About
Lymphoma >
Symptoms & Complications of Lymphoma
Last update:
08/24/2010 |
TOPICS
General
Symptoms | Reporting Symptoms | Disease
Direction Indicators | Blood counts |
Ascites | Cutaneous (skin) | Itching (pruritus) | Lymphedema
| Nosebleed | Night
Sweats | Pain
| Pleural effusions |
Performance
Standards | Restless
Leg | Weight Loss (cachexia) |
General
symptoms
Understanding the
symptoms of lymphoma lets you better participate in your care
and treatment.
Patients often report that it's
difficult to distinguish between important symptoms and those that may
be unrelated to lymphoma.
Some Definitions:
Anemia
absolute reduction in the
quantity of the oxygen-carrying pigment hemoglobin (Hgb) in the
circulating blood.
Leukopenia low white
blood cell count (WBC) less than 5.0 X 109/L
Lymphadenopathy
abnormal increase in size of lymph nodes.
Thrombocytopaenia
platelet count of less than 150 X 109/L)
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General
symptoms of lymphoma
Alphabetical List |
B-Symptoms
| Systemic Symptoms |
A Systems Checklist | Printable
Symptoms Checklist (PDF)
Lymphoma is often first noticed as
painless enlarged lymph nodes (adenopathy
or lymphadenopathy). However, most of the time, enlarged lymph nodes
do not mean lymphoma. Only a biopsy
and subsequent pathology evaluations of
the tissue can determine or exclude the diagnosis of lymphoma.
See Lymphadenopathy: Differential
Diagnosis and Evaluation Robert Ferrer,
M.D., M.P.H. - American
Family Physician for an excellent
description of lymphadenopathy, as well as the many benign causes of
enlarge lymph nodes.
Symptoms can
vary widely depending on the type of lymphoma, and where the lymphoma is actively
growing. Symptoms related to bone marrow
dysfunction, such as anemia (low red blood cell count), are not as
common when the disease is first diagnosed, but are likely to present
in later stages of the disease and also as side effect of some
treatments. MALT
lymphomas may present as an upset stomach; or a change in bowel movement
could be caused by an enlarged lymph node.
Reporting
symptoms:
It can be difficult at times to identify the
meaning of a symptom. Some symptoms may be common to certain stages of
lymphoma and to specific treatments. But you may have or develop other
medical conditions and illnesses that are unrelated to lymphoma, such
as flu or an ulcer.
When informing your doctor about a
symptom also describe:
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the intensity using a scale of 1 to
10
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for visible symptoms, describe the
size and appearance
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when it
started
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how long it has
lasted
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if it waxes and
wanes
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the medications and supplements you
may be taking and when you started taking them
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how the symptom might change when you change
position
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if the symptom is associated with
meals or specific foods
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the time of day the symptom might
be most intense
These and other like details can assist your doctor in identifying
the possible cause or causes, or if further tests are warranted.
NEWS: Talking to Your Doctor about
Symptoms
http://bit.ly/dgctDj
"Because symptoms are
what you experience, your healthcare providers can only
know about your symptoms if you tell them. This puts you in the
unique position of being the symptoms expert. " by Charles S. Cleeland, PhD, with Diana Lazzell
Also see our Symptoms Checklist (PDF)
Regarding fatigue: Clinical signs of anemia - changes in
performance - would be important to report, such as fatigue,
shortness of breath on exertion, general weakness - but these are
difficult to be aware of when a condition comes on gradually - which
is another reason regular exercise is a very good idea, as
you will more readily notice a decrease in performance when you do
regular activities, (could do this yesterday, but not today). Such
reports on performance will be of more use to our doctors as well,
compared to reporting "I feel tired."
Alphabetical
list of common symptoms:
Unexplained and persistent:
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Anemia - low red blood count*
secondary to bone marrow involvement that can inhibit blood cell
production. |
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Appetite loss
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Fatigue (see also anemia)
secondary to bone marrow involvement that can inhibit blood cell
production. |
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Fever |
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Flu-like symptoms - aches, fever, chills
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Infections associated with low white count*
secondary to bone marrow involvement that can inhibit blood cell
production. |
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Pain
Depending on the anatomic location that is secondary to pressure to bone or organs,
or obstruction of bodily functions |
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Skin - Itchy skin (purititis); red patches
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Skin - Jaundice - yellowish tinge (related to liver function)
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Thrombocytopenia -
low platelets (bleeding)*
secondary to bone marrow involvement that can inhibit blood cell
production. |
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So called "b-symptoms"
are common. Onset of b-symptoms may suggest that the lymphoma is progressing.
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B-symptoms
include unexplained and persistent:
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Fever and chills
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Pruritus - skin itchiness
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Other symptoms
related to area of involvement:
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Localized pain may occur
depending on the location of tumors.
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"If lymphoma occurs in the stomach or intestines, they may
have gastrointestinal bleeding, a feeling of fullness,
or abdominal swelling. |
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Lymphoma arising in the central nervous system
(uncommon)
can cause
neurological symptoms such as partial paralysis, seizures,
confusion, and memory loss. |
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Lymphoma in the chest can cause
coughing, shortness of
breath, and chest discomfort." 1 (MSKCC)
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Swelling of limbs
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peripheral neuropathy
(uncommon)
Muscle Nerve. 2005 Mar;31(3):301-13.
Lymphoma and peripheral neuropathy: a clinical review.
Kelly JJ, Karcher DS.
Department of Neurology, The George Washington University
Medical Center, 2150 Pennsylvania Avenue NW, Washington, DC
20037, USA.
Abstract
Lymphoma occasionally affects the peripheral nervous system.
When it does, the diagnosis can be elusive since many patients
present without known lymphoma. Most peripheral nerve
complications are due to non-Hodgkin's lymphoma (NHL), which
infiltrates nerves causing axonal damage. This disorder can
affect nerve roots and cranial nerves, often associated with
lymphomatous meningitis. NHL may also infiltrate peripheral
nerves and cause plexopathy, mononeuropathy, or generalized
neuropathy. These neuropathies may resemble an asymmetric
mononeuropathy multiplex or a generalized disorder such as
chronic inflammatory demyelinating polyradiculoneuropathy. When
NHL infiltrates diffusely, the term neurolymphomatosis is used.
Hodgkin's lymphoma (HL), by contrast, rarely infiltrates nerves.
More often, HL causes immunological disorders of the peripheral
nervous system such as inflammatory plexopathy or Guillain-Barré
syndrome. Other rare lymphomas such as intravascular lymphoma
and Waldenstrom's macroglobulinemia can also affect peripheral
nerves in specific ways. In addition, other malignant and
nonmalignant lymphoproliferative disorders enter into the
differential diagnosis of lymphomatous neuropathy. This review
discusses the multiple peripheral nerve presentations of
lymphoma from the clinician's point of view and provides a guide
to the evaluation and diagnosis of these uncommon, challenging
disorders.
PMID: 15543550
See also Neurological complications of lymphomas
http://www.ncbi.nlm.nih.gov/pubmed/17151523
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General
symptoms may include:
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flu-like symptoms
such as aches and pains.
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Frequent
infections
from depressed immunity.
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Since the symptoms of
lymphoma are common to both minor and serious medical conditions, the diagnosis
of lymphoma (which requires a biopsy) is often delayed.
So called systemic symptoms,
such as fever, night sweats, weight loss in excess of 10%, or
asthenia, are infrequent at presentation of the disease but can be
observed in
later stages. Progression to an intermediate-grade or
high-grade lymphoma should be considered when a patient develops
systemic symptoms.
Monitoring blood for increasing levels of LDH and
Human beta-2 microglublin is
commonly used to monitor progression. See
LDH |
Human
beta-2 microglublin
A systems-based checklist:
My appointments with my oncologist include the following review of systems which I answer Yes or No for each individual symptom and add comments if necessary:
Do you now, or have you had, any problems related to the following systems?
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Constitutional Symptoms: Fever, Chills, Headache, Other
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Eyes: Blurred Vision, Double Vision, Pain, Other
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Allergic/Immunologic: Hay fever, Drug Allergies, Other
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Neurological: Tremors, Dizzy Spells, Numbness/Tingling, Other
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Endocrine: Excessive Thirst, Too Hot/Cold, Tired/Sluggish, Other
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Gastrointestinal: Abdominal Pain, Nausea/Vomiting, Heartburn, Other
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Cardiovascular: Chest Pain, Varicose Veins, High Blood Pressure, Other
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Integumentary: Skin Rash, Boils, Persistent Itch, Other
(an organ system that protects the body from damage)
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Musculoskeletal: Joint Pain, Neck Pain, Back Pain, Other
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Ear/Nose/Throat/Mouth: Ear Infection, Sore Throat, Sinus Problems, Other
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Genitourinary: Urine Retention, Painful Urination, Urinary Frequency, Other
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Respiratory: Wheezing, Frequent Cough, Shortness of Breath, Other
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Hematologic/Lymphatic: Swollen Glands, Blood Clotting Problems, Other
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Psychological: Are you generally satisfied with your life?, Have you considered suicide?
__________________
Provided by Sylvia (WebMagic)
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Resources:
General symptoms:
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Disease Direction
indications
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Disease Direction Indication
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Increasing or decreasing lab
values may help to gauge progression or response to treatment. However,
location of disease can affect interpretation of the indicators provided here.
Therefore, it's important to consult with your doctor about questions
you may have.
Increased
levels: ALT (sSGPT), Alkaline Phosphatase, AST (sGOT), Beta2-microglobulin,
BIlirubin, Total Calcium, Creatinine, LD (LDH), Lymphocytes, Monocytes,
Sodium, BUN, Uric Acid
Decreased
levels: Albumin, Cholesterol, Globulin Iron, Total MCH,
MCHC, MCV, Protein
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Abnormal Blood Counts
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Abnormal Blood Counts
Anemia
(low red blood cells)
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Blood
counts cannot be reliably used to diagnose disease or monitor it, but
abnormal counts are sometimes associated with lymphomas, leukemias,
disease progression, or the side effects
of treatment.
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Leukocytosis emedicine.com
"refers to an increase in the total
number of white blood cells (WBCs) from any cause. From a
practical point of view, leukocytosis traditionally is classified
according to the component of white cells that is contributing to
an increase in the total number of white cells. Thus, leukocytosis
may be caused by an increase in (1) neutrophil count (ie,
neutrophilia), (2) lymphocyte count (ie, lymphocytosis), (3)
monocyte count (ie, monocytosis), (4) eosinophilic
granulocyte count (ie, eosinophilia), (5) basophilic granulocyte
count (ie, basophilia), or (6) immature cells (eg, blasts).
A combination of any of the above may be involved."
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Leukopenia Merck
Manual
"is usually characterized by a reduced
number of blood neutrophils, although a reduced number of
lymphocytes, monocytes, eosinophils, or basophils may also
contribute to the decreased total cell count. Neutropenia
accompanied by monocytopenia and lymphocytopenia is often a more
serious disorder than neutropenia alone."
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Ascites
(not common)
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Click to enlarge
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TOPIC SEARCH: PubMed
| Web
| Wikipedia.org
Ascites
is an excess of fluid in the membrane lining of
the abdomen (the peritoneal cavity). Lymphoma might cause ascites by
obstructing the lymphatic system. To relieve symptoms and
diagnose the cause, a peritoneal fluid tap may be performed. Successful
treatment of the lymphoma can resolve this problem.
"Ascites usually can be detected
clinically by the presence of fullness in the flanks, shifting
dullness, generalized abdominal distention with a fluid wave, and
umbilicus eversion. In obese patients, moderate amounts of ascitic
fluid may be difficult to detect. Ultrasound typically is performed to
confirm the diagnosis in obese patients, because it can detect as
little as 100 mL of fluid in the peritoneal cavity. Accumulation of
fluid is first detected in Morison's pouch, then in the paracolic
gutters; eventually, generalized ascites is noted."
postgradmed
Diagnosis "may be based on physical examination if there is a large amount of fluid, but imaging tests are more sensitive. Ultrasound and CT reveal much smaller volumes of fluid (100 to 200 mL) than does physical examination.
Spontaneous bacterial peritonitis (SBP) (an infection of
ascitic fluid) is suspected in a patient with ascites who also has abdominal pain, fever, or unexplained deterioration.
Diagnostic paracentesis (see Diagnostic and Therapeutic GI Procedures: Abdominal Paracentesis) should be performed if ascites is newly diagnosed, if its cause is unknown, or if SBP is suspected."
The rare milky (chylous) ascites is most common with lymphoma. Merck
manual
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"Chylous ascites
is the extravasation
of milky chyle into the peritoneal cavity. This can occur de novo
as a result of trauma or obstruction of the lymphatic system.
Moreover, an existing clear ascitic fluid can turn chylous as a
secondary event."
Emedicine
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Case Report: Intraperitoneal rituximab: an
effective measure to control recurrent abdominal ascites due to
non-Hodgkin's lymphoma Springer-Verlag
2002
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Intraperitoneal Rituxan: Weight
loss - unexplained (Cachexia)
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Peritoneal fluid analysis
(draining the fluid to relieve
discomfort and diagnose cause)
Medline Plus
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Cutaneous
(skin)
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Cutaneous
lymphomas can present on anywhere on the skin.
Image of Cutaneous B-Cell Lymphoma - Large Cell Type -
Trunk
Click to enlarge
Source: Dermatologic Image Database
Source: Aafp.org:
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T-Cell Lymphoma Presenting as Benign Dermatoses -
includes images aafp.org
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Itching
(Pruritus)
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Itching
(Pruritus)
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TOPIC SEARCH:
PubMed
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Web
Pruritus,
also known as itch, is a common symptom of lymphoma.
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Management of Pruritus (nonspecific) fpnotebook.com
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Pruritus as a manifestation of systemic
disorders.
Cutis. 1978 Jun;21(6):873-80. PMID: 657843 PubMed
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Efficacy and safety of naltrexone, an oral
opiate receptor antagonist, in the treatment of pruritus in
internal and dermatological diseases. J Am Acad Dermatol. 1999
Oct;41(4):533-9. PMID: 10495371 PubMed
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Severe pruritus should be a B-symptom in
Hodgkin's disease.
Cancer. 1983 May 15;51(10):1934-6. PMID: 6831358 PubMed
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Itch: scratching more than the surface. QJM.
2003 Jan;96(1):7-26. Review. PMID: 12509645 PubMed
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Night
Sweats
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Drenching Night Sweats
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TOPIC
SEARCH: PubMed
Drenching
night sweats is one of the so-called b-symptoms
associated with lymphomas. This type usually " involves the entire
body and are not confined to a specific hour during the night.
What causes night
sweats in lymphoma? There does not appear to
be a definitive
answer. One possible mechanism behind night sweats is that the progression of lymphoma,
and the body's way of fighting infection, have some things in
common - both may require the mobilization of immune cells and cytokines
(such as interferon, Interleukin); and that these immune activities
might account for causing night sweats, fever, and achy muscles.
Your doctor will look at the
possible meaning of night sweats in the context of other clinical
symptoms and test results. It can be a sign of progression or
transformation, depending on the severity and frequency. For
this reason we believe it's prudent to notify your doctor when you
have frequent night sweats to be sure.
Resources:
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Hot and Bothered By Night Sweats MSN
Great tips by Dr. Rob for MSN Health & Fitness:
"Needless to say, you as the patient can play a key role in
narrowing down the diagnosis by providing key information to your
physician. This would include:
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How long have your night sweats occurred (days, weeks,
months)? |
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Do they occur only at night
or do you experience
drenching sweats at other times of the day?
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Is your sleeping area too hot or crowded?
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Have you had any recent illnesses?
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Have you experienced any unexplained weight loss,
fevers or shaking chills? |
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Are you taking any medications, large doses of
vitamins,
dietary or herbal supplements?
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Do you have difficulty sleeping
or been
diagnosed with a sleep disorder? |
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Do you eat within several hours of bedtime?
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Do you drink alcohol or use substances of abuse?
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Have you recently traveled to other
areas? |
In
narrowing down
the potential causes of night sweats, your physician may group
the possible triggers into the following categories:
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Environmental
(uncomfortable room temperature,
poor air circulation, too many blankets, thick sheets, close
proximity to a bed partner)
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Emotional (stress,
anxiety,
disturbing dreams)
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Hormonal
(hyperthyroidism, pregnancy,
perimenopause or early menopause, hypoglycemic episodes in
those with or without diabetes, others)
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Medications
including certain antidepressants,
niacin (high doses), tamoxifen, leuprolide, prednisone, drugs
for erectile dysfunction (flushing and warm sensation), and
high blood pressure. Even medications used to fight fever
(aspirin, acetaminophen) can lead to rebound sweating as their
effectiveness wears off.
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Infections such as tuberculosis, mononucleosis,
human immunodeficiency virus
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Medical conditions
such as gastroesophageal
reflux disease, obstructive sleep apnea and chronic fatigue
syndrome
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Cancers
Itching
(Pruritus)
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Neurological
concerns such as autonomic
neuropathy or a delayed complication from a spinal cord
injury."
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Nosebleed
(not common)
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Nosebleed
(not common)
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TOPIC SEARCH: PubMed
| Web
NHL can present
itself in many ways, and the symptoms can have so many other causes. In NHL-info I
wrote in response to a question: " I've never heard of nose bleeds associated with
NHL, but I suppose it's not out of the question." Then came two quick replies:
"My mother was also just diagnosed with NHL
after recurring nosebleeds and a stuffy nose for about 6 months. There were no
other symptoms." - Lesli (NHL-info)
"One of the symptoms which lead to my Mother's diagnosis of NHL was reoccurring
nosebleeds." - Sandra (NHL-info)
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Pleural
effusions
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Pleural
effusions
click to enlarge
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TOPIC SEARCH -
PubMed
| Medscape
| Web
Pleural effusions, or abnormal
accumulations of fluid in the pleural space around the lungs, can be
caused by a wide variety of diseases, including lymphoma.
Sometimes an enlarged lymph node can block drainage of fluid that
lubricates the pleural space. In such cases, successfully treating the
lymphoma can resolve the condition. To relieve symptoms and
diagnose the cause, a Thoracentesis, or pleural tap may be performed.
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Restless leg
syndrome (not common)
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Restless leg
syndrome (not common)
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TOPIC SEARCH:
PubMed
| Web
This
syndrome can make it difficult to get adequate sleep because of pain
or sensations experienced in the legs while sleeping. Restless
leg syndrome might be related to an iron deficiency, which could be
related to anemia.
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Weight
loss - unexplained (Cachexia)
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Weight
loss - unexplained (Cachexia)
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TOPIC SEARCH: PubMed
| Web
| Clinical
Trials
A symptom of lymphoma progression is
weight loss that cannot be explained by diet. Cachexia,
the loss of lean body mass, is
most typically associated with advanced progression of the
disease.
“The formal definition of cachexia
is the loss of body mass that cannot be reversed nutritionally: even if
the affected patient eats more calories”
wikipedia.org
Is there a
difference between weight loss and wasting?
"Yes. As its name implies, weight loss refers to a loss of body
weight. Wasting syndrome refers to a loss of body mass or size, most
notably muscle mass (sometimes referred to as "lean body
mass"). Very often, both occur at the same time. However, this is
not always the case. It is possible that someone who is losing weight
might not lose muscle mass. It is also possible that someone losing
muscle mass might not lose a lot of weight." beingalivela.org
You should report unexplained
weight loss to your doctor or nurse and seek the underlying
cause.
Some patients will try alternative
diets that severely restrict calories. These diets can make it
difficult to determine what is causing the weight loss, and they can
be potentially dangerous if they contribute to wasting.
Related articles on
weight loss, cachexia, and nutrition:
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