Non-Hodgkin’s Lymphoma: Recognizing Early Head and Neck Symptoms

Non-Hodgkin’s lymphoma often begins with subtle symptoms in the head and neck region, such as painless swelling of lymph nodes, a persistent sore throat, or difficulty swallowing. Early detection of these signs is vital for prompt diagnosis and effective treatment.

This cancer arises when lymphocytes, a type of white blood cell, grow abnormally. While it typically starts in lymph nodes or lymphatic tissue, it can also originate in the skin.

Non-Hodgkin’s lymphoma is one of the two main lymphoma types, distinguished from Hodgkin’s lymphoma by the microscopic appearance of cancer cells.

It ranks as the third most frequent cancer affecting the head and neck areas. According to the American Cancer Society, it represents about 4% of all cancer cases in the U.S.

Swelling of lymph nodes on the side of the neck is a common early indicator. Depending on the lymphoma’s location, you may also experience headaches, dizziness, or a sore throat.

Continue reading to explore the early warning signs of non-Hodgkin’s lymphoma impacting your head and neck.

What Are the Initial Symptoms of Non-Hodgkin’s Lymphoma?

The hallmark early symptom is swollen lymph nodes caused by an accumulation of abnormal lymphocytes.

These swollen nodes are usually painless and feel like soft or rubbery lumps that move slightly when touched. The neck, armpits, and groin are common areas where these lumps appear. Notably, the neck contains roughly 300 of the body’s 800 lymph nodes.

Additional Symptoms in the Head and Neck

With over 60 identified subtypes of non-Hodgkin’s lymphoma, symptoms can vary widely. If the lymphoma involves the central nervous system, symptoms may include:

• Headaches
• Cognitive changes
• Seizures

Signs of Extranodal Lymphoma

When lymphoma spreads beyond lymph nodes, it is termed extranodal lymphoma, occurring in 10% to 35% of cases at diagnosis.

Approximately half of extranodal lymphomas in the head and neck develop in Waldeyer’s ring, which includes the tonsils and lymphatic tissue lining the throat. Symptoms here may include:

• Difficulty swallowing
• Sore throat
• Unilateral tonsil enlargement

Other symptoms near the throat and nasal areas might be:

• Enlarged neck lymph nodes
• Nasal congestion or blockage
• Hearing impairment

Oral Lymphoma Symptoms

Lymphoma can also manifest inside the mouth, particularly in individuals with HIV. Symptoms include painful ulcers and swelling.

Rarely, lymphoma may develop at the tongue’s base, causing:

• A choking sensation while drinking
• Feeling of a foreign object in the mouth
• Restricted tongue movement
• Difficulty swallowing
• Limited tongue control

Lymphomas account for 1.7% to 3.1% of salivary gland cancers, with symptoms including:

• Lumps or swelling in the mouth, cheek, neck, or jaw
• Persistent pain in these regions
• Facial numbness
• Difficulty opening the mouth fully

Common General Symptoms of Non-Hodgkin’s Lymphoma

The accumulation of abnormal lymphocytes can suppress healthy blood cells, leading to symptoms such as:

• Chills
• Easy bruising and bleeding
• Fatigue
• Frequent or severe infections
• Shortness of breath
• Chest discomfort or pressure
• Loss of appetite
• Abdominal swelling
• Itching

Advanced Symptoms of Non-Hodgkin’s Lymphoma

As lymphoma progresses, “B symptoms” may develop, including:

• Unexplained fever above 100.4°F (38°C)
• Night sweats severe enough to soak bedding
• Unintentional weight loss exceeding 10% of body weight within six months

Other Causes of Swollen Lymph Nodes

Most swollen lymph nodes result from infections and usually resolve once the infection clears.

Other causes for lumps under the skin include cysts and lipomas.

Here’s a comparison of lymphoma symptoms versus infection symptoms:

When to Consult a Doctor

The UK’s National Health Service advises seeing a doctor if:

• Swollen lymph nodes continue to enlarge or persist beyond two weeks
• Nodes feel hard or immobile when pressed
• Night sweats or high fever last more than 3–4 days
• No other signs of infection or illness are present
• Swollen nodes appear above or below the collarbone

Diagnosing Non-Hodgkin’s Lymphoma

Your primary care physician will begin with a symptom review, medical history, and physical exam.

If lymphoma is suspected, further tests may include:

• Lymph node biopsy: The definitive test involving tissue removal from a lymph node for laboratory analysis.
• Bone marrow aspiration and biopsy: Sampling bone marrow to detect cancer involvement.
• Spinal tap: Checking cerebrospinal fluid for lymphoma cells.
• Imaging studies: X-rays, CT, PET, or MRI scans to assess cancer spread and treatment response.
• Blood tests: To evaluate cancer progression and exclude other conditions.

Next Steps After Diagnosis

Following diagnosis, additional testing helps identify the lymphoma subtype. Together with your healthcare team, you will determine the most suitable treatment plan.

Your multidisciplinary team may include:

• Oncologists
• Radiologists
• Dermatologists
• Nurses and nurse practitioners
• Clinical social workers

Treatment Approaches

Therapy depends on cancer type, stage, aggressiveness, and overall health, often involving:

• Chemotherapy
• Immunotherapy
• Targeted drug therapy
• Radiation therapy
• Stem cell transplantation
• Surgery

Support Resources

Support groups can provide valuable assistance. Your doctor may refer you to local groups, or you can explore organizations such as:

• CancerCare
• Leukemia & Lymphoma Society
• Cancer Support Community
• Lymphoma Support Network
• American Cancer Society

Summary

The earliest sign of non-Hodgkin’s lymphoma is typically a painless swollen lymph node, often in the neck, armpit, or groin.

While most swollen lymph nodes are due to infections rather than cancer, persistent or growing lumps warrant medical evaluation.

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