Lymphoma is a cancer of the lymphatic system, which helps rid the body of waste and unwanted materials. This cancer begins in lymphocytes, a type of white blood cell that is a primary component of the immune system. When abnormal lymphocytes multiply uncontrollably, they collect in lymph nodes or other tissues. Lymphoma can definitively cause chest pain, particularly when the disease originates or spreads to the central chest cavity. This symptom arises from the physical consequences of cell accumulation within the limited space of the chest.
The Mechanism of Lymphoma-Related Chest Pain
Lymphoma frequently involves lymph nodes in the mediastinum, the central chest compartment containing the heart, esophagus, and major blood vessels. Accumulating cancerous lymphocytes form masses that occupy this confined space. This physical compression on nearby organs is the direct source of chest pain experienced by patients with mediastinal lymphoma.
Large tumor masses can press directly against the trachea, causing difficulty breathing, or the esophagus, causing difficulty swallowing. The tumor can also exert pressure on the chest wall or spinal area, leading to pain due to nerve impingement. Pain caused by nerve compression is often described as sharp or radiating.
The growth of lymphoma can also lead to fluid accumulation around the lungs (pleural effusion) or the heart (pericardial effusion), a secondary mechanism for chest pain. Pleural effusion results in sharp, pleuritic pain that worsens with deep breathing or coughing, while pericardial effusion causes pressure or sharp pain as the fluid restricts the heart’s movement.
Recognizing Associated Systemic and Local Symptoms
Chest pain caused by lymphoma is often accompanied by other physical changes, categorized as systemic or localized symptoms. Systemic symptoms, known as B symptoms, are caused by the body’s reaction to the cancer and the release of inflammatory signaling proteins (cytokines).
B symptoms include unexplained fevers lasting several days or weeks, drenching night sweats severe enough to soak clothing or bedding, and unexplained weight loss. Weight loss is defined as losing 10% or more of total body weight over six months.
Localized symptoms relate directly to the mass effect of the lymphoma within the chest cavity. A persistent cough that does not resolve is common because the mass presses on the airways. Shortness of breath (dyspnea) can also occur as the mass restricts lung expansion or compresses the main windpipe.
In severe cases, the tumor may compress the superior vena cava (SVC), the large vein carrying blood from the upper body back to the heart, leading to superior vena cava syndrome. Symptoms include swelling of the face, neck, and upper chest, accompanied by pressure due to reduced blood return. Difficulty swallowing (dysphagia) may also occur if the mass presses on the esophagus.
Distinguishing Lymphoma-Related Pain from Other Causes
Chest pain is a common symptom for numerous conditions, ranging from muscle strain to cardiac events, making medical evaluation important for proper diagnosis. Anyone experiencing new, persistent, or worsening chest pain should seek immediate medical attention. Initial evaluation often begins with tests designed to rule out life-threatening causes, such as an electrocardiogram (ECG) and blood work for cardiac enzyme elevation.
Blood tests look for non-specific markers associated with lymphoma, such as elevated lactate dehydrogenase (LDH) or abnormalities in a complete blood count (CBC). While these changes suggest a broader problem, they do not confirm a cancer diagnosis. Imaging studies are the next step in visualizing the chest cavity and identifying the source of the pain.
A chest X-ray may reveal a mediastinal mass or fluid accumulation, prompting further investigation. A computed tomography (CT) scan or a positron emission tomography (PET) scan provides cross-sectional images that map the location, size, and metabolic activity of abnormal masses. These images clearly show enlarged lymph nodes or masses in the mediastinum that are the likely source of the symptoms.
Although imaging can strongly suggest lymphoma, a definitive diagnosis requires a biopsy. A small sample of the suspicious tissue is removed, often from the enlarged lymph node. A pathologist examines this tissue to confirm the presence of cancerous lymphocytes and determine the exact type of lymphoma, necessary for planning appropriate treatment.