Non-Hodgkin Lymphoma (NHL) Signs and Symptoms

Non-Hodgkin lymphoma refers to a group of cancers that develop in certain white blood cells (lymphocytes), which play a key role in the body’s immune defense. The two main types of NHL are B-cell lymphoma and T-cell lymphoma. While these cancers share many similarities, they differ in several important ways, including their molecular makeup, growth behavior, effects on the body and response to treatment.

NHL is one of the most common blood cancers, accounting for up to 4% of all cancer diagnoses in the United States. Each year, approximately 80,000 new cases are identified.

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Malignant Hematology Program

What are the early warning signs of non-Hodgkin lymphoma?

NHL often develops slowly and may not cause noticeable symptoms in its early stages. The most common sign is painless swelling of the lymph nodes (lymphadenopathy), typically in the neck, armpits or groin. Because these small, bean-shaped glands are part of the immune system, they often become enlarged when the body is fighting an infection. In most healthy individuals, swollen lymph nodes are a normal immune response and not a sign of lymphoma. However, persistent or unexplained swelling should be evaluated by a physician.

What are the symptoms of non-Hodgkin lymphoma?

NHL may cause symptoms that can be seen or felt. In many cases, the signs are subtle at first and may be easy to overlook. Because they are also common in many other conditions, it is important to consult a healthcare professional if they persist or worsen over time.

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What does non-Hodgkin lymphoma look like?

NHL can sometimes cause visible or physical changes in the body. Enlarged lymph nodes may appear as lumps under the skin, most commonly in the neck, armpits or groin. Some individuals may also notice swelling or bloating in the abdomen caused by enlarged organs or lymph nodes in that region. Other visible signs can include unexplained weight loss and, in some cases, skin redness or irritation.

What does non-Hodgkin lymphoma feel like?

In addition to painless lumps that can be felt under the skin, NHL may cause a range of physical sensations and general symptoms throughout the body. These can include:

• Fever
• Headaches
• Itchy skin
• Mental confusion
• Nausea and vomiting
• Night sweats
• Overwhelming fatigue
• Persistent coughing
• Shortness of breath

What are “B symptoms?”

The “B symptoms” of non-Hodgkin lymphoma are a specific group of systemic symptoms that indicate the cancer is affecting the entire body rather than remaining confined to the lymph nodes or a localized area. Typically, B symptoms suggest a more aggressive or advanced disease course and can influence treatment decisions.

The three classic B symptoms of NHL are:

• Fever – A persistent body temperature above 100.4°F that is not related to an infection
• Drenching night sweats – Profuse sweating that soaks clothing and bedding, occurring independently of room temperature or physical exertion
• Unexplained weight loss – Losing more than 10% of body weight within six months or less, without any changes in diet or physical activity

The presence of B symptoms can help the physician determine the stage of the lymphoma. Staging classifications often include the letters “A” or “B” to indicate whether B symptoms are absent or present. For instance, a diagnosis of “Stage 3B” lymphoma means stage 3 lymphoma accompanied by B symptoms.

Can the signs and symptoms of non-Hodgkin lymphoma vary based on the subtype?

NHL can present in many different ways depending on the specific subtype. Because each subtype has its own growth rate and pattern, symptoms may range from gradual and mild to sudden and severe.

Symptoms of low-growing (indolent) lymphoma

Indolent lymphomas, such as follicular lymphoma and marginal zone lymphoma, typically progress slowly, and symptoms may go unnoticed for a long time. In some cases, the condition is discovered incidentally during a routine physical exam or imaging test performed for another reason.

Common symptoms of slow-growing lymphoma include:

• Painless lymph node swelling in the neck, armpits or groin
• Unusual fatigue or weakness
• Occasional fever or night sweats
• Unexplained weight loss over time

Although these symptoms may be mild at first, ongoing monitoring will be important to track any changes in the cancer.

Symptoms of fast-growing (aggressive) lymphoma

Aggressive lymphomas, such as diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma, often develop quickly and cause more noticeable, whole-body symptoms. These cancers require a prompt diagnosis and treatment.

Common symptoms of fast-growing lymphoma include:

• Rapidly growing lymph nodes that may become painful
• Persistent fever or drenching night sweats
• Significant weight loss
• Fatigue or weakness that worsens over time
• Pain or pressure in the chest, abdomen or bones

Symptoms based on where the lymphoma originated

The signs of non-Hodgkin lymphoma can vary based on the affected area of the body:

• Abdomen – Bloating, discomfort and a sensation of fullness after a small meal
• Brain or spinal cord – Headaches, confusion and neurological changes
• Chest – Coughing, shortness of breath and chest pain
• Skin – Itchy patches, bumps and rashes, particularly in cases of cutaneous T-cell lymphoma

When is it important to discuss non-Hodgkin lymphoma symptoms with a physician?

You should see a physician right away if you notice possible NHL symptoms that persist, worsen or lack an obvious cause. While many lymphoma symptoms may be related to a mild infection or another more common health condition, ongoing or unexplained changes should be evaluated by a physician.

Even if the symptoms are mild, the physician can determine whether additional testing—such as blood work or imaging—may be necessary. An early evaluation is essential to ensure an accurate diagnosis and timely treatment, which is especially important for aggressive lymphoma subtypes that can progress rapidly.

What are some frequently asked questions (FAQs) about non-Hodgkin lymphoma signs and symptoms?

Because NHL can appear in several different ways depending on its subtype, location and growth rate, many people have questions about what to look for and when to see a physician. Here are answers to some of the most frequently asked questions about the signs and symptoms of non-Hodgkin lymphoma:

Can I have non-Hodgkin lymphoma without any symptoms?

Yes. Early-stage lymphoma may not cause noticeable symptoms. This is especially common with slow-growing types of NHL. As the cancer progresses, symptoms such as swollen lymph nodes, fatigue, fever and night sweats may begin to develop.

To support early detection, it is important to have regular medical checkups and report any persistent or unusual changes to a physician. A prompt evaluation can help identify lymphoma before it advances.

Are swollen lymph nodes always a sign of cancer?

No. Most swollen lymph nodes are not caused by cancer. In fact, lymphadenopathy is quite common and often indicates that the body’s immune system is working hard to fight an infection, such as the common cold, strep throat or sinusitis.

However, if lymph nodes continue to enlarge or remain swollen for more than two to four weeks, it is important to have them evaluated by a physician. Persistent swelling—especially when painless or accompanied by other symptoms, such as fever or unexplained weight loss—may require further testing to rule out lymphoma and other underlying conditions.

What do cancerous lymph nodes feel like?

Cancerous lymph nodes are typically painless, firm and rubbery to the touch. Rather than moving easily under the skin, they may feel fixed or immobile. In contrast, lymph nodes enlarged due to an infection are often soft, tender and sometimes painful.

In non-Hodgkin lymphoma, enlarged lymph nodes most commonly appear in the neck, armpits or groin, but they can also develop deeper in the chest or abdomen, where they cannot be felt during a physical examination.

Why does non-Hodgkin lymphoma cause night sweats?

Night sweats are one of the classic B symptoms of NHL. They occur when lymphoma activity triggers the immune system to release cytokines. Normally released in response to a perceived threat, such as a pathogen, these cell-signaling proteins act as chemical messengers, instructing the brain’s hypothalamus to increase the body’s thermal set point, thereby triggering a fever. In an effort to cool itself down, the body may produce excessive sweat, often resulting in drenching night sweats that soak clothing and bedding.

Are there any other conditions that can mimic the symptoms of non-Hodgkin lymphoma?

Yes. Several other conditions can produce symptoms similar to those of NHL, including:

• Viral and bacterial infections, such as mononucleosis (mono), human immunodeficiency virus (HIV) and tuberculosis (TB)
• Autoimmune disorders, such as lupus and rheumatoid arthritis
• Other cancers that spread to the lymph nodes
• Chronic fatigue syndrome

Because these conditions can have overlapping symptoms, an accurate diagnosis often requires blood work, imaging studies and sometimes a lymph node biopsy to confirm or rule out lymphoma.

Benefit from world-class care at Moffitt Cancer Center

Non-Hodgkin lymphoma can be challenging to detect because its early symptoms are often subtle and easily missed. The multispecialty team in Moffitt’s renowned Malignant Hematology Program focuses exclusively on diagnosing and treating NHL and other blood cancers. We develop a tailored treatment plan for each patient, overseeing all aspects of their care in a single location.

As the only National Cancer Institute-recognized Comprehensive Cancer Center based in Florida, Moffitt is nationally known for its groundbreaking research. Through our robust clinical trials program, we offer our patients early access to leading-edge lymphoma treatments before those options are made widely available in other settings.

If you would like to learn more about non-Hodgkin lymphoma signs and symptoms, you can request an appointment with a specialist in our Malignant Hematology Program by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.