Lymphoma of the Neck: Signs and Symptoms

Lymphoma is a cancer of the b- and t-cell lymphocytes, part of the immune system. They account for the most frequent head and neck malignancies. The two major classifications are Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). Because it is a broad category of disease rather than a single, concrete disorder, head and neck lymphomas will present in a variety of ways and may have vastly different outcomes depending on location, severity, age of the patient, and other factors.

Signs and Symptoms of Lymphoma in the Neck

The most common of the symptoms of lymphoma of the neck is an enlargement of one or more lymph nodes. These swollen nodes are not usually sensitive or tender, and tend to occur in a single localized region. Hodgkin’s in the neck is almost exclusively limited to the lymph nodes, while NHL can be either nodal or extranodal. NHL also tends to occur submucosally, or deeper in the tissues of the neck than things like squamous cell carcinoma.

In addition to these primary symptoms of lymphoma of the neck, there are a number of systemic symptoms that may occur in a minority of cases. These include night sweats, weight loss, and chronically low energy levels. Also, specific symptoms will present depending on the area of primary involvement. For example, lymphoma in the tonsils will appear as a sore throat, while a tumor in the larynx may cause hoarseness or breathing problems, and one in the sinuses will cause sinusitis.

Diagnosis of Lymphoma in the Neck

To test for lymphoma of the neck, the doctor will try to obtain an excisional biopsy of one the enlarged nodes. This means that a slice of an enlarged node will be removed, intact, and will be sent to a pathologist for immediate processing. It is important to conduct the analysis quickly because that allows better differentiation between normal healthy cells and fast-growing cancer cells. Additionally, an excision is preferable to the other common option, fine needle aspiration, because it preserves the cellular structure for analysis.

Staging of Lymphoma in the Neck

A positive diagnosis will typically include an attempt to stage the disease (i.e., to determine how far it has progressed). This is more important for HL forms because each stage has a distinct treatment protocol developed for best outcomes. In addition, for both Hodgkin's disease and NHL, each stage carries a different prognosis and projected survival rates.

To determine the staging of a particular case, the doctor will examine the following factors:

• Patient history
• Physical exam
• Blood tests and lab work
• X-rays
• Invasive biopsies

The patient will then be assigned a stage on a scale of I (single node involvement) to IV (diffuse involvement of multiple sites/organs). It is this staging that will determine next treatment steps.

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