DLBCL Symptoms: Signs of Diffuse Large B-Cell Lymphoma

This page is for anyone who has, or may have, diffuse large B-cell lymphoma (DLBCL), and the people caring for them. It starts with the signs that need emergency care, then covers the common symptoms and why DLBCL is treated promptly.

Each of the signs below is a reason to call 911 or go to an emergency department, except the treatment fever and infection line, which needs a call to your care team right away. None of them should wait for a routine visit.

• You have swelling of the face, neck, or arms with shortness of breath. This can be superior vena cava (SVC) syndrome, caused by a chest mass pressing on a major vein. Go to an emergency department.
• You have new, severe back pain along with leg weakness, numbness, or a change in bladder or bowel control. This can signal spinal cord compression, a medical emergency. See Spinal Cord Compression During Cancer Care.
• You have a fever of 100.4°F (38°C) or higher during or after treatment. Call your care team right away, day or night. The CDC says to call your doctor immediately for this temperature during chemotherapy. If you cannot reach them, go to an emergency department. Chills, a sore throat, mouth sores, burning when you pass urine, or redness at a catheter site also need a call right away, even with a normal temperature. See Neutropenic Fever During Cancer Treatment.
• You have sudden confusion, a severe headache, seizures, or new weakness on one side of the body. This can signal spread to the brain.
• You have rapidly worsening shortness of breath or chest pain.
• You have black or tarry stool, blood in your vomit, a lot of bleeding, or you suddenly cannot urinate at all.

Do not treat these as something to mention at your next routine visit. Use your care team's emergency plan, or go to an emergency department if you cannot reach them.

Diffuse large B-cell lymphoma (DLBCL) is the most common fast-growing, or aggressive, type of non-Hodgkin lymphoma. Because it grows quickly, symptoms can build noticeably. That is different from slower-growing lymphomas, which can go unnoticed for a long time.

DLBCL's speed is its main defining feature. NCI says it grows quickly.

• One or more enlarged lymph nodes, often in the neck, underarm, or groin, that keep growing and are usually painless.
• Fatigue.
• Fever and chills.
• Unexplained weight loss.
• Night sweats.
• A swollen or full-feeling abdomen, or feeling full after a small amount of food, from an enlarged spleen or an abdominal mass.
• Chest pain, cough, or shortness of breath, if lymph nodes in the chest are involved.

Fever without an infection to explain it, drenching night sweats, and losing more than 10% of body weight over six months without trying are called B symptoms. They are common in DLBCL. Doctors record them specifically because they are used in staging.

DLBCL can also start in an organ outside the lymph system: the stomach, skin, bone, or occasionally the brain. It then causes symptoms specific to that site, in addition to, or instead of, a swollen lymph node.

NCI says treatment for aggressive lymphoma is different from treatment for slow-growing lymphoma. Some slow-growing lymphomas are watched closely without treatment. Ask your team how soon your treatment should start.

• Where exactly is my lymphoma, and is it anywhere outside the lymph nodes?
• Do I have B symptoms, and how does that affect staging?
• How quickly do we need to start treatment?
• Which new symptoms should prompt a same-day call?

• National Cancer Institute — Non-Hodgkin Lymphoma Treatment (PDQ®)–Patient Version
• CDC — Fever (patients getting chemotherapy)
• American Cancer Society — Signs and Symptoms of Non-Hodgkin Lymphoma