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Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphoma (NHL). It is a malignant condition (cancer) affecting a type of white blood cells called lymphocytes.
Unlike leukaemia, in lymphoma, the cancer cells are found in organs and tissues of the lymphatic system although occasionally it can be spread to the bone marrow. The lymphatic system is a network of fine vessels, glands and channels which occur throughout the body. It also conveys nutrients and cells, and is responsible for draining fluid and waste products away from tissues, and into the blood stream to be processed. The lymphatic system is an important part of the immune system and is made up of lymph nodes and vessels and of collections of lymphocytes in other tissues.
DLBCL is a high-grade form of NHL, this means that it develops quickly and, if not treated, it grows quickly. Diffuse describes the appearance of affected lymph nodes under the microscope and large B cell describes the type of lymphocyte which is affected.
In most cases of DLBCL, there is no obvious cause. There are some things which are known to be associated with a higher than average chance of developing lymphoma, including DLBCL. These include:
In most cases of lymphoma, there is no obvious cause. There are some things which are known to be associated with a higher than average chance of developing lymphoma. These include:
It is important to understand that:
The most common sign of DLBCL is a lump in the neck, armpit or groin or stomach. These are usually, but not always, painless and are often described as feeling “rubbery”. Patients with DLBCL often develop frequent, persistent infections.
Other common symptoms include:
The most important test for diagnosis of DLBCL is a biopsy of affected tissue. This may mean removing a whole abnormal lymph node (excision biopsy) or just a sample of tissue.
Other tests which may be done include:
Staging is the use of test results to show how widely the lymphoma has spread. There are four stages in the standard system used:
Stages 1-2 are known as early-stage disease and stages 3-4 are known as advanced-stage disease.
This stage description may be modified by adding the letters A, B, E or S:
Virtually all patients who have DLBCL start treatment straight away. DLBCL is often curable with standard treatments. DLBCL will sometimes come back, this is known as a relapse and it can usually be treated again, using similar treatments as were used the first time.
The main ways in which DLBCL is treated are:
Chemotherapy is the use of cell-killing drugs. These kill the cancer cells and/or stop them from dividing. Chemotherapy is usually given in blocks or ‘cycles’ of treatment. One cycle of treatment will consist of a series of doses of chemotherapy followed by a break for the healthy cells to recover.
Chemotherapy is normally given as a combination of drugs, which will usually include steroids. Steroids used to treat DLBCL are a laboratory-made version of chemicals naturally made by the body. They are very different from the type of steroids sometimes misused by body-builders or sportsmen.
The details of your treatment will vary depending on the stage of your DLBCL and your general fitness. You will be given a chance to discuss treatment options and detailed information on your treatment plan before it starts. The side effects of treatment vary between different types of treatment and different patients. You will be given detailed information about any likely side effects before you start treatment.
We understand going through a blood cancer through journey can be difficult. It may help to talk to a close friend or relative about how you are feeling. Here are some questions that may be useful to ask your doctor.