Lymphoma is a type of cancer that originates in the lymphatic system, a network of vessels, tissues, and organs vital for the body’s immune defenses. This system includes lymph nodes, which filter lymph fluid, as well as the spleen, bone marrow, and thymus. When lymphocytes, a type of white blood cell, become abnormal and multiply uncontrollably, they can form tumors within this system. “Diffuse lymphoma” most commonly refers to an aggressive form of this cancer. Understanding its characteristics, symptoms, diagnosis, and treatment is important.
Understanding Diffuse Large B-Cell Lymphoma
Diffuse Large B-cell Lymphoma (DLBCL) is the most common aggressive subtype of non-Hodgkin lymphoma. This fast-growing cancer develops from B-lymphocytes, a type of white blood cell that produces antibodies and fights infections. In DLBCL, these B-cells become abnormal, grow larger than healthy cells, and multiply rapidly.
The term “diffuse” indicates that these cancerous cells are spread throughout the lymph node or affected organ, rather than being clustered. “Large B-cell” refers to the size of the abnormal cells, which are noticeably larger than normal B-cells, and their origin from B-lymphocytes. DLBCL can affect individuals of all ages, though it is more frequently diagnosed in older adults, with a median age of around 70 years. It can arise in lymph nodes or in extranodal sites, meaning areas outside the lymphatic system, such as the gastrointestinal tract, skin, or bone.
Recognizing the Symptoms
DLBCL symptoms can appear or worsen rapidly, sometimes within weeks, due to the aggressive nature of the disease. The most frequent initial symptom is one or more painless, rapidly growing swollen lymph nodes. These lumps are often noticeable in areas like the neck, armpit, or groin.
Beyond localized swellings, systemic symptoms, known as “B symptoms,” are often associated with DLBCL. These include unexplained fevers that may come and go. Drenching night sweats, severe enough to soak through nightclothes and bedding, are another common B symptom. Unexplained weight loss also falls into this category.
Other general symptoms can include persistent fatigue, loss of appetite, generalized itching, or pain if the lymphoma presses on organs or nerves. While these symptoms can be caused by many less serious conditions, their persistence or rapid onset warrants prompt medical evaluation.
Diagnosing Diffuse Large B-Cell Lymphoma
Diagnosing DLBCL begins with a physical examination and a review of the patient’s medical history. The physician checks for swollen lymph nodes in areas like the neck, armpits, and groin, and may also examine the abdomen for an enlarged spleen or liver. These initial steps guide further investigations.
The most definitive diagnostic tool for DLBCL is a biopsy, which involves removing a tissue sample for laboratory analysis. An excisional lymph node biopsy, where an entire lymph node is removed, is often used over a core needle biopsy as it provides a larger sample. This allows pathologists to more accurately classify the lymphoma and distinguish it from other conditions. The tissue sample is then examined under a microscope and tested for specific proteins that help identify DLBCL cells.
Imaging tests are also performed to determine the extent of the disease, a process known as staging. Positron Emission Tomography (PET) scans, often combined with Computed Tomography (CT) scans (PET/CT), are used to visualize active cancer cells throughout the body, including in lymph nodes and other organs. These scans help identify all affected areas, guiding treatment decisions. Blood tests, such as a complete blood count (CBC), are conducted to assess overall health, check for irregularities in blood cell levels, and measure lactate dehydrogenase (LDH) levels, which can be elevated in lymphoma. Testing for viruses like hepatitis B, hepatitis C, and HIV is also routinely performed, as these can influence treatment planning.
Treatment Options
DLBCL is an aggressive cancer that usually requires immediate treatment, yet it is often curable. Chemotherapy serves as the primary treatment, frequently combined with immunotherapy. The most common regimen is R-CHOP, which includes a monoclonal antibody called Rituximab along with four chemotherapy drugs. R-CHOP is administered in cycles, often every 21 days for about six cycles, though the number can vary based on disease stage and patient health.
Radiation therapy plays a role, especially for localized disease or large tumors, known as bulky disease. It may be given after chemotherapy to destroy any remaining cancer cells in specific areas. For patients whose DLBCL relapses or does not respond to initial treatment, other options are considered.
Stem cell transplantation, either autologous (using the patient’s own stem cells) or allogeneic (using donor stem cells), can be an option for those with relapsed or refractory DLBCL. This intensive treatment involves high-dose chemotherapy followed by the infusion of healthy stem cells to restore bone marrow function. CAR T-cell therapy has also emerged as an option for certain patients with relapsed or refractory DLBCL. This immunotherapy involves genetically modifying a patient’s own T-cells to specifically target and destroy lymphoma cells. Treatment plans are highly individualized, taking into account the lymphoma’s characteristics, its stage, and the patient’s overall health and preferences.