Bury the Buzzword: B Symptoms

“B symptoms” is a buzzword used to describe the systemic (constitutional) symptoms of:

·        Fever (unexplained, > 38⁰C or > 100.4⁰F)

·        Night sweats (soaking)

·        Weight loss (> 10% over past 6 months)

These symptoms are used in the Ann Arbor Staging Classification for Hodgkin’s disease and non-Hodgkin’s lymphoma, published in Cancer Research in 1971. The letter is used following the numerical numbering to complete the classification. However, that was not the first time the letter “B” was used in the staging system.

The Ann Arbor committee that met in 1971 revised the original Rye Classification for Hodgkin’s disease, published in Cancer in 1966. The Rye system was the first to come up with the sub-classifications for stages I-IV. The letter “A” was used if systemic symptoms were absent, and the letter “B” was used if systemic symptoms were present. The “B symptoms” in this classification were different and included fever (unexplained), night sweats, and pruritus. The Ann Arbor committee decided to remove pruritus and add weight loss to the “B symptoms” definition.

I think that the above history of how the term “B symptoms” came to be is very interesting. Knowing some additional background information can help in memorization, because now the term can be put into context.

A mnemonic to help remember the difference between the “A” and “B” symptoms is the following:

The letter “A” is used when the symptoms are Absent

The letter “B” is used when the symptoms are Bothersome

A mnemonic to help remember the three components of the “B symptoms” is with the saying “These Bothersome symptoms give the patient Wednesday Night Fever!”

Congratulations, you have just buried another buzzword!

Sources:

Carbone, Paul P., Henry S. Kaplan, Karl Musshoff, David W. Smithers, and Maurice Tubiana. "Report of the Committee on Hodgkin's Disease Staging Classification." Cancer Research 31 (1971): 1860-861. Cancer Research. American Association for Cancer Research. Web. 13 Dec. 2011. <http://cancerres.aacrjournals.org/content/31/11/1860.long>.

Lukes, Robert J., James J. Butler, and Ethel B. Hicks. "Natural History of Hodgkin's Disease as Related to Its Pathologic Picture." Cancer 19.3 (1966): 317-44. Wiley Online Library. 23 June 2006. Web. <http://onlinelibrary.wiley.com/doi/10.1002/1097-0142%28196603%2919:3%3C317::AID-CNCR2820190304%3E3.0.CO;2-O/abstract>.

Newton, K. A., D. H. Mackenzie, Margaret F. Spittle, and Anna Mikolajczuk. "Hodgkin's Disease A Clinico-Pathological Study of 250 Cases with a 5-Year Follow-up." British Journal of Cancer 27.1 (1973): 80-91. PubMed. Web. 13 Dec. 2011. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2008821/?tool=pubmed>.

Weinkove, Robert. "Ann Arbor Staging." BloodRef.com. Web. 13 Dec. 2011. <http://www.bloodref.com/lymphoma/ann-arbor-staging>.