin lymphoma and affect the legs or the scalp. The skin lesions look like reddened and raised nodules, plaques, or papules. The location can also be diffuse depending on the subtype of lymphoma.
- Shortness of breath: This is a very important sign, usually associated with compression by swollen lymph nodes. They could either compress the superior vena cava or the airways. When they compress the superior vena cava, the blood flow does not return to the heart, and there is congestion of blood to the airways and other parts of the upper body. When there is compression of the airways, it is usually a mediastinal mass pushing the airways apart and causing breathing problems.