What Exactly Is Large B-Cell Lymphoma?

Since David announced publicly that he has Large B-Cell Lymphoma, I've been asked the same question over and over:

"What is that?"

Great question!

Honestly, I didn't know either until we began this journey.

Shortly after David's diagnosis, we received a book from Blood Cancer United. According to the organization, lymphoma is:

"A general term for a group of blood cancers that originate in the lymphatic system, part of the body's immune system."

The first thing many people recognize is that David has Non-Hodgkin Lymphoma (NHL).

The difference between Hodgkin lymphoma and Non-Hodgkin lymphoma comes down to what doctors see when they examine cancer cells under a microscope. Hodgkin lymphoma contains Reed-Sternberg cells, while Non-Hodgkin lymphoma does not. Non-Hodgkin lymphoma is also more common and includes many different subtypes that develop from B-cells, T-cells, or NK cells.

Non-Hodgkin lymphoma is the category of cancer David is battling.

From there, NHL is divided into many different subtypes based on the type of lymphocyte involved. David's specific subtype is Diffuse Large B-Cell Lymphoma (DLBCL).

There are more than 90 different subtypes of NHL, including Burkitt lymphoma, Follicular lymphoma, Mantle Cell Lymphoma, Marginal Zone Lymphoma, Cutaneous T-Cell Lymphoma, Waldenström Macroglobulinemia, and many others.

Once doctors identify the subtype, they can determine the most appropriate treatment plan.

According to Blood Cancer United, DLBCL is the most common subtype of Non-Hodgkin lymphoma, accounting for approximately 30% of NHL diagnoses in the United States. It gets its name from the large size of the cancer cells and how they appear under a microscope. Rather than growing in clusters, the cancer cells spread throughout the tissue in a diffuse pattern.

Like many cancers, DLBCL can develop at any age, but it is most commonly diagnosed in adults between the ages of 65 and 74.

One characteristic of DLBCL is that it grows quickly. Unfortunately, we've witnessed that firsthand.

The disease often begins in the lymph nodes and can spread to other parts of the body, including the spleen, liver, bone marrow, and other organs. In David's case, it began in the lymph nodes. Common symptoms include fever, night sweats, and unexplained weight loss.

Since lymphoma begins in the lymphatic system, let's talk a little about what that system actually does.

The lymphatic system is a network of organs, vessels, and tissues that helps the body fight infection and disease while maintaining fluid balance. It includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels.

Lymphatic vessels carry lymph fluid and white blood cells throughout the body. The lymph nodes act like filtering stations, helping identify and fight infections. Eventually, the lymphatic fluid drains into large ducts that empty back into the bloodstream.

When doctors suspect lymphoma, they perform a biopsy. This allows them to study the cancer cells and identify characteristics such as their appearance, genetic features, and proteins found on the cell surface.

These samples are examined by a specialized physician called a hematopathologist, a doctor who diagnoses blood disorders and blood cancers.

After determining the subtype, doctors also assess how quickly the cancer is growing.

Lymphomas are generally classified as either:

• Aggressive (fast-growing) or

• Indolent (slow-growing)

People with indolent lymphoma often experience fewer symptoms than those with aggressive lymphoma. Understanding the growth rate helps the medical team determine the most effective treatment approach.

For David, the diagnosis is an aggressive lymphoma. While that sounds scary, aggressive lymphomas are often treated aggressively as well. As we've learned throughout this journey, every diagnosis comes with its own challenges, treatment options, and outcomes.

At the end of the day, we've become experts in a subject neither of us ever wanted to study. But if sharing what we're learning helps others better understand David's journey, then at least some good can come from it.

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