Produced 28.02.2011 Revision due 28.02.2013 Symptoms of Hodgkin lymphoma Lymphoma is a cancer of cells called lymphocytes. These cells are part of our immune system, which helps us to fight off infections. There are several different kinds of lymphoma but they are put into two main categories, Hodgkin lymphoma and non-hodgkin lymphoma. In Hodgkin lymphoma a particular abnormal cell is seen under the microscope (the Reed Sternberg cell). Non-Hodgkin lymphomas, which are much more common, are all the lymphomas where this cell is not seen. Lymphoma can be tricky to identify compared with other cancers and many people, looking back, will have had symptoms for weeks or even months before being diagnosed. A few people with Hodgkin lymphoma will have no symptoms at all. There is no one symptom that is unique to Hodgkin lymphoma there are many potential symptoms, depending on what parts of your body are involved. Another problem is that many of the symptoms people experience with Hodgkin lymphoma are symptoms that can also happen with other illnesses. For example, the commonest symptom, a lump in the neck, often happens after you have had an infection in the throat or the mouth. In spite of these difficulties, however, it is possible to say that certain symptoms and particularly certain combinations of symptoms are common in Hodgkin lymphoma. In this article we will describe the most common symptoms and explain why they happen. The symptoms you might have can be: local symptoms, which means that they develop around where the lymphoma is growing, or systemic symptoms, which relate to the impact of the lymphoma on your body as a whole. Local symptoms of Hodgkin lymphoma include: lumps these are enlarged lymph nodes (glands) and are not usually painful chest symptoms cough, breathlessness abdominal symptoms lumps, discomfort or pain, change in bowel habit (eg diarrhoea). 1
The systemic symptoms you might experience are: fevers night sweats weight loss if this is unexplained (eg if you haven t been on a diet) itching fatigue (extreme tiredness) difficulty fighting off infections tendency to bruise or bleed more easily. The first three symptoms in this list fevers, night sweats and unexplained weight loss are called B symptoms. They often occur together, and whether you have these B symptoms or not will be taken into consideration when your medical team is planning your treatment. Local symptoms Enlarged lymph nodes The most common symptom of Hodgkin lymphoma is the appearance of a lump or lumps. Lymphoma typically starts to grow in the lymph nodes. The lymph nodes enlarge because they contain lots of cancerous cells. Because cancer cells don t die in the way that normal cells do, and because they grow more quickly, they collect to form lumps. People with Hodgkin lymphoma will almost always have enlarged lymph nodes somewhere in the body. Some lymph nodes are easier to find than others. For example, an enlarged lymph node in the neck, armpit or groin will be obvious because it is close to the surface. Other lymph nodes, like those in the abdomen or the chest, are not so easy to feel from the outside. These can press on other things to cause pain or irritation, or they might only be detected when you have a scan or an X-ray. People with Hodgkin lymphoma often have enlarged lymph nodes in just one area, quite commonly in the neck and collarbone area. Seven out of ten people diagnosed with Hodgkin lymphoma will have an enlarged lymph node in their neck. About a third of people with Hodgkin lymphoma have lumps in their armpit, and the groin is another common place for the lumps to appear. 2
Some people feel that their enlarged lymph nodes ache a bit, but usually they are not painful unless they are pressing on something else, such as a nerve. In a very small number of people with Hodgkin lymphoma they notice that the lymph nodes become painful after drinking alcohol. Chest symptoms cough and breathlessness If you have enlarged lymph nodes in your chest these can press on the lung tissue and the airways in the chest, causing irritation and a cough. This is quite common in Hodgkin lymphoma almost two-thirds of people will have enlarged lymph nodes in their chest when they are first diagnosed. You can be short of breath if: the pressure of enlarged lymph nodes on your lungs and airways is preventing them from expanding and working properly. This means that your lungs have to work harder to get enough oxygen and this will make you feel short of breath. you are anaemic, meaning that you have a shortage of red blood cells. If your body does not have enough red blood cells, it can t carry sufficient oxygen. This makes you breathe harder your body is compensating by getting more oxygen in. Anaemia is not a very common symptom of Hodgkin lymphoma, but it can happen as a result of lymphoma being present in the bone marrow. Abdominal symptoms If there is any lymphoma in the abdomen, for example in the lymph nodes or in the spleen or liver, this can cause feelings of pressure or pain in the abdomen or a change in bowel habit, such as diarrhoea. You might have a feeling of fullness after eating even small amounts of food. Systemic symptoms About a quarter of people with Hodgkin lymphoma experience the so-called B symptoms of night sweats, fevers and unexplained weight loss. Other systemic symptoms are itching, fatigue, difficulty with shaking off infections and a tendency bleed or bruise easily. Fevers and night sweats The precise explanation for fevers and night sweats is not known. It might be that the presence of cancerous cells in your system causes your immune system to react in a way that is similar to fighting infection. This can result in your temperature going up and down. 3
Having a temperature of over 38 C (over 100.4 F) for several days in a row is considered to be high enough for long enough to be suspicious of what doctors would call fever. Night sweats are sweats that are bad enough to make your nightclothes and bedlinen wet. They might happen because your body detects a rise in temperature and attempts to cool itself off by sweating, something like perspiration. It might be that night sweats happen when you are asleep because you are not aware of feeling hot so you don t do anything about it. Fevers and night sweats could also be a response to some of the abnormal hormones and proteins produced by the cancerous cells your body is reacting to get rid of something that is unknown and unwelcome. Unexplained weight loss An unexplained weight loss means a weight loss of more than a tenth of your total body weight over a period of a few months which happens without you trying to lose weight. Weight loss occurs because the cancerous cells are placing a heavy demand on your system. Your body is using up its resources to feed the cancerous cells and to try and get rid of them. Lymphomas that grow very quickly and place a sudden demand on your body s resources are more likely to make this happen. Itching Itching is a common symptom and up to a third of people with Hodgkin lymphoma will have itching as a symptom. The itching is sometimes just felt in the hands and feet, sometimes over the lower legs. A few people will feel itchy all over their body. It is usually worse in bed at night. The cause of the itch in Hodgkin lymphoma is not known, but it is thought to be due to chemicals that the immune system releases as it reacts against the malignant lymphoma cells. These chemicals, which are called cytokines, irritate nerves in the skin and make it feel itchy. Fatigue Fatigue is a very common experience for people with Hodgkin lymphoma before, during and after treatment. Fatigue is not just feeling a bit tired because you have been busy or exercising it means that you feel exhausted for no apparent reason or feel washed out after doing very little. 4
The precise reasons for feeling fatigue are not known, but it is thought to be the result of a combination of factors, including the impact of the disease on your body s energy resources, the impact of stress and the effects of the treatment. Difficulty shaking off infections Because lymphoma is a disease of your immune system, it can mean that your immune system doesn t work as well as it should. The cancerous white cells that make up the lymphoma are produced at the expense of the good white cells that normally fight infections. This can make you more prone to pick up infections and they might be more severe or last for longer than they would normally. Bruising and bleeding Occasionally the numbers of special blood cells that help with blood clotting (platelets) are reduced when you have Hodgkin lymphoma, though this is unusual. This can show up as nosebleeds, heavy periods in women, or tiny blood spots just under the skin. If you are worried Any symptom or combination of symptoms you have will be considered in light of your individual medical history when you first go to your family doctor or hospital assessment. If your lymphoma comes back after it has been treated it might show up with the same symptoms you had the first time, but you can develop new symptoms. You should always talk to your specialist about any symptom that is worrying you at any stage of your diagnosis, treatment or follow-up. More information This article is based on a Lymphoma Association article, Signs and symptoms of lymphoma and our booklet, Hodgkin lymphoma. For more information, or for a copies of these, visit our website at or telephone the Lymphoma Association s freephone helpline 0808 808 5555. Talk to your key worker if you have any concerns about your health or treatment. The Lymphoma Association cannot provide information about individual diagnosis or treatment. The information provided by the Lymphoma Association is not a substitute for advice from your health professionals. 5
About our publications: The Lymphoma Association is committed to the provision of high quality information for people with lymphoma, their families and friends. We produce our information in accordance with nationally recognised guidelines. These include the DISCERN tool for information about treatments, the NHS Toolkit for producing patient information, and the Campaign for Plain English guidelines. Our publications are written by experienced medical writers, in close collaboration with medical advisers with expertise in the appropriate field. Textbooks and professional journals are consulted to ensure that information is as up to date as possible. References are provided where they have been used. Some publications are written by professionals themselves, acting on guidance provided by the Lymphoma Association. Our publications are reviewed every two years and updated as necessary. Our publications are reviewed by a panel of volunteers with experience of lymphoma. Publications are also reviewed by members of the Lymphoma Association helpline team, who have many years collective experience of supporting those with lymphoma. In some instances, our publications are funded by educational grants from pharmaceutical companies. These sponsors do not have any involvement in the content of a publication. They are not invited to see the content and have no editorial input. Lymphoma Association Views expressed in this publication are those of the contributors. The Lymphoma Association does not necessarily agree with or endorse the comments included here. 6