Lymphoma is a form of cancer that originates in the lymphatic system, a network of vessels, tissues, and organs integral to the body’s immune function. The disease involves the uncontrolled growth of lymphocytes, a type of white blood cell responsible for fighting infection. Since the lymphatic system extends throughout the body, lymphoma can begin almost anywhere, making its presentation highly varied. The physical signs are often internal, vague, or easily mistaken for other, common conditions, requiring medical evaluation for a proper determination.
Localized Physical Manifestations
The most common physical indication of lymphoma is enlarged lymph nodes, known as lymphadenopathy. These swellings frequently occur in superficial areas where nodes are easily felt, such as the neck, armpits, and groin. Unlike lymph nodes swollen due to infection, which are often tender and painful, a cancerous lymph node is typically painless.
A lymph node affected by lymphoma often feels firm or rubbery to the touch and may be described as fixed rather than mobile. While infection causes nodes to temporarily enlarge and then shrink, a cancerous node tends to remain enlarged and may grow progressively. The size of these nodes can vary significantly, sometimes reaching a diameter of two to ten centimeters.
Less commonly, lymphoma may appear as a localized mass outside of accessible peripheral nodes. For instance, an accumulation of cancerous cells within the chest cavity (the mediastinum) can press on the windpipe, leading to symptoms like a persistent cough or shortness of breath. Similarly, masses in the abdominal area can cause uncomfortable fullness, pain, or digestive issues due to pressure on the stomach or intestines. These internal masses are physical manifestations localized to a specific internal site, even if not visible.
Systemic Indicators of Disease
Beyond localized swelling, lymphoma can present with a collection of internal, non-specific symptoms that signal the disease is affecting the body as a whole. These systemic issues are grouped as “B symptoms,” and their presence is a significant factor in disease staging. The first indicator is an unexplained fever, defined as a temperature above 38°C (100.4°F), which may be persistent or cyclical. These fevers occur without any apparent underlying infection.
Another defining B symptom is drenching night sweats, severe enough to require changing clothes or bedding. This intense nocturnal perspiration is thought to be caused by the body’s reaction to chemical signals released by the cancer cells. The third systemic indicator is significant, unintentional weight loss, specifically a reduction of more than ten percent of total body weight over six months or less.
These systemic symptoms reflect a broader activation of the immune system and the release of inflammatory substances in response to the cancer. Their appearance suggests a more advanced state of the disease, indicating that the lymphoma has spread beyond its initial localized site. The presence of B symptoms is a sign of how the disease is manifesting internally.
Differences Between Hodgkin and Non-Hodgkin Lymphoma
Lymphoma is a group of cancers, broadly categorized into Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL). The distinction between these two types affects the typical pattern of physical presentation. Hodgkin Lymphoma often begins in the lymph nodes of the upper body, most frequently in the neck and chest cavity.
HL tends to spread in an orderly, predictable manner, moving sequentially from one group of lymph nodes to adjacent groups. Consequently, the initial physical signs of HL are often isolated, localized lymphadenopathy in the upper body. In contrast, Non-Hodgkin Lymphoma (NHL) is more common and encompasses numerous subtypes with highly variable presentations.
NHL can arise in lymph nodes anywhere in the body, but it also has a greater tendency to originate outside the lymph nodes entirely, known as extranodal presentation. For approximately 30% of NHL cases, the first sign may be a mass or lesion appearing in an organ like the stomach, skin, or brain, rather than a swollen lymph node. This difference in starting location and spread pattern means NHL presents with a wider range of initial localized symptoms than HL.
Confirmatory Medical Tests
Because the signs of lymphoma, whether localized or systemic, overlap with those of many other conditions, a definitive diagnosis requires medical intervention. The only way to confirm lymphoma is through a biopsy, a procedure where a tissue sample is removed for examination under a microscope. An excisional biopsy, where the entire suspicious lymph node is surgically removed, is often the preferred method, as it provides the most comprehensive tissue sample for analysis.
Once the biopsy confirms the existence of cancerous lymphocytes and determines the specific type of lymphoma, other tests are necessary to assess the extent of the disease, a process called staging. Imaging technologies are used to visualize areas inside the body that cannot be physically examined. Positron Emission Tomography (PET) scans and Computed Tomography (CT) scans are employed to map the location of affected lymph nodes and identify any extranodal involvement throughout the chest, abdomen, and pelvis.
Blood tests are a component of the diagnostic workup, providing information about blood cell counts and organ function, which can be affected by the disease. A bone marrow biopsy may also be performed to check if the lymphoma cells have spread to the bone marrow, which is important for staging and treatment planning. These tests collectively provide a complete picture of the lymphoma inside the body, guiding the therapeutic strategy.