B symptoms are a set of symptoms, namely fever, night sweats, and unintentional weight loss, that can be associated with both Hodgkin lymphoma and non-Hodgkin lymphoma. These symptoms are not specific to lymphomas, especially each one considered individually, and even as a trio they are not pathognomonic for lymphomas, but the presence of the trio is sensitive enough for lymphomas to warrant diagnostic investigation and differential diagnosis. The presence or absence of B symptoms has prognostic significance in lymphomas and is reflected in their staging.
B symptoms are so called because Ann Arbor staging of lymphomas includes both a number (I–IV) and a letter (A or B). "A" indicates the absence of systemic symptoms, while "B" indicates their presence.
B symptoms include:
Fever greater than 38 °C. Pel–Ebstein fever, the classic intermittent fever associated with Hodgkin disease, occurs at variable intervals of days to weeks and lasts for 1–2 weeks before resolving. However, fever associated with lymphoma can follow virtually any pattern.
Drenching sweats, especially at night.
Unintentional weight loss of >10% of normal body weight over a period of 6 months or less.
The presence of B symptoms is a marker for more advanced disease with systemic, rather than merely local, involvement. B symptoms are a clear negative prognostic factor in Hodgkin lymphoma. The relevance of B symptoms in non-Hodgkin lymphoma is less clear, although B symptoms tend to correlate with disease that is either more widespread or of a higher histologic grade.
It has been suggested that, in Hodgkin lymphoma, fever and weight loss are much more prognostically significant than night sweats. In one series of patients with early-stage Hodgkin disease, the presence or absence of night sweats had no impact on cure rates and outcome. However, fever and weight loss had a pronounced negative impact on cure and survival rates, regardless of treatment modality.
Similar systemic symptoms can be found in non-cancerous states such as tuberculosis and various inflammatory or rheumatologic conditions.
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Night sweats or nocturnal hyperhidrosis is the repeated occurrence of excessive sweating during sleep. The person may or may not also perspire excessively while awake. One of the most common causes of night sweats in women over 40 is the hormonal changes related to menopause and perimenopause. This is a very common occurrence during the menopausal transition years. Over 80% of women experience hot flashes, which may include excessive sweating, during menopause. Night sweats range from being relatively harmless to a sign of underlying disease.
Hodgkin lymphoma (HL) is a type of lymphoma in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells (RS cells) are present in the patient's lymph nodes. The condition was named after the English physician Thomas Hodgkin, who first described it in 1832. Symptoms may include fever, night sweats, and weight loss. Often, nonpainful enlarged lymph nodes occur in the neck, under the arm, or in the groin. Those affected may feel tired or be itchy.
Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using values between in humans. The increase in set point triggers increased muscle contractions and causes a feeling of cold or chills. This results in greater heat production and efforts to conserve heat. When the set point temperature returns to normal, a person feels hot, becomes flushed, and may begin to sweat.
Lymphomas are a group of heterogeneous blood cancers that arise from lymphocytes. The two primary clinical classifications of lymphomas are Hodgkin's lymphoma (HL), and non-Hodgkin's lymphoma (NHL). In particular, B-cell lymphoma refers to the malignancies ...