What does it feel like to have lymphoma? The classic symptoms are swollen lymph nodes and night sweats. But the signs can be very different, depending on where the cancer is growing. Symptoms can also be very subtle at first—ranging from fatigue to getting a lot of colds—making it harder to get diagnosed in the cancer’s earliest stages. If the symptoms below sound familiar, make an appointment with your doctor, just to be safe.
What Is Lymphoma, Again?
Lymphoma is a cancer of the blood and the lymphatic system—part of your body’s germ-fighting setup that includes lymph nodes (like the ones in your neck that get swollen when you have a bad cold), the spleen, bone marrow, and an immune gland in the chest called the thymus.
Lymphoma starts when infection-fighting white blood cells called lymphocytes mutate and start to grow out of control.
There are more than 70 different “subtypes” of lymphoma, but all of them fall under two main categories: Hodgkin’s lymphoma—which used to be called “Hodgkin’s disease” after Thomas Hodgkin, the doctor who first described it in 1832—and non-Hodgkin lymphoma.
An estimated 8,000 Americans are diagnosed with Hodgkin’s lymphoma each year, and about 74,000 will be diagnosed with NHL.
Lymphoma is serious, but it also has a really high survival rate: Today, someone diagnosed with Hodgkin’s lymphoma has an 87% chance of living another five years or more. The average five-year survival rate for people with non-Hodgkin lymphoma is 71%.
And if you’re diagnosed early, even better—five-year survival is 92% for Hodgkin’s and 82% for NHL. For that reason, it’s super-important to pay attention to any early indications of the disease, and to talk with your doctor if you think something’s not right. So, what might those indications be?
Symptoms of Lymphoma
Of the dozens of different subtypes of lymphoma, which one you have can affect how quickly symptoms come on and how sick you feel. Many people with this disease may not have any symptoms at first; or the symptoms might be so mild that you pass it off as having a cold or flu. That said, there are some classic signs that should raise red flags.
Respiratory Symptoms of Lymphoma
Lymphoma cells release substances that can increase body temperature, leading to a low fever that may come and go. It’s easy to write it off as a common cold or flu, but if it keeps happening, it could be more than that.
Lymphoma can masquerade as a bad cold in other ways, too: If the cancer cells are growing within lymph nodes in the chest, they may swell and lead to coughing and a feeling of tightness or pressure, or pain behind the breastbone. There’s also a rare type of lymphoma that grows within the actual lining of the lungs, which sometimes causes coughing and chest tightness.
Lymphoma and Weight Loss
Unexplained weight loss is a symptom in many types of cancers. If your body is using up energy and resources trying to fight off cancer, you can lose weight rapidly without trying. A couple of pounds aren’t a big deal, but if you have lost anywhere close to 10% of your body weight—that’s 15 pounds for 150-pound person, 25 pounds for a 250-pound person and so on—over the course of several months without trying, you should talk to your doctor ASAP.
Night Sweats and Lymphoma
Some people with lymphoma wake up with their sheets soaked from drenching night sweats. Doctors aren’t exactly sure how or why the cancer causes sweating, but it may be triggered by certain chemicals the cancer cells make. Sometimes people with lymphoma will sweat heavily during the daytime, too.
The lymphocytes that cause lymphoma are mostly found in the lymph nodes, but they’re also located in “lymphoid” tissues in other places in the body, including the skin. Skin lymphoma symptoms can range from eczema-like patches to pimply, red rashes. Sometimes, patches of skin can thicken and become crusty and itchy. Early-stage lymphoma rashes may just look like small patches of red, dry skin.
Other Symptoms of Lymphoma
- Bruising and bleeding. Healthy bone marrow produces all of your body’s white and red blood cells and blood platelets, tiny blood cells that help your blood clot after an injury. But if lymphoma cells have started growing inside the bone marrow, they can crowd out the healthy tissue, leading to slower production of platelets. In turn, that makes you more susceptible to bruising and can lead to excessive bleeding from little cuts and scrapes.
- Infections. Lymphoma can also lower your number of germ-fighting white blood cells, raising your risk for all kinds of infections, including respiratory ailments, earaches, and even stomach bugs.
- Itchiness. Occasionally, Hodgkin’s lymphoma can cause your skin to itch. Some people notice it on their feet, lower legs, or hands; others have it all over their bodies. Usually, there’s no visible skin rash involved, or any other obvious cause for the itchiness. Doctors think it may be triggered by cytokines, immune chemicals your body releases to fight off the cancer.
- Pain after drinking alcohol. One uncommon, but very specific, symptom of lymphoma: Some people with the illness feel pain or soreness in their lymph nodes after drinking alcohol. (Doctors aren't sure why this happens, but it appears to be related to the dilation of blood vessels after drinking.)
- Pain or swelling around breast implants. Textured breast implants, as opposed to the kind with smooth outer shells, are linked to a very rare type of lymphoma called breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL). It grows in the scar tissue around the implant and may spread to nearby lymph nodes. Symptoms include breast swelling, pain in and around the implant, and/or a lump near the implant.
- Swollen belly. If lymphoma cells have attacked your spleen or the lymph nodes in your stomach, it can lead to abdominal swelling.
How Do Doctors Diagnose Lymphoma?
Getting diagnosed with lymphoma can be a bit more challenging than it is with some other cancers. Some blood and bone marrow cancers, such as multiple myeloma, show up right in the blood—so diagnosis often starts with a simple blood draw. Although your doctor may run some blood tests on you to rule out other conditions, lymphoma usually can’t be diagnosed through the blood.
Instead, your doctor will likely start with a physical exam and biopsy to see if you have the disease.
During your exam, your doctor will pay close attention to any lumps or swollen areas and will probably poke and press on lymph nodes in your neck, under your arms, around your collar bones, and possibly in the groin. Your physician will also likely want to feel your abdomen for any signs of a swollen spleen, an organ that’s part of the lymphatic system.
Your doctor will surgically remove a bit of tissue, or sometimes an entire lymph node, and send it to a lab to be tested. Lymphoma testing requires a fairly large sample compared to some other cancers, which is why your doc may use a scalpel instead of a needle for the biopsy.
Still, it’s a minimally invasive procedure and can be done quickly in-office if the area your doctor wants to biopsy is near the surface and easy to access (you’ll get some numbing medication first). If the area is deep in your chest or abdomen, you may need to be put to sleep for the procedure.
If only part of a lymph node or other tissue is taken out, it’s called an incisional biopsy. If an entire lymph node is removed, it’s called an excisional biopsy.
Over your diagnosis journey, your doctor may order total blood count tests or imaging tests such as CT scans in order to determine how far the lymphoma has spread and help stage the disease. In some cases, a doctor may want to take a closer look at a concerning area with a CT or PET scan before doing a biopsy.
Being diagnosed with lymphoma is scary, but if there’s a silver lining, it’s knowing that your journey to getting better starts with identifying what’s wrong. And to get to that step, you need to pay attention to signs that could indicate cancer. Of course, having any of these symptoms (or more than one) is no guarantee of lymphoma. But if you’re concerned, or something just doesn’t feel right, it’s always best to check with your doctor to be sure.