Non-Hodgkin Lymphoma Symptoms and Signs

July 13, 2024

This page was reviewed under our medical and editorial policy by Alex Herrera, M.D., associate professor, division of lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope^® Cancer Center Duarte

Not all non-Hodgkin lymphoma (NHL) patients experience symptoms. Some patients won’t experience any symptoms until lymphoma cells have grown a lot or spread.

But sometimes, NHL is discovered during a routine checkup or during treatment or blood testing for another unrelated illness before patients notice any symptoms.

If patients do have symptoms, they might be mistaken for other more common conditions, such as an infection.

Symptoms of Non-Hodgkin Lymphoma

It is important that patients experiencing any of the following symptoms have them checked by a doctor.

Enlarged lymph node(s): Lymphomas affect the lymph system, which is why enlarged lymph nodes may occur with NHL. The lymph system is the network of lymph tissue found throughout the body that, along with certain blood cells, make up the body’s immune system.

Painless swelling of one or more lymph nodes is often the first sign of NHL. Typically, swollen lymph nodes are in the neck, armpit or groin. Occasionally, enlarged lymph nodes are seen first near the ears, elbow or in the throat.

NHL may start in places other than the lymph nodes. Sometimes, it starts in bone, a lung, the skin or the digestive tract. Patients may experience symptoms that are specific to the site where the cancer has begun.

Patients may also have other symptoms of NHL, such as those listed below.

Fever that has no obvious cause: Fevers may start and stop and last for days or even several weeks.

Frequent or severe infections: Patients may experience chills and/or night sweats that may be drenching.

Fatigue that won’t go away: This may result from low blood cell counts.

Weight loss without explanation: Losing 10% of body weight without trying over a half-year or so may be an indication of lymphoma.

Cough or chest pain or pressure: Lymphoma that starts in the thymus gland or lymph nodes of the chest may press on the windpipe, making breathing difficult. It may also cause coughing and chest pain or pressure.

Pain or swelling in the abdomen: This may happen when lymphomas grow in the belly. Pain or swelling may also occur from enlarged lymph nodes or abdominal organs such as the spleen or liver. Lymphomas may also cause a buildup of fluid in the abdomen, causing discomfort and pain. Patients may feel bloated or full after eating very little.

Loss of appetite: When the liver and spleen swell, they may press on the stomach area and lead to loss of appetite.

Nausea or vomiting: Lymphomas in the stomach or intestines may cause these symptoms.

Skin lumps: When enlarged lymph nodes are close to the surface of the body, patients may feel them as lumps. Typically, they are not painful. They most often develop on the sides of the neck, in the groin or underarms, and above the collarbone.

Itching: This symptom may be caused by painless lumps or bumps that form under the skin.

Bruising or bleeding easily: When patients have lymphoma cells in their bone marrow, changes in the number of blood cells may occur. Low platelets, for instance, may lead to excessive bleeding, unusual bruising and visible spots of blood under the skin.

Mental changes: Headaches, trouble concentrating and seizures may accompany lymphomas of the brain. Called primary brain lymphomas, they may also cause personality changes.

B Symptoms of Non-Hodgkin Lymphoma

When three symptoms — fever, drenching night sweats and significant weight loss over six months — happen at the same time, they are called B symptoms. These B symptoms are important to staging a patient’s disease and to determining his or her prognosis.

A rare syndrome, causing a cluster of symptoms, may also occur in people with NHL.

Superior vena cava syndrome (SVCS): The superior vena cava is a large vein that carries blood from the upper body back to the heart. If the superior vena cava becomes blocked from lymphoma in the chest area, patients may have swelling in the head, arms and upper chest. Patients may also have difficulty breathing and could lose consciousness. This is considered a life-threatening emergency.

Non-Hodgkin Lymphoma Signs

Signs of a disease are different from symptoms. Symptoms are evidence of disease experienced by a patient; signs are evidence of disease based on a doctor’s objective examinations, measurable tests and medical investigation. Blood tests may uncover signs of non-Hodgkin lymphoma, such as an enlarged spleen or anemia. Doctors know that patients who have lymphoma cells in their bone marrow are at risk for anemia, a shortage of hemoglobin or red blood cells in the bloodstream. The reason is that the lymphoma cells take up space in the marrow and crowd out healthy blood cells that should be forming there. 

Low blood platelets or low white blood cells may also be signs that a lymphoma is growing in the patient’s bone marrow and affecting their ability to form new blood cells. In blood test results, the numbers and ratios of different blood cells are abnormal if this happens. These altered blood counts may be the cause of fatigue and other symptoms.

Measurable signs, along with symptoms that patients can see and feel, may indicate lymphoma. However, other tests may be performed to make a definitive non-Hodgkin lymphoma diagnosis.