7 Key Symptoms of Diffuse Large B-Cell Lymphoma You Should Know

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, accounting for approximately 30-40% of all cases. This aggressive form of cancer develops in the B-cells, which are white blood cells responsible for fighting infections. Understanding the symptoms of DLBCL is crucial for early detection and timely medical intervention, which can significantly improve treatment outcomes.

DLBCL can develop in lymph nodes or outside the lymphatic system in organs such as the stomach, intestines, bones, or brain. The disease progresses rapidly, making it essential to recognize warning signs early. This article explores the seven key symptoms associated with diffuse large B-cell lymphoma to help you identify potential concerns and seek appropriate medical care.

1. Painless Swelling of Lymph Nodes

The most common and often earliest symptom of DLBCL is the enlargement of lymph nodes, which typically appears as painless lumps under the skin. These swollen lymph nodes can occur in various locations throughout the body:

• Neck: Enlarged nodes may be felt on either side of the neck or at the base of the skull
• Armpits: Lumps in the axillary region that don’t resolve within a few weeks
• Groin: Swelling in the inguinal lymph nodes
• Above the collarbone: Supraclavicular lymph node enlargement

Unlike lymph node swelling caused by infections, which are usually tender and painful, lymphoma-related swelling is typically painless and persists for weeks or months. The nodes may feel rubbery and mobile under the skin. While not all swollen lymph nodes indicate cancer, any persistent enlargement lasting more than two weeks warrants medical evaluation, especially if accompanied by other symptoms.

2. Unexplained Fever

Recurring or persistent fever without an obvious cause is a significant symptom of DLBCL. This fever is characterized by:

• Temperature elevation above 100.4°F (38°C)
• Absence of infection or other clear explanation
• Pattern of coming and going over several weeks
• May worsen in the evening or at night

The fever associated with large B-cell lymphoma results from the body’s immune response to cancer cells and the release of certain chemicals called cytokines. Unlike fevers from common illnesses that resolve within days, lymphoma-related fevers persist despite rest and standard fever-reducing medications. Some patients experience what’s known as “Pel-Ebstein fever,” a cyclical pattern of fever lasting several days followed by fever-free periods, though this is less common in DLBCL than in Hodgkin lymphoma.

3. Drenching Night Sweats

Severe night sweats are a hallmark symptom of DLBCL and are considered one of the “B symptoms” used to stage the disease. These night sweats are notably different from normal perspiration:

• Intensity: Sweating is so profuse that it soaks through nightclothes and bedding
• Frequency: Occurs regularly, often multiple nights per week
• Timing: Primarily happens during sleep
• No external cause: Not related to room temperature, heavy blankets, or hot weather

Night sweats in DLBCL can be debilitating, disrupting sleep and significantly affecting quality of life. Patients often report waking up completely drenched and needing to change clothes and sheets. The severity of night sweats may correlate with disease activity and tumor burden. While many conditions can cause night sweats, when combined with other symptoms like swollen lymph nodes or unexplained weight loss, they become particularly concerning for lymphoma.

4. Unintentional Weight Loss

Significant weight loss without trying is another important B symptom of diffuse large B-cell lymphoma. This symptom is defined medically as:

• Loss of more than 10% of body weight within six months
• No changes in diet or exercise habits
• Progressive and ongoing weight reduction
• Often accompanied by loss of appetite

The weight loss associated with DLBCL occurs due to multiple factors. Cancer cells consume large amounts of energy and nutrients, altering the body’s metabolism. The disease also triggers inflammatory responses that can suppress appetite and increase calorie burning. Additionally, if lymphoma affects the digestive system, it may cause nausea, early satiety, or difficulty eating. Some patients notice their clothes becoming loose or receive comments from others about their appearance before recognizing the weight loss themselves. This symptom combined with fever and night sweats indicates more advanced disease and is used in lymphoma staging.

5. Persistent Fatigue and Weakness

Overwhelming fatigue is one of the most common and distressing symptoms experienced by patients with large cell lymphoma. This fatigue differs significantly from normal tiredness:

• Severity: Exhaustion that doesn’t improve with rest or sleep
• Impact on daily activities: Difficulty performing routine tasks
• Physical weakness: Muscles feel weak and heavy
• Mental fog: Difficulty concentrating or thinking clearly

The fatigue associated with DLBCL results from several mechanisms. Anemia, which occurs when lymphoma affects bone marrow’s ability to produce red blood cells, is a major contributor. The body’s immune system working overtime to fight cancer cells also depletes energy reserves. Furthermore, cytokines released by lymphoma cells can directly cause fatigue. This symptom often develops gradually, with patients initially attributing it to stress, aging, or busy lifestyles. However, lymphoma-related fatigue is disproportionate to activity level and progressively worsens, interfering with work, social activities, and quality of life.

6. Abdominal Pain or Swelling

When DLBCL develops in or spreads to the abdomen, it can cause various gastrointestinal symptoms:

• Abdominal distension: Visible swelling or bloating of the belly
• Pain or discomfort: May be localized or diffuse across the abdomen
• Feeling of fullness: Early satiety after eating small amounts
• Digestive issues: Nausea, vomiting, or changes in bowel habits

Abdominal involvement in diffuse large B-cell lymphoma can occur in several ways. The lymphoma may develop in lymph nodes within the abdomen (mesenteric or retroperitoneal nodes), or it can arise in extranodal sites such as the stomach, intestines, liver, or spleen. Enlarged lymph nodes or organs can press on surrounding structures, causing pain and obstruction. Some patients develop ascites (fluid accumulation in the abdominal cavity), contributing to swelling. If the lymphoma affects the digestive tract directly, it may cause symptoms resembling other gastrointestinal conditions, sometimes leading to delayed diagnosis. Persistent abdominal symptoms, especially when combined with other lymphoma symptoms, require thorough medical evaluation including imaging studies.

7. Shortness of Breath and Chest Pain

When DLBCL affects the chest area, it can produce respiratory symptoms that range from mild to severe:

• Difficulty breathing: Shortness of breath with minimal exertion or at rest
• Chest discomfort: Pain, pressure, or tightness in the chest
• Persistent cough: Dry cough that doesn’t resolve
• Wheezing: Whistling sound when breathing
• Swelling of face or neck: Due to superior vena cava compression

Thoracic involvement in large B-cell lymphoma typically occurs through enlargement of lymph nodes in the mediastinum (the central part of the chest between the lungs). These enlarged nodes can compress the airways, lungs, or major blood vessels, leading to breathing difficulties. The superior vena cava syndrome, a potentially serious complication, occurs when lymph nodes compress the large vein that returns blood from the upper body to the heart, causing facial swelling, neck vein distension, and breathing problems. DLBCL can also directly involve the lungs or the pleura (lung lining), causing fluid accumulation (pleural effusion) that further compromises breathing. Chest symptoms require urgent medical attention, as they may indicate significant tumor burden and potential airway compromise.

Main Causes and Risk Factors of DLBCL

While the exact cause of diffuse large B-cell lymphoma remains unclear, researchers have identified several factors that may increase the risk of developing this disease:

Immune System Dysfunction

A weakened or compromised immune system significantly increases DLBCL risk. This includes people with HIV/AIDS, those taking immunosuppressive medications after organ transplants, and individuals with autoimmune diseases such as rheumatoid arthritis or Sjögren’s syndrome.

Infections

Certain viral and bacterial infections are associated with increased lymphoma risk:

• Epstein-Barr virus (EBV): This common virus is linked to several lymphoma subtypes
• Helicobacter pylori: This bacterium that causes stomach ulcers is associated with gastric DLBCL
• Hepatitis C: Chronic infection may increase lymphoma risk

Age and Gender

DLBCL risk increases with age, with most cases diagnosed in people over 60 years old. The disease is slightly more common in men than women, though the reasons for this difference are not fully understood.

Previous Cancer Treatment

Exposure to chemotherapy or radiation therapy for other cancers may increase the risk of developing DLBCL years later, likely due to damage to DNA in healthy cells.

Chemical Exposure

Occupational or environmental exposure to certain chemicals, including pesticides, herbicides, and organic solvents, has been associated with increased lymphoma risk in some studies.

Genetic Factors

While DLBCL is not typically hereditary, having a first-degree relative with lymphoma slightly increases risk. Certain genetic mutations and chromosomal abnormalities in B-cells can lead to uncontrolled growth and lymphoma development.

Chronic Inflammation

Long-term inflammatory conditions create an environment where abnormal cell growth may occur more readily, potentially contributing to lymphoma development.

Frequently Asked Questions

How quickly do DLBCL symptoms develop?

DLBCL is an aggressive lymphoma, meaning symptoms typically develop relatively quickly, over weeks to a few months. Most patients notice rapidly enlarging lymph nodes or other symptoms that progressively worsen. This is different from indolent (slow-growing) lymphomas where symptoms may develop gradually over years.

Can you have DLBCL without swollen lymph nodes?

Yes, approximately 30-40% of DLBCL cases are extranodal, meaning they start outside the lymph nodes in organs such as the stomach, intestines, bones, brain, or skin. In these cases, symptoms depend on the affected organ and may not include obvious lymph node swelling. However, the disease may eventually spread to lymph nodes as it progresses.

Are DLBCL symptoms constant or do they come and go?

Most DLBCL symptoms are persistent and progressive, meaning they continue and typically worsen over time. However, some symptoms like fever may fluctuate, coming and going in patterns. Swollen lymph nodes usually remain enlarged rather than appearing and disappearing, which helps distinguish lymphoma from reactive lymph node swelling caused by infections.

What distinguishes DLBCL symptoms from other types of lymphoma?

DLBCL symptoms are similar to other lymphomas but tend to develop more rapidly due to the aggressive nature of the disease. The rapid onset and progression of symptoms is a key distinguishing feature. Additionally, extranodal involvement (affecting organs outside lymph nodes) is more common in DLBCL compared to some other lymphoma types.

When should I see a doctor about potential DLBCL symptoms?

You should seek medical evaluation if you experience: persistent lymph node swelling lasting more than two weeks, unexplained fever lasting more than a week, drenching night sweats, unintentional weight loss of more than 10 pounds, or severe fatigue that doesn’t improve with rest. If you have multiple symptoms occurring together, prompt medical attention is especially important. Any chest symptoms like difficulty breathing or severe abdominal pain require urgent evaluation.

Can DLBCL symptoms be mistaken for other conditions?

Yes, DLBCL symptoms can mimic many other conditions. Swollen lymph nodes may be attributed to infections, fatigue to stress or anemia, and gastrointestinal symptoms to digestive disorders. This is why persistent or progressive symptoms require thorough evaluation including blood tests, imaging studies, and possibly biopsy. If symptoms don’t respond to standard treatments for common conditions, further investigation for lymphoma may be warranted.

Do all DLBCL patients experience B symptoms?

No, not all patients with DLBCL experience B symptoms (fever, night sweats, and weight loss). Approximately 30-40% of patients present with B symptoms at diagnosis. The presence of B symptoms typically indicates more advanced disease and is used in staging. Patients without B symptoms can still have significant disease but may have a somewhat better prognosis.

Is it possible to have DLBCL with only mild symptoms?

While DLBCL is aggressive and typically causes noticeable symptoms, some patients may initially experience only mild symptoms, particularly in early stages or when the disease is localized to a single area. However, due to the rapid growth characteristic of DLBCL, mild symptoms usually progress to more severe manifestations within weeks to months if left untreated.

References:

• American Cancer Society – Non-Hodgkin Lymphoma Types
• Mayo Clinic – Non-Hodgkin’s Lymphoma
• National Cancer Institute – Adult Non-Hodgkin Lymphoma Treatment
• Lymphoma Research Foundation – Diffuse Large B-Cell Lymphoma
• NHS – Non-Hodgkin Lymphoma