If you’ve been diagnosed with diffuse large B-cell lymphoma you’re likely to have a long list of questions that you’d like answered. While most everyone has heard of lymphoma as a type of blood cancer that affects the lymph system, you may not have heard of this specific subtype of lymphoma prior to diagnosis. What will happen next after diagnosis and what is your prognosis?
What is Diffuse Large B-cell Lymphoma?
Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma accounting for about one-quarter of all non-Hodgkin lymphoma cases each year. Diffuse large B-cell lymphoma affects the B-lymphocytes, which are a type of white blood cell. These blood cells are responsible for making antibodies to help fight infections. Diffuse large B-cell lymphoma may develop in the lymph nodes or in other areas outside of the lymph nodes such as in the gastrointestinal (GI) tract, testes, thyroid, breast, skin, bone, brain, or any other organ of the body. This could mean that a tumor could develop in your colon, breast, or bones that is not treated as the typical colon, breast, or bone cancer. Rather, a lymphoma treatment plan would be recommended.
Diffuse large B-cell lymphoma can be further broken down into the following subtypes:
- T-cell/histiocyte-rich B-cell lymphoma
- Primary DLBCL of the central nervous system (CNS)
- Primary cutaneous DLBCL, leg type
- Epstein-Barr virus (EBV)-positive DLBCL of the elderly
- DLBCL not otherwise specified (this is when your diagnosis does not fall under one of the above categories)
How is Diffuse Large B-cell Lymphoma Diagnosed?
If you were diagnosed with lymphoma it’s likely you were seeing a hematologist who reviewed your symptoms, blood test results, and possibly other tests to determine a diagnosis of diffuse large B-cell lymphoma.
Some common signs and symptoms of DLBCL include:
- Swollen lymph nodes in the neck, armpits, or groin.
- A lump or mass that doesn’t go away and seems to get larger
- A high fever that is not associated with a sickness or infection
- Night sweats
- Unexplained weight loss
It’s important to remember that many of these symptoms are signs of non-cancerous conditions. However, they shouldn’t be ignored. Talk to your doctor who may recommend you visit with a hematologist as a next step.
Diagnostic Tests and Procedures for Lymphoma
At the time you visit with the hematologist, they’re not going to know right away that your symptoms or your blood tests are a sure sign of diffuse large B-cell lymphoma.
They are going to conduct some additional tests to see if they can uncover the cause of the symptoms. These tests can include a complete blood count, metabolic profile, and HIV/AIDS status. They will then move forward with additional tests, such as a biopsy and imaging scans if the other tests show signs that cancer is present.
A lymph node biopsy is a common approach to diagnosing DLBCL. This means that your doctor will remove a small tissue sample of your swollen lymph node and send it to a lab for further testing. The analysis of the sample will indicate if cancer is present. If it is, the specific subtype can also be determined from the tissue sample.
Imaging scans may involve a CT scan and/or PET scan.
CT and PET scans help your doctor stage your cancer by giving them an idea of where the cancer is located and whether it has spread or not. The results of these tests will be used as part of the staging process.
Staging and Prognosis of Diffuse Large B-Cell Lymphoma
Your prognosis, or likely outcome, is determined in part by the stage when the cancer was found. The later the stage, the harder it is to treat.
This type of lymphoma seems to respond well to the treatments that are available today. In fact, 3 out of 4 people who have diffuse large B-cell lymphoma have no signs of the disease after treatment and many never have to receive treatment for this again.
The stages of DLBCL are listed below:
- Stage I. The cancer is in one lymph node area or one lymphoid organ (these include the thymus, spleen, and tonsils).
- StageIE. There is cancer in one area of a single organ outside of the lymph system, meaning one of the organs other than those listed above is involved.
- Stage II (2). The cancer is in two or more groups of lymph nodes either above or below the diaphragm (this is the muscle that separates your chest and abdomen).
- Stage IIE. The lymphoma is in a group of lymph node(s) and in one area of a nearby organ (IIE). It may also affect other groups of lymph nodes on the same side of the diaphragm.
- Stage III (3). The cancer has been found in the lymph node areas on both sides of the diaphragm or in lymph nodes above the diaphragm and in the spleen.
- Stage IV (4). The cancer is growing in at least one area outside of your lymph system, such as your bone marrow, liver, or lung.
Cancer staging is used to help your hematologic oncologist determine the best course of treatment for your unique situation. It can also help with determining the order of treatments and if or when surgery should be performed.
Meet Your Lymphoma Care Team
The same hematologist is likely to also be the oncologist who treats your cancer. This is because cancer specialists also train in blood conditions as part of this specialty.
The cancer care team includes several different healthcare professionals at various points in the treatment depending on your specific plan. Some providers you may meet with in addition to the hematologic oncologist include:
- Surgeon if surgery is going to be a part of the treatment process.
- Radiation oncologists help to oversee any radiation therapy treatments that may be given.
- Advanced practice nurse practitioners work alongside doctors to help oversee your care.
You may also work with a triage nurse, infusion nurse, and/or radiation therapist.
Treatment for Diffuse Large B-cell Lymphoma
The most common treatment approach for diffuse large B-cell lymphoma is a medication regime called R-CHOP. This treatment combines the monoclonal antibody drug rituximab with three chemotherapy drugs and a drug that helps kill lymphoma cells.
This treatment is considered safe and effective, but it is somewhat common for the cancer to return, even after completing this treatment. If your cancer comes back after treatment, then your doctor may recommend the following treatments:
- Second-line therapy and stem cell transplant. This involves getting another chemotherapy regimen that is a higher dose and getting healthy stem cells transplanted. The chemotherapy wipes away all of the old stem cells and the new stem cells to create new healthy cells in replacement.
- Chimeric antigen receptor (CAR) T-cell therapy. This can be an effective way of treating recurrent blood cancers like DLBCL. This therapy works by altering your T-cells to make them fight the cancer.
- Targeted therapy. Targeted therapy targets mutations in the cancer cells to help precisely kill cancer cells.
There are quite a few clinical trials currently available to patients in Colorado to test new treatment options for diffuse large B-cell lymphoma. Your hematologic oncologist may discuss this as part of your treatment plan if they feel one would be beneficial for you.
Side Effects and Complications
Going through treatment for Diffuse Large B-cell lymphoma will likely result in some side effects.
Common side effects include:
- Nausea and vomiting
- Fatigue
- Brain fog
- Mouth sores
- Hair loss
- Frequent infections/weakened immune system
- Nerve damage
- Fevers
- Skin sores and blisters
- Organ damage
It is important to talk with your cancer team about what types of side effects to expect from treatment. Write down all of the questions you have and talk with your doctor about them before starting treatment so that you can know what to expect. Clear communication is an essential way to ensure that cancer treatment is a seamless process.
Personalized Lymphoma Treatment in Colorado
At Rocky Mountain Cancer Centers, we see many hematology patients every day. Some of these patients are diagnosed with a blood-related cancer. Our hematologic-oncologists work closely with these patients to create a personalized treatment plan they understand and matches their personal treatment goals.
If your doctor recommends you visit with a hematologist for additional testing, request an appointment with the Rocky Mountain Cancer Centers team at a location near you in the Denver area, Colorado Springs, Boulder, and other locations throughout the Front Range.
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