Diffuse Large B-Cell Lymphoma Stage II

Diffuse large B-cell lymphoma stage II is a fast-growing blood cancer that affects lymph nodes on the same side of the diaphragm. While this cancer is aggressive, it is often treatable and curable, especially with early diagnosis and treatment.

Table of contents

• What is diffuse large B-cell lymphoma?
• Understanding stage II
• Signs and symptoms
• How it is diagnosed
• Treatment options

What is diffuse large B-cell lymphoma?

Diffuse large B-cell lymphoma, or DLBCL, is a blood cancer that involves changes in B cells, a particular type of white blood cell. It is the most common form of aggressive non-Hodgkin lymphoma (a group of blood cancers that affects the lymphatic system)^[1].

DLBCL affects your lymphatic system, which is a network of tissues, vessels and organs that help fight infection in your body. Normal B cells are part of that infection-fighting network. But with DLBCL, healthy B cells change into fast-growing cancer cells that overtake healthy ones. They are no longer able to fight off infection-causing invaders, like viruses and bacteria^[1].

The cancer is called diffuse large B-cell lymphoma because it develops from abnormal B cells, the abnormal cells are larger than normal healthy B cells, and the abnormal cells are spread out (diffuse) rather than grouped together^[2].

With diffuse large B-cell lymphoma, cancerous B cells may appear in your lymph nodes. But they may also appear in virtually any organ, including your gastrointestinal tract, thyroid, skin, breast, bone or brain^[1].

Although DLBCL is aggressive, it is often treatable and curable, especially with early diagnosis and treatment^[1]. Each year about 5,000 people are diagnosed with DLBCL in the UK, making up more than 40 out of 100 cases (40%) of non-Hodgkin lymphoma in adults^[3].

Understanding stage II

The stage of lymphoma helps doctors understand where the cancer is in your body and plan the best treatment. Stage II is considered early stage or localized disease^[5].

Stage II means that more than one group of lymph nodes is affected, but all of them are on the same side of the diaphragm (the sheet of muscle that separates your chest from your stomach area), either above or below it^[5]. Sometimes you might see the stage written as Stage IIE, which means the lymphoma has also spread to a single area outside the lymph nodes (called an extranodal site) on the same side of the diaphragm^[14].

Doctors may also add letters to describe the lymphoma in more detail. The letter B means you have one or more of these symptoms: heavy sweating at night, high temperatures that come and go with no obvious cause, or losing a lot of weight (more than one tenth of your total weight)^[5].

Stage II lymphoma is highly treatable. For many types, especially when diagnosed early, the outlook is excellent with current treatment approaches^[14].

Signs and symptoms

The symptoms most people notice with diffuse large B-cell lymphoma are swollen lymph nodes in their neck, armpits or groin. They 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. These swellings are enlarged lymph nodes, and they can grow very quickly^[1][3].

About 30% of people with DLBCL have what doctors call “B symptoms,” which include^[1]:

• A fever above 103 degrees Fahrenheit (39.5 degrees Celsius) that lasts longer than two days or comes and goes
• Unexplained weight loss that involves losing more than 10% of your body weight over six months
• Heavy night sweats (so intense that it drenches your sheets)

Some people may also have unexplained itching^[3].

DLBCL can develop outside the lymph nodes. The symptoms you have depend on where it grows. For example, DLBCL growing in your stomach area or bowel might cause pain, diarrhea or bleeding. DLBCL growing in your chest might cause breathlessness or a cough^[3].

Symptoms can start or get worse in just a few weeks^[3]. Having these symptoms doesn’t necessarily mean you have diffuse large B-cell lymphoma. That said, you should contact a healthcare provider anytime you notice changes in your body that last for several weeks^[1].

How it is diagnosed

Diffuse large B-cell lymphoma diagnosis often begins with a physical exam that checks for swollen lymph nodes in the neck, underarms and groin and an enlarged spleen or liver^[4].

Main diagnostic tests

The main test to diagnose lymphoma is a lymph node biopsy. A doctor removes part or all of the swollen lymph node and sends it to the laboratory for a specialist to look at it under a microscope. A biopsy is a procedure to remove a sample of tissue for testing in a lab. In the lab, tests can show whether you have diffuse large B-cell lymphoma^[3][4].

Blood tests can sometimes show whether lymphoma cells are present. Blood tests may be used to test 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^[4].

Imaging and staging tests

Imaging tests make pictures of the body. They can show the location and extent of diffuse large B-cell lymphoma. Tests might include MRI, CT and positron emission tomography (PET) scan^[4]. A PET/CT scan is the standard staging tool and is used to confirm the exact location and extent of the disease^[14].

Bone marrow aspiration and biopsy are procedures to collect cells from the bone marrow for testing. Bone marrow is the soft matter inside bones where blood cells are made. The samples are typically taken from the hip bone and go to a lab for testing to check whether lymphoma cells have spread to the bone marrow^[4].

You might also have a lumbar puncture to check for lymphoma cells in the fluid around your brain and spinal cord, or an MRI scan to look at your head or spine^[3].

Treatment options

Since DLBCL can advance quickly, it usually requires immediate treatment. Treatment for stage II diffuse large B-cell lymphoma typically includes a combination of chemotherapy and targeted therapy, sometimes followed by radiation therapy^[9][12].

Standard treatment approach

The most widely used treatment for DLBCL presently is the combination known as R-CHOP. This includes rituximab (a monoclonal antibody, which is a targeted drug that attaches to cancer cells), cyclophosphamide, doxorubicin, vincristine, and prednisone^[9]. Treatment usually includes chemotherapy together with rituximab. Doctors call this chemoimmunotherapy^[3].

The R-CHOP regimen is usually given in 21-day cycles (once every 21 days) for an average of 6 cycles. However, the length and number of cycles given can vary based on the patient’s individual disease and health status. For limited stage disease (Stage I or II), 3-4 cycles may be used followed by radiation therapy^[9].

In some cases, radiation therapy may be used after chemotherapy, particularly for early stage disease^[11][12].

Alternative treatment regimens

Sometimes an additional chemotherapy drug, etoposide, is added to the R-CHOP regimen, resulting in a drug combination called R-CHOEP. A related regimen, called R-EPOCH, involves the same drugs administered as a continuous infusion over 4 days^[9].

Another treatment option for DLBCL is polatuzumab vedotin combined with rituximab, cyclophosphamide, doxorubicin, and prednisone^[9].

The goal of treatment should be to achieve a durable complete remission, which means cure. A combination of rituximab and anthracycline-based multiagent chemotherapy, possibly followed by radiation therapy, is the standard approach^[12].

Treatment outlook

R-CHOP treatment combined with targeted therapy can lead to disease remission in a large number of patients with this form of lymphoma^[9]. For stage II DLBCL, the outlook is favorable, and many patients achieve excellent outcomes with modern therapies^[14]. With current treatment protocols, approximately two thirds of patients with DLBCL can be cured^[12].