Doctor checking patient for diffuse large B-cell lymphoma symptoms

Diffuse large B-cell lymphoma is a type of cancer that affects the lymphatic system, a large network of lymph nodes, vessels, organs and tissues that maintains the body’s fluid levels and helps fight off infection. The most common form of non-Hodgkin lymphoma, diffuse large B-cell lymphoma tends to be aggressive and currently accounts for approximately 22% of newly diagnosed cases. Although it affects people of all ages, it is more common in adults 60 and older.

What are the symptoms of diffuse large B-cell lymphoma?

The hallmark sign of diffuse large B-cell lymphoma is one or more painless lumps that can be felt in the neck, armpits, groin or abdomen. These enlarged lymph nodes tend to grow quickly and can cause other symptoms based on their location. For example, lymph node swelling in the chest can cause coughing and shortness of breath, while lymph node swelling in the abdomen can cause nausea, vomiting and diarrhea. Some people also experience “B symptoms,” which are frequently associated with lymphoma and include fever, night sweats and unintended weight loss.

What causes diffuse large B-cell lymphoma?

Like all types of lymphoma, diffuse large B-cell lymphoma occurs when certain infection-fighting white blood cells (B cells) undergo abnormal changes that cause them to grow and divide very rapidly. The abnormal B cells are larger than healthy B cells and tend to spread out (diffuse) rather than bind together. Both characteristics can be seen when the cells are viewed under a microscope.

In most cases, the causes of diffuse large B-cell lymphoma are unknown, although scientists have identified a possible link to a weakened immune system. Therefore, certain medical conditions, such as rheumatoid arthritis, systemic lupus erythematosus and human immunodeficiency virus (HIV), can increase the risk. Additionally, the malignancy sometimes develops in individuals who took antirejection drugs (immunosuppressants) after an organ transplant and those who had a low-grade form of lymphoma in the past.

How is diffuse large B-cell lymphoma diagnosed and staged?

If diffuse large B-cell lymphoma is suspected based on the symptoms, a physician will order a biopsy, which is necessary to reach a definitive diagnosis. A biopsy involves removing part or all of an affected lymph node or other suspicious tissue so a pathologist can analyze it under a microscope for signs of cancer, such as certain proteins commonly found on the surface of lymphoma cells.

Once the diagnosis is confirmed, a physician will stage the cancer to better understand its progression. Because diffuse large B-cell lymphoma can affect tissues throughout the body, the staging process usually includes a positron emission tomography (PET) scan, which involves injecting a radioactive tracer that helps to highlight areas of rapid cell growth in the resulting images. The staging process may also include a bone marrow biopsy to look for lymphoma cells in the bone, or a spinal tap (lumbar puncture) to look for lymphoma cells in the brain and spinal cord.

After analyzing the test results, the physician will assign a stage to the cancer. Diffuse large B-cell lymphoma is staged as 1 through 4, with a higher number representing a more advanced cancer:

Stage 1 – One group of lymph nodes is affected either above or below the diaphragm.
Stage 2 – Two or more groups of lymph nodes are affected either above or below the diaphragm.
Stage 3 – Lymph nodes are affected both above and below the diaphragm, and there may be spleen involvement.
Stage 4 – Bone marrow and/or organs and tissues other than the lymph nodes and spleen are affected.

How is diffuse large B-cell lymphoma treated?

When developing a treatment plan for diffuse large B-cell lymphoma, a physician will typically order blood work to check the patient’s overall health, blood cell counts, kidney function and liver function, and also to rule out infections that could be associated with the lymphoma, such as HIV, hepatitis B and hepatitis C.

The most common treatment regimen for diffuse large B-cell lymphoma includes a short course of chemotherapy administered with antibody therapy (chemo-immunotherapy), followed by radiation therapy to the specific areas of the body affected by the lymphoma. If a patient is not healthy enough to endure full-strength chemotherapy, the dose may be reduced or a clinical trial may be considered.

After completing treatment for diffuse large B-cell lymphoma, most patients are monitored with periodic PET scans and follow-up appointments with a physician. Based on the imaging results, the physician can determine whether the lymphoma is in remission or if the patient requires further treatment.

Moffitt's approach to lymphoma

A world-recognized leader in cancer care tied to research, Moffitt Cancer Center offers the latest treatment options for all types of lymphoma, including diffuse large B-cell lymphoma. The multispecialty team in our highly acclaimed Malignant Hematology Program focuses exclusively on diagnosing and treating hematological malignancies and collaborates closely to create and refine an individualized treatment plan for each patient.

At Moffitt, we know that better science leads to innovative clinical trials that will become tomorrow’s standard of care. Our robust portfolio of clinical trials includes breakthrough therapies for lymphoma, which our patients can benefit from before those options are made widely available elsewhere.

To learn more about diffuse large B-cell lymphoma, contact Moffitt Cancer Center by calling 1-888-663-3488 or completing a new patient registration form online. A referral is not required. As Florida’s top cancer hospital, we are changing the model, and we will connect you to a cancer expert as soon as possible—regardless of whether you have a referral. You can feel confident that you are a top priority of a cancer center that delivers nationally ranked care in new and transformative ways.