Stage II diffuse large B-cell lymphoma is a fast-growing blood cancer that affects B cells, a type of white blood cell that helps fight infections. When diagnosed at stage II, the cancer is still considered localized but involves more than one group of lymph nodes on the same side of the diaphragm, or has spread to a nearby organ or tissue.

What Stage II Means for Your Diagnosis

Understanding your stage is an important part of planning your treatment. Staging is the process doctors use to determine how far the cancer has spread in your body, which helps them recommend the most appropriate treatment approach. In stage II diffuse large B-cell lymphoma, the disease is still considered early stage, which generally means it has not spread widely throughout the body^[5].

When doctors assign a stage, they use a numbered system from 1 to 4, along with letters that provide additional information. Stage II specifically means that more than one group of lymph nodes is affected, but all of them are on the same side of the diaphragm, which is the sheet of muscle that separates your chest from your abdomen. Sometimes you might see stage II written with the letter “E” (as in Stage IIE), which means the lymphoma has spread to a single area outside the lymph nodes, such as an organ near the affected lymph nodes, but still on the same side of the diaphragm^[5].

Doctors may also add the letter “B” to your stage if you experience what are called B symptoms. These include fever above 103 degrees Fahrenheit that lasts longer than two days or comes and goes, unexplained weight loss of more than 10% of your body weight over six months, or heavy night sweats that are so intense they drench your sheets^[10]. Having these symptoms doesn’t change your stage number, but it does provide your medical team with important information about how the lymphoma is affecting your body.

Epidemiology: Who Gets This Disease

Diffuse large B-cell lymphoma is the most common type of lymphoma, though as cancer diagnoses go overall, it remains relatively uncommon. According to the National Cancer Institute, in 2020, about 6 people in 100,000 received a DLBCL diagnosis. To put this in perspective, about 500 people in 100,000 received a diagnosis of cancer affecting any part of their bodies during the same period^[10].

In the United Kingdom, approximately 5,000 people are diagnosed with DLBCL each year, which makes up more than 40 out of 100 cases of non-Hodgkin lymphoma in adults. The disease is more common in males than females^[13]. DLBCL accounts for approximately 30% of all malignant lymphomas, making it an aggressive lymphoma that many healthcare providers encounter regularly^[11].

Causes of Diffuse Large B-Cell Lymphoma

Diffuse large B-cell lymphoma happens when B cells undergo changes or mutations. B cells are a particular type of white blood cell, also called lymphocytes, that are part of your body’s infection-fighting network within the lymphatic system. These genetic mutations are acquired, meaning you develop them during your lifetime rather than being born with them^[10].

When these B cells mutate, they transform from healthy infection-fighting cells into fast-growing cancer cells. These abnormal cells overtake the healthy ones and are no longer able to fight off infection-causing invaders like viruses and bacteria. The mutated B cells are larger than normal, healthy B cells, and they spread out in a diffuse pattern rather than clustering together, which is how the disease gets its name^[13].

The cancerous B cells may appear in your lymph nodes, but they can also show up in virtually any organ throughout your body, including your gastrointestinal tract, thyroid, skin, breast, bone, or brain^[10]. In stage II disease, however, the cancer remains relatively localized to lymph node groups or nearby tissues on one side of the diaphragm.

Some types of DLBCL have been associated with specific viruses. For example, people with EBV-positive DLBCL have an Epstein-Barr virus infection. Healthcare providers may test for various viruses including Epstein-Barr virus, HIV, hepatitis B, and hepatitis C as part of the diagnostic workup^[7].

Risk Factors

While the exact cause of the genetic mutations that lead to DLBCL isn’t fully understood, certain factors may increase a person’s risk of developing this disease. The specific risk factors are not extensively detailed in general information about stage II disease, but the mutations that cause DLBCL are acquired during a person’s lifetime rather than inherited^[1].

Symptoms You Might Experience

The symptoms of diffuse large B-cell lymphoma can start or get worse in just a few weeks because it is a fast-growing cancer. The most common symptom that people notice is swollen lymph nodes in their neck, armpits, or groin. These usually appear as a lump that doesn’t go away and seems to be getting larger. The lump isn’t usually painful, but it can be in some cases^[10].

These swellings are enlarged lymph nodes, and they can grow very quickly. Because DLBCL is aggressive, these changes tend to happen rapidly rather than gradually over many months^[13].

About 30% of people with DLBCL experience what doctors call “B symptoms.” These include a fever above 103 degrees Fahrenheit that lasts longer than two days or comes and goes without an obvious cause, unexplained weight loss that involves losing more than 10% of your body weight over six months, and heavy night sweats that are so intense they drench your sheets^[10].

Having these symptoms doesn’t necessarily mean you have diffuse large B-cell lymphoma, but you should contact a healthcare provider anytime you notice changes in your body that last for several weeks. Some people may also experience unexplained itching, and it’s important to tell your doctor about any symptoms like these^[13].

DLBCL can also develop outside the lymph nodes, and when it does, the symptoms depend on where it grows. For example, if DLBCL is growing in your abdomen or bowel, it might cause pain, diarrhea, or bleeding. If it’s growing in your chest, you might experience breathlessness or a cough^[13].

How Stage II DLBCL is Diagnosed

The diagnosis of diffuse large B-cell lymphoma often begins with a physical exam where your doctor checks for swollen lymph nodes in the neck, underarms, and groin, and looks for an enlarged spleen or liver^[7].

The main test to definitively diagnose lymphoma is a lymph node biopsy. This is a procedure where a doctor removes all or part of a swollen lymph node and sends it to a laboratory. A specialist then examines the tissue under a microscope to look for cancer cells and identify their specific characteristics. This is the only way to confirm you have lymphoma and determine exactly what type it is^[13].

A biopsy may involve removing all or part of a lymph node, or taking a sample from other parts of the body depending on your symptoms and where the disease appears to be located. The laboratory tests will show whether you have diffuse large B-cell lymphoma and can identify specific features of the cancer cells^[7].

Blood tests are also an important part of diagnosis. These can sometimes show whether lymphoma cells are present and help check for viruses including Epstein-Barr virus, HIV, hepatitis B, and hepatitis C. Blood tests also measure levels of lactate dehydrogenase (LDH), which is often higher in people with lymphoma. Additionally, blood tests check your general health, blood cell counts, and kidney and liver function^[7].

Once lymphoma is diagnosed, you will have further tests to determine the stage. Imaging tests are crucial for staging because they show the location and extent of the disease. A PET-CT scan is the standard staging tool. This combines a Positron Emission Tomography scan, which uses a radioactive glucose tracer to highlight areas where cancer cells are actively consuming sugar, with a Computed Tomography scan that provides detailed anatomical pictures. This test helps confirm the exact location and extent of the disease to determine if you have stage II lymphoma^[14].

Other imaging tests might include MRI scans to look at your head or spine, or additional CT scans. Your doctor might also recommend a bone marrow aspiration and biopsy, which are procedures to collect cells from the bone marrow for testing. Bone marrow is the soft matter inside bones where blood cells are made. These samples, typically taken from the hip bone, are sent to a lab to check whether lymphoma cells have spread to the bone marrow, which is crucial for accurate staging and treatment planning^[7].

In some cases, you might have a lumbar puncture to check for lymphoma cells in the fluid around your brain and spinal cord, particularly if there’s concern about the lymphoma affecting the central nervous system^[13].

Prevention Strategies

Because the exact causes of the genetic mutations that lead to diffuse large B-cell lymphoma are not fully understood, and the mutations are acquired during a person’s lifetime rather than inherited, specific prevention strategies are not well established in the available information. The disease develops when B cells mutate spontaneously, and these changes cannot currently be predicted or prevented through lifestyle modifications or other interventions^[1].

Understanding What Happens in Your Body

To understand what happens in diffuse large B-cell lymphoma, it helps to know about your lymphatic system. Your lymphatic system is a network of tissues, vessels, and organs that help fight infection in your body. It includes tubes called lymph vessels that branch through all parts of your body, carrying a straw-colored liquid called lymph. This liquid circulates around your body tissues and contains a high number of white blood cells, specifically lymphocytes, which fight infection^[13].

There are two main types of lymphocytes: T lymphocytes (T cells) and B lymphocytes (B cells). Normal B cells are an important part of your infection-fighting network. They work to protect you from invaders like viruses and bacteria^[1].

When you develop diffuse large B-cell lymphoma, your body makes abnormal B lymphocytes. These abnormal cells are larger than normal, healthy B cells, which is why “large” is part of the disease name. They also spread out in a diffuse pattern throughout the affected areas rather than clustering together in groups^[13].

These abnormal lymphocytes build up in the lymph nodes or other body organs, but they don’t work properly. Because they’re cancerous, they can’t fight infection the way normal white blood cells do. Instead, they grow rapidly and overtake the healthy cells, disrupting the normal function of your immune system^[13].

In stage II disease specifically, these abnormal B cells have spread to more than one group of lymph nodes, but all the affected areas remain on the same side of the diaphragm, or the disease may have spread to a single organ or tissue near the affected lymph nodes. This localized pattern is what distinguishes stage II from more advanced stages where the cancer has spread to both sides of the diaphragm or to multiple distant organs^[5].