Symptoms | Lymphoma

Symptoms

Lymphoma is a cancer of the lymphatic system. These can develop in lymph nodes or in other lymphatic structures and in the blood system. Depending on the localization of the lymphoma and the affected structure, different symptoms may occur.

In most cases, however, lymphomas usually show symptoms at a very late stage, sometimes they even turn out to be symptom-free. For this reason, lymphomas are often discovered in the course of other – mostly routine – examinations. The following section deals with the general symptoms that can occur in the context of lymphoma.

Lymphomas often manifest themselves through swollen lymph nodes. This lymph node swelling can affect one or more lymph nodes. Common localizations are the neck, groin or axillary folds.

Malignant lymph node swelling in the context of a lymphoma often presents itself as painless, firmly caked and little to no displacement. Affected lymph nodes can remain the same size or continue to grow over time. The swelling of the lymph nodes is usually asymmetrical.

This means that usually only the lymph nodes of one half of the body in a certain region are affected. Symmetrical painful lymph node swelling of the neck, for example, is more likely to be an infectious disease than a cancerous disease. It is also important to emphasize that lymph node swelling in most cases has a benign cause such as an infection.

Other symptoms that can occur in lymphomas are summarized under the term B-symptomatics. These include fever, night sweats and general fatigue and exhaustion. The fever is above 38 °C and has no obvious cause, such as influenza.

Night sweat is understood to be very heavy night sweating. Patients often report having to change their nightgown several times during the night. Another symptom of the B-symptomatic is unintentional weight loss.

This complex of symptoms also occurs in the context of other diseases, but is actually very common in lymphomas.Furthermore, a so-called splenomegaly, a swelling of the spleen, can occur. This can be explained by the fact that the spleen is an important lymphatic organ and is therefore usually also affected by lymphoma. Splenomegaly can become noticeable in patients with pain in the left upper abdomen.

Some lymphoma diseases, e.g. some non-Hodgkin lymphomas, lead to a displacement of the bone marrow. This leads to anemia, which manifests itself as fatigue. In addition, fewer blood platelets, so-called thrombocytes, are formed, which leads to an increased tendency to bleed.

Finally, the lack of intact white blood cells leads to an increased susceptibility to infections. Other specific symptoms include itching of the skin in Hodgkin’s lymphoma or vomiting of blood in malt lymphoma. Lymphomas are particularly common in the neck region.

For example, 60-70% of lymph node swellings in Hodgkin’s lymphoma are located at the cervical lymph nodes. There are many lymphatic pathways in the neck region. There are also many lymph nodes in this region.

In most cases, patients notice a firm, hard swelling of the neck, which can vary in size. The swollen lymph nodes in the neck are often painless and not reddened. They cannot be moved at all or only very little and are baked together with their surroundings.

Single or several lymph nodes in the neck can be affected. The infestation is usually asymmetrical, so one side of the neck is usually more affected than the other. A symmetrical infestation is also possible in principle, but much less frequently.

There are lymphomas that can also make themselves felt on our skin. One of these symptoms is the generalized itching of the skin, i.e. itching that affects the entire body, in the context of so-called Hodgkin’s lymphoma. This is a specific type of lymphoma.

However, there are also lymphomas that originate directly from the skin and thus affect it. They are called cutaneous lymphomas. The best known and most common cutaneous lymphoma is Mycosis fungoides.

This lymphoma goes through three stages, which are accompanied by characteristic changes in the skin. In the eczema stage, which can often persist for years, itchy and scaly skin rashes appear, which are resistant to therapy. In the infiltrate stage, the rashes look plaque-like and brownish.

Between the affected skin areas there is still healthy skin. In the tumor stage, nodular, reddish-brownish tumors form within the plaques. These are prone to infection and can flake and ulcerate.

In the course of the disease, lymph nodes, internal organs and the bone marrow are also affected, so that further symptoms such as fever, weight loss, fatigue, night sweats and lymph node swelling can develop. Initially, the physician should try to obtain information about the course of the disease (lymphoma), the symptoms and the first occurrence from the patient by means of a patient survey (anamnesis). He will also ask about the presence of the B-symptoms, which could already give first indications of a malignant disease.

In addition, the anamnesis interview should include a family history of malignant disease and previous illnesses of the patient. During the physical examination, great importance should be attached to the search for enlarged lymph nodes. Furthermore, a complete physical examination should be performed, including listening to the lungs, examination of the gastrointestinal system and blood pressure measurement.

Liver and spleen enlargements are examined by palpation on the lying patient. This should be followed by a blood examination (large blood count), in which blood cell changes could be seen. If an enlarged lymph node is found, it should be removed for histological examination and examined in the laboratory.

A local anesthetic is usually sufficient here. If lymph nodes in the chest are affected, general anesthesia and surgery are usually necessary. In order to determine the extent of the disease, a computer tomography will be performed if malignant disease is suspected.

This allows the diagnosis of lymph node swelling distributed throughout the body as well as infestation of organs such as the liver or spleen. In order to find out whether the liver or spleen is involved, however, an ultrasound examination should first be performed.In order to determine whether the skeletal system is affected, a skeletal scintigraphy is also carried out during the course of the examination series, in which the patient is injected with a radioactive agent, which can then be made visible on a film and thus areas with increased activity (metastases) can be depicted. The procedure is similar for non-Hodgkin’s lymphoma.

In chronic lymphatic leukemia, the blood test is the most important test according to the general medical examinations. Thus, it is absolutely necessary to perform a blood smear of the patient’s blood to perform a so-called immunophenotyping. The diagnosis of chronic lymphocytic leukemia is considered confirmed if the blood smear shows more than 5000 lymphocytes per microliter and the lymphocytes show signs of maturity and very specific surface characteristics.

An examination of the bone marrow as well as a sample collection of a lymph node are only necessary if a differentiation from Hodgkin’s lymphoma is to be made or an exact assessment of the extent of the clinical picture is to be made. Especially for the diagnosis of non-Hodgkin lymphoma, blood testing is very important, but also for other lymphomas, blood testing is always performed. This allows the general condition of the patient to be assessed, but also the function of important internal organs such as the liver or kidneys.

Blood tests include counting the blood smear under the microscope, measuring the blood sedimentation rate (BSG), which is often elevated, and determining the blood proteins (immunoglobulins). It is also possible to see whether there is a viral infection that could be responsible for the enlarged lymph nodes. The blood count may show an over- or underproduction of the various white blood cells and lymphocytes.

Lymphocytopenia, i.e. a reduction in the number of lymphocytes, occurs in about one quarter of patients with Hodgkin’s lymphoma. The type of lymphoma can be determined more precisely by immunohistochemistry. This method determines surface markers on cells that provide information about the type of lymphoma.