Pathophysiology
- Hodgkin lymphoma (HL): Large, malignant, multinucleate Reed-Sternberg cells are the diagnostic hallmark. Progresses in a predictable, organized pattern from a single node or chain. One of the most treatable cancers
- Non-Hodgkin lymphoma (NHL): Over 60 subtypes lacking Reed-Sternberg cells. Less predictable. Often originates at extranodal sites
- Mutated lymphocytes replicate uncontrollably, enlarge lymphoid tissues, and crowd out functional blood cells (causing anemia)
- Staging (I-IV) based on number of nodal regions affected and whether cancer has crossed the diaphragm or invaded distant organs
- Lymphoma can metastasize to bones, making them brittle
- NHL is an AIDS-indicator disease; EBV/mononucleosis and autoimmune conditions are also risk factors
Signs and Symptoms
Hallmark Indicators
- Painless, nontender swelling of lymph nodes (neck, axilla, groin). Nodes feel enlarged, firm, and fixed
- "B" symptoms: Unexplained fever, drenching night sweats, significant weight loss
- Persistent itching (pruritus) or unexplained rashes (common in Hodgkin lymphoma)
- Profound fatigue and low stamina (secondary anemia)
- Abdominal pain or fullness/loss of appetite (extranodal tumors or splenomegaly)
Red Flags and Rule-Outs
- Painless, firm, fixed lymph nodes persisting >2 weeks: Malignancy must be ruled out — refer
- "B" symptoms: Indicate systemic disease involvement
- Any lump >5 cm or intractable pain not improving with rest: Immediate referral
- Areas of numbness or paresthesia: Tumor compressing nerves — risk of overtreatment where sensation is impaired
- Distinguish malignant nodes (fixed, firm, nontender) from infectious nodes (mobile, tender, soft)
MT Considerations
- "It Depends" rule: Decisions are based on the client's clinical presentation, not just the diagnosis
- Rigorous massage: Massage demanding a significant adaptive response may be too taxing for active lymphoma patients
- Benefits: Expertly performed gentle massage improves sleep, reduces anxiety/depression, and alleviates pain and nausea
- Avoid: Direct pressure on known tumor sites, undiagnosed lumps, or vicinity of involved lymph nodes
- Bone metastasis: Lymphoma can metastasize to bones. Adjust pressure and positioning accordingly
- Lymphedema risk: Node surgery or radiation creates lifelong risk of protein-rich fluid accumulation
- Active treatment: During chemotherapy/radiation, massage should be short, gentle, and non-circulatory (see chemotherapy and radiation-therapy)
CMTO Exam Relevance
- Reed-Sternberg cells are the diagnostic hallmark of Hodgkin lymphoma
- NHL lacks Reed-Sternberg cells and is less predictable in spread pattern
- "B" symptoms (fever, night sweats, weight loss) are key constitutional signs
- Painless, firm, fixed lymph nodes are characteristic of malignancy vs. mobile, tender infectious nodes
- NHL is an AIDS-indicator disease
- Staging I-IV depends on nodal regions and whether cancer has crossed the diaphragm
Key Takeaways
- Lymphoma divides into Hodgkin (Reed-Sternberg cells, organized spread) and Non-Hodgkin (60+ subtypes, less predictable)
- Painless, firm, fixed lymph node enlargement is the hallmark. "B" symptoms indicate systemic involvement
- During active treatment, sessions should be short, gentle, and non-circulatory
- Lymphedema is a lifelong risk following lymph node surgery or radiation
- NHL is an AIDS-indicator disease. EBV/mononucleosis and autoimmune conditions are also risk factors