B symptoms
Encyclopedia
B symptoms refer to systemic
Systemic
Systemic refers to something that is spread throughout, system-wide, affecting a group or system such as a body, economy, market or society as a whole. Systemic may also refer to:-In medicine:...

 symptoms of fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

, night sweats, and weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...

 which can be associated with both Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma, previously known as Hodgkin's disease, is a type of lymphoma, which is a cancer originating from white blood cells called lymphocytes...

 and non-Hodgkin's lymphoma. The presence or absence of B symptoms has prognostic significance and is reflected in the staging
Cancer staging
The stage of a cancer is a description of the extent the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to , and whether it has spread to distant organs...

 of these lymphoma
Lymphoma
Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...

s.

Description and nomenclature

B symptoms are so called because lymphoma staging 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
    Pel-Ebstein fever
    Pel-Ebstein fever is a rarely seen condition noted in patients with Hodgkin's lymphoma in which the patient experiences fevers which cyclicly increase then decrease over an average period of one or two weeks...

    , 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.

Prognostic importance

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
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...

 in Hodgkin lymphoma. The relevance of B symptoms in non-Hodgkin lymphoma is less clear, although here also B symptoms tend to correlate with disease that is either more widespread or of a higher histologic grade.

Relative importance of specific B symptoms

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.

"B symptoms" in other diseases

Similar systemic symptoms can be found in non-cancerous states such as tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

 and various inflammatory
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 or rheumatologic
Rheumatology
Rheumatology is a sub-specialty in internal medicine and pediatrics, devoted to diagnosis and therapy of rheumatic diseases. Clinicians who specialize in rheumatology are called rheumatologists...

 conditions. In these settings, the term "B symptoms" is sometimes colloquially applied to refer to such systemic or constitutional symptoms
Constitutional symptoms
Constitutional symptoms refers to a group of symptoms that can affect many different systems of the body.Examples include Weight loss, fevers, fatigue, and malaise.Other examples include chills, night sweats, and decreased appetite....

. However, in a pure sense, the term "B symptoms" is restricted to lymphoma staging.
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