There are over 60 types of lymphoma, broadly divided into Hodgkin lymphoma and non-Hodgkin lymphoma. These lymphomas can cause many different symptoms, depending on which type it is and where it develops in the body.
The most common symptoms of lymphoma are:
Swollen lymph nodes
The most common sign of lymphoma is a lump or several lumps. These are swollen lymph nodes and are usually painless. They are often noticed in the neck, armpit or groin. Not all lymphomas have obvious lumps.
Fatigue can be a sign of lymphoma. It is not a normal feeling of being tired. It means you are exhausted for no obvious reason or feel washed out after doing very little.
Unexplained weight loss
Unexplained weight loss means losing a lot of weight quite quickly without dieting.
Lymphoma can cause night sweats that make your nightclothes and bed sheets soaking wet. The night sweats are often described as ‘drenching’. They can happen with any type of lymphoma and can also happen during the day.
Itching (pruritus) without a rash can be a symptom of lymphoma. It can be very troublesome, particularly in hot weather.
Most of these symptoms can occur in other, more common illnesses as well. This means that lymphoma can be hard for doctors to diagnose compared with other cancers.
Watch Dr Andrew Davies, Consultant in Medical Oncology, talk about the most common symptoms of lymphoma:
You may hear the term ‘B symptoms’, especially when your lymphoma is being staged. Staging is the process of doing tests to find out how many different parts of your body are affected by lymphoma. The following symptoms are referred to as B symptoms:
- weight loss
Doctors will take into account whether you have any B symptoms when they plan your treatment.
Everyone is different. For example:
- you might have lots of symptoms or just a few (some people with lymphoma have no symptoms at all and the lymphoma is discovered during tests for another condition)
- you might have become very unwell quickly or barely noticed anything
- your symptoms might be
What should I do if I have these symptoms?
Having one or more of these symptoms does not automatically mean that you have lymphoma; there are many other reasons that you may have these symptoms. Note that you should see a doctor about any unexplained lump that persists for longer than 3–4 weeks.
If you think that you might have lymphoma, or you are worried about any aspect of your health, visit your GP.
If you have already been diagnosed with lymphoma, we have some general guidance for coping with some of the common symptoms. Speak to your doctor for more tailored advice about managing your symptoms.
Lymph nodes help to fight infection. The most common sign of lymphoma is a swollen lymph node. It can be one (or more) painless lump or swelling, often in the neck, armpit or groin. The medical name for swollen lymph nodes is ‘lymphadenopathy’. About half of people with lymphoma have swollen lymph nodes that they can feel. (Another common cause of lymphadenopathy is ‘dermatopathic lymphadenopathy’, in which people with severe skin disease [such as eczema or psoriasis] develop enlarged nodes).
Sometimes, a few swollen lymph nodes are the only sign that anything is wrong. This is more usual with low-grade non-Hodgkin lymphomas, where the cells appear to be dividing slowly, and which take longer to develop.
It is possible to have swollen lymph nodes:
- in just one area of your body, which can happen with any lymphoma and normally causes swollen lymph nodes, for example in the neck and collarbone area, armpits or groin
- spread throughout your body, which is known as ‘generalised lymphadenopathy’.
Swollen lymph nodes in people with lymphoma:
- are usually round and mobile, which means that when you press on the lump, it moves out of the way
- are not usually painful to the touch, but they can ache
- can occasionally cause pain in nearby areas (for example if they are pressing on a nerve)
- are often described as having a ‘rubbery feeling’
- can become painful after drinking alcohol – this seems to be more common in Hodgkin lymphoma.
With low-grade non-Hodgkin lymphoma, these lumps can sometimes come and go, or at least shrink for a little while. This is because the activity of the disease can vary from time to time. Sometimes it is active, making lots of cancerous cells that build up and cause the lymph nodes to swell. Then it quietens down – some of the cells die or are absorbed, and the lymph node becomes smaller again.
Lymph nodes that are closer to the surface, for example, the neck, armpit or groin, are easier to see and feel. Others, such as those in the abdomen (stomach) or the chest aren’t so easy to feel from the outside. These nodes can press on other tissues or organs and cause pain. They can make you cough if they are in the chest. Sometimes, they are only found when you have a scan.
Having swollen lymph nodes does not automatically mean that you have lymphoma but if you notice a small lump that doesn’t go away within a few weeks, or you find that a lump is growing bigger, you must see your doctor.
Note: you should see a doctor about any unexplained lump that persists for longer than 3–4 weeks, regardless of whether it is mobile or not.
Swollen lymph nodes can sometimes block the flow of fluid called lymph draining from the body’s tissues. The fluid then builds up, causing symptoms such as soreness, heaviness, tightness or swelling, usually in an arm or leg although other areas of the body can be affected. It is important to know that such blockages are very uncommon and usually resolve once treatment is started.
There are many other possible reasons for lymph nodes to swell when they are working as they should. The most common reason is infection; with infection the nodes are usually sensitive or even painful to the touch. Other possible reasons include illnesses that affect the body’s immune system such as rheumatoid arthritis. Some medications, including antibiotics, can also cause lymph nodes to swell.
The exact cause of fatigue as a symptom of lymphoma is not known; it is likely that there are several reasons for it. Lymphoma can drain your body’s energy resources, as can the stress of feeling unwell. Fatigue can happen with many health conditions other than lymphoma. Just because you feel fatigued, it does not necessarily mean that you have lymphoma.
‘Unexplained’ weight loss means losing weight over a short period of time without trying to. The NHS advises that you see your GP if you lose more than 5% of your normal body weight in a month or more than 10% over 6 months. For an average person, this means losing around half a stone or more within one month.
Weight loss can happen because cancerous cells are using up your body’s energy resources and your body is working hard to try to get rid of them. Weight loss is more common with lymphomas that grow very quickly and put a sudden demand on your body.
As with many other symptoms, unexplained weight loss can happen for a lot of other reasons and lymphoma is just one of them.
Pyrexia (fever) is a rise in your inside body temperature above the normal level. Lymphoma may cause mild fevers (over 37.5°C or 99.5°F in adults).
Fever is almost always caused by an infection, but there are a few other much less common causes, including lymphoma. Usually the sorts of fevers that people with lymphoma get are not extremely high – they are described as ‘low-grade’ fevers and they come and go.
It is thought that the lymphoma causes fevers because of:
- a release of chemicals into the blood that raise your body temperature (similar to when you have an infection)
- the rise in temperature makes you feel hot and so your body sweats to cool itself down
- the rise in temperature also re-sets the thermostat in your brain
- the thermostat sends out signals to tell the body it is too cold compared to this new temperature setting
- the body shivers to try to warm up again.
Lymphoma can cause night sweats that are severe enough to make your nightclothes and bed linen soaking wet. They are often described as ‘drenching’. They can happen with any type of lymphoma and can also sometimes happen during the day.
If you have night sweats, this does not automatically mean you have lymphoma. Doctors do not know exactly why night sweats happen when you have lymphoma. One possible reason is that they are your body’s reaction to your temperature rising to above a normal level (fever).
Night sweats may also be a response to some of the abnormal hormones and proteins produced by the lymphoma cells.
There are things you can do that might help you to cope with night sweats, but do also speak to your medical team for advice.
Itching (pruritus) is a common symptom of Hodgkin lymphoma – up to a third of people with Hodgkin lymphoma will have itching as a symptom. It is less common in non-Hodgkin lymphoma. Usually, people have itching without an obvious rash:
- in just their hands and feet, or
- in their lower legs, or
- all over their body.
Itching can be very troublesome, especially in hot weather. It is usually worse at night in bed.
The cause of itching as a symptom of lymphoma is not known, but it is thought to be due to chemicals called cytokines; these irritate the nerves in the skin and make it itch. Cytokines are released by your immune system as it reacts against the lymphoma cells.
If you are having problems with itching, there are some things you could try that might help. Speak to your medical team too for advice.
Symptoms that develop in or around where the lymphoma is growing are called ‘local’ symptoms. The most common local symptom is a swollen lymph node.
Other local symptoms depend on where the lymphoma is growing and could include:
- chest symptoms
- stomach (abdominal) symptoms
- skin symptoms
- brain and nerve symptoms
- lumps in other areas (eg in the breast, testicle, neck, or cheek).
Coughing and shortness of breath can be a symptom of lymphoma – however, both of these can happen with many other illnesses, especially lung diseases.
Swollen lymph nodes can press on lung tissue, on the breathing passages and on nearby blood vessels. The pressure this causes can make you cough.
Lymphoma can make you short of breath for a number of reasons:
- Lymph nodes may press on your lungs and airways, so your lungs have to work harder to get oxygen into the body.
- Fluid may collect around the lung (known as a 'pleural effusion') as a result of damage to the lymph nodes or the tissue around them.
- A shortage of red blood cells (anaemia), which makes it harder for your blood to carry enough oxygen. Anaemia will make you breathe harder so that your body can get more oxygen in. Anaemia is not a very common symptom of lymphoma but it can sometimes happen if there is lymphoma in the bone marrow.
The gut is the most common place that lymphoma develops outside of the lymph nodes (extranodal site).
Symptoms depend on what part of the gut is involved, for example:
- Lymphoma in the stomach can cause inflammation of the stomach lining (gastritis) with pain and bleeding.
- Lymphoma in the bowel can cause abdominal pain, diarrhoea or constipation.
You might feel full after eating only small amounts of food, or you might have a feeling of pressure in the stomach (abdomen) or pelvis (the lowest part of your stomach, above your thighs).
Your stomach can be swollen – especially if your spleen or liver are enlarged, or if fluid has collected in your abdomen (known as ‘ascites’). This can be uncomfortable or painful.
Swollen lymph nodes themselves are not usually painful but lymphoma can press on the tissues around the nodes and cause pain. For example, pain in the back and in the abdomen are quite common if lymphoma is in these areas – particularly with high-grade non-Hodgkin lymphoma.
Lymphoma in the bone itself is rare but when it does happen, it can cause pain in the affected bone. It is more common to have lymphoma in the bone marrow (the spongy part in the middle of some of our larger bones) but this rarely causes pain.
If you have skin lymphoma, you might get symptoms on your skin such as:
- flat red patches
- raised plaques with a scaly surface
Lymphoma in the skin can look a lot like other skin conditions, such as eczema or psoriasis. Skin lymphomas are usually low-grade lymphomas. Sometimes other parts of the body are also affected but for most people, signs of lymphoma stay in the skin.
Lymphoma starting in the brain or nervous system is very uncommon but can lead to headaches, fits (seizures), memory problems, dizziness, sight problems, numbness, tingling or weakness in a limb.
Some people with lymphoma experience cancer-related cognitive impairment (often called 'chemo brain', although it can affect people who aren't on chemotherapy). This means changes to your thinking processes, such as difficulty with concentrating or with remembering things.
‘Systemic’ means your whole body. Systemic symptoms are caused by the impact of the lymphoma on your body as a whole.
Systemic symptoms of lymphoma include:
Fevers, night sweats and unexplained weight loss are B symptoms.
Difficulty in shaking off infections
Having lymphoma can mean that your immune system doesn’t work as well as it should.
Normally, white blood cells fight infections. If you have lymphoma, cancerous white blood cells (that make up the lymphoma) are produced instead of the healthy, ‘good’ white blood cells. This can make you pick up infections more easily. The infections could be more severe or last for longer than they would normally.
If lymphoma relapses (comes back) after treatment, it usually causes symptoms. These could be:
- the same symptoms that you’ve had before, or new ones
- lumps that appear where they were before or in new places
- more general (fevers, sweats or itching, for example) that start up again or for the first time.
If your lymphoma relapses, your doctors will plan your treatment based on your symptoms, the results of further tests, whether your lymphoma has changed (transformed) and your general health.
Remember that not every symptom you have after your treatment will be a sign of lymphoma coming back or transforming – you can still get coughs and colds or aches and pains like everyone else.
If you develop new lumps, symptoms that are like those you had before, or new symptoms that aren’t clearing up, talk to your GP or a member of your medical team. Don’t wait until your next clinic appointment if you have symptoms that are worrying you.