The symptoms of Non-Hodgkin’s lymphoma vary, depending on the type of cells and their location. The classic symptom experienced by the majority of patients involves a painlessly enlarged lymph node or nodes, most commonly in the neck (cervical), groin (inguinal), or armpit (axillary). The nodes tend to feel very firm, rubbery, and distinct. Sometimes the patient hasn’t actually notice any symptoms at all, but an enlarged lymph node is identified during a routine physical examination or chest x-ray.
Other symptoms may occur if the tumor has grown to a size that allows it to compress nearby structures or organs, causing a variety of symptoms. For example:
- A tumor that arises in the thymus gland behind the breast bone may grow to a size that allows it to press on the airways leading to the lungs, causing the individual to notice shortness of breath, hoarseness, cough, or chest pain.
- A tumor mass may compress the large vein that returns blood from the head and arms toward the heart, the vena cava. When the blood backs up, it can cause the face, neck, and arms to swell, often with swollen veins visibly obvious underneath the skin of the neck and chest.
- If the affected lymph nodes are in the lower abdomen or pelvis, they may grow large enough to compress the bladder or the tubes that carry urine from the kidneys to the bladder (ureters), resulting in pain with urination, frequent urination, the need to urinate at night, or even kidney enlargement and failure.
- Enlarged nodes in the groin area can also compress lymph vessels that drain lymph from the lower limbs, causing the legs and feet to swell.
- Tumors in the abdomen may cause the accumulation of fluid in the abdomen (ascites), and swelling and enlargement of the liver (hepatomegaly) and/or spleen (splenomegaly).
- When lymphoma invades the central nervous system, the patient may notice vision changes, headaches, seizures, confusion, or paralysis of the muscles that control facial expression.
- MALT lymphomas can invade the intestine, resulting in bowel obstruction, abdominal pain, distention, a sensation of fullness after eating very little, nausea and vomiting, diarrhea or constipation, blood in the stool, and severe anorexia (an inability to eat).
- Since between seven and fifteen percent of all lymphomas present in the skin, rashes and/or itching (pruritus) are also early symptoms of NHL. Early skin manifestations include red or purple patches or raised areas, or generalized skin redness.
So-called “constitutional symptoms” (also called “B” symptoms), are those that affect the whole body – they are not due to the local effects of cancer cells in a particular area, but are caused by the effects of circulating chemicals produced or induced by the tumor. “B” symptoms often suggest the presence of a more aggressive form of NHL. About 20% of people with NHL will experience these types of constitutional symptoms, which can include:
- Unintentional weight loss, usually occurring over the six months prior to diagnosis, and comprising approximately 10% of weight.
- Fever, usually low-grade (under 100° F or 37.7° C). The fever may be either persistently present or “undulating,” meaning that it alternates over the course of days or weeks with either a normal temperature or with very high fevers.
- Night sweats: This is more than simple sweating during sleep – night sweats are defined as “drenching,” meaning that sheets and clothing become so soaked with perspiration that they need to be changed.
- Severe fatigue and weakness: Again, this is more than just simple tiredness. The degree of fatigue is often described as extremely profound “bone weariness.”
Around 33% of all people with NHL have anemia (low red blood cells and/or hemoglobin) at the time of their diagnosis. This may be due to bleeding, an enlarged spleen that accidentally destroys circulating red blood cells, or decreased bone marrow functioning due to its invasion by NHL cells. This anemia can greatly exacerbate to an individual’s fatigue.
If the bone marrow is extensively involved, levels of other types of blood cells may also drop, causing other symptoms. For example, if platelets are low, the individual may notice an increased tendency to bleed. If white blood cells are low or if they function poorly, the patient may repeatedly develop a variety of infections.