42-Year-Old Man’s ‘Aching & Wobbling’ Teeth Leads To Diagnosis Of Diffuse Large B-Cell Lymphoma (DLBCL): ‘I Expected It To Be a Cavity Or Something’

Sharing his story with Kennedy News & Media, as per The Mirror, Vieira recounted being on vacation, on the island of Madeira in Portugal, when the discomfort arose in his mouth. He ultimately chose to see a dentist on the island, which led a doctor to take an X-ray.

The dentist quickly realized something wasn’t right when the X-ray showed an unusual absence of bone.

A follow-up CT scan later revealed a mass in his sinus cavity that had spread beneath his nose toward the right side, while much of the bone in the left side of his upper jaw had disappeared.

After discovering the mass, Vieira flew home the next day and underwent a biopsy and additional testing at Kettering Hospital in September. About a month later, he was diagnosed with stage 2 diffuse large B-cell lymphoma. Additional X-rays later showed the tumor had destroyed the bone on the left side of his upper jaw.

WATCH: When Caught Early, Diffuse Large B-Cell Lymphoma Is Highly Treatable

Vieira told Kennedy News & Media, “I expected it to be a cavity or something, get a filling and be done with it.

“I didn’t expect it to be cancer and to be going through all this treatment that has affected our lives and my health so much.”

RELATED: Revolutionizing Lymphoma Treatment: How CAR T-Cell Therapy is Transforming Outcomes in Diffuse Large B-Cell Lymphoma
He explained further, “It was a dull ache on my left canine tooth, and all the front and left teeth were also aching and started wobbling, which is what raised my concern. I had no other symptoms at all.

“I couldn’t blow my nose because it would hurt, and I felt a small hard lump by my right-side nostril which I thought maybe was normal, I wasn’t looking for lumps, so it wasn’t until after diagnosis that I realized it was linked.”

Vieira, who began chemotherapy in December 2025, noted that if he didn’t seek medical advice, the cancer could have spread more and he said he “probably would have lost his teeth.”

Diffuse Large B-Cell Lymphoma and CAR T-Cell Therapy: When to Seek a Second Opinion

He now urges, “Don’t ever ignore a toothache, regardless of how small it is, you never know what’s hiding behind it.”

As Vieira awaits the conclusion of his treatment to learn whether therapy has been successful, his 44-year-old wife Many tells Kennedy News & Media, “They say that with the type that he’s got it’s a view to cure with the chemotherapy so they’re hopeful that after chemo is done.

“Or if radiotherapy is needed then he would be in remission and are hopeful it shouldn’t come back but in some cases, it can come back.”

RELATED: When Diffuse Large B-Cell Lymphoma Comes Back: The First Steps After a Relapse

Treating Diffuse Large B-Cell Lymphoma

The standard treatment for diffuse large B-cell lymphoma is a combination of four drugs that doctors nickname CHOP — the chemotherapy drugs cyclophosphamide, doxorubicin, and vincristine plus the steroid prednisone — which has been around since the 1970s. In addition, the newer monoclonal antibody rituximab (Rituxan) targets a specific protein called CD20 on the surface of cancer cells. This addition is often represented as R-CHOP, an effective treatment for aggressive B-cell lymphoma.

“R-CHOP has been a standard treatment regimen for aggressive non-Hodgkin lymphomas of the B-cell subtype for many years,” Dr. Adrienne Phillips, medical oncologist at Weill Cornell Medicine, tells SurvivorNet.

“There are clinical trials looking to improve upon that standard by adding or removing medications to improve outcomes or minimize toxicity, but R-CHOP is still the standard of care for aggressive B-cell lymphomas.”

Dr. Stephen Schuster, medical oncologist at Penn Medicine, tells SurvivorNet that while a 100% success rate in oncology isn’t applicable, he adds, “diffuse large B-cell lymphoma in the early stage is a highly treatable disease.”

WATCH: Fever and Other Side Effects to Watch for After R-CHOP Treatment

In people with stage I or stage II diffuse large B-cell lymphoma, where the areas of cancer are next to one another, doctors can also use radiation, “which is the oldest form of therapy for lymphoma,” he adds. Radiation uses high-energy X-rays to kill cancer cells.

The success rate with this treatment is about 80% in people with stage I or II cancers. “So you’re getting two potentially curative approaches to your disease to get very high success rates,” Dr. Schuster says.

R-CHOP side effects can include:

• Tiredness and weakness
• Hair loss
• Mouth sores
• Bruising and bleeding
• Increased risk of infection
• Appetite loss and weight loss
• Changes in bowel movements

If R-CHOP doesn’t help you, your doctor can give you another cocktail with a different combination of chemotherapy drugs. This is called salvage chemotherapy, and there are a variety of different options.

Your doctor may decide that after salvage chemotherapy, you need an autologous stem cell transplant (a transplant using your own stem cells), which is a method of giving you high-dose chemotherapy. This is part of the standard of care for the treatment of non-Hodgkin B-cell lymphomas that don’t respond to R-CHOP, or that come back after being treated with R-CHOP.

“For patients with a disease that’s not sensitive to chemotherapy, we try to look for different types of therapy that use different approaches,” Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Institute, tells SurvivorNet.

“That’s when we would look for immune-type therapies, and the most exciting one at the moment is CAR T-cell therapy.”

Turning to CAR T-Cell Therapy and Bispecific Antibodies to Treat Diffuse Large B-Cell Lymphoma

CAR T‑Cell Therapy uses a patient’s own T cells, which are modified in the lab to recognize and attack lymphoma cells. It is approved for relapsed or refractory DLBCL after at least two prior therapies or if it came back within 12 months.

WATCH: CAR T-Cell Therapy for Diffuse Large B-Cell Lymphoma: Do I Qualify?

The approved products include axi‑cel (Yescarta), liso‑cel (Breyanzi), and tisa‑cel (Kymriah). Across clinical trials, overall response rates range from about 60-80%, with complete response rates of roughly 40-55%, depending on the product and patient population.

“I would recommend anybody who has a relapse or recurrence of their lymphoma to at least request a referral to a CAR T-Cell Therapy center in their region,” explains Dr. Jonathon Cohen, a professor of hematology and medical oncology at Emory University School of Medicine and the Winship Cancer Institute in Atlanta, Georgia.

Overall survival at two years is approximately 40-50%, though individual outcomes vary based on factors such as age, disease characteristics, and prior treatments.

WATCH: A Breakthrough For Non-Hodgkin’s Lymphoma

Dr. Jason Westin is a Professor in the Department of Lymphoma and Myeloma at The University of Texas MD Anderson Cancer Center. His research focuses on developing therapeutic strategies for lymphoma. He is just one of many cancer experts in the Houston metropolitan area who specialize in treating diffuse large B-cell lymphoma. For patients with a relapse of diffuse large B-cell lymphoma, CAR T-Cell Therapy may offer a potential path to a cure.

“The ability to potentially cure people who’ve had aggressive lymphomas that came back time and time again — this is the breakthrough we’ve been waiting for,” says Dr. Westin.

Bispecific Antibodies

For patients who relapse (see their cancer return after treatment) after CAR T‑Cell Therapy or are not candidates for it, bispecific antibodies offer an effective treatment option.

“Often we consider bispecifics as complementary therapies to CAR T-Cell Therapies and not necessarily mutually exclusive therapies,” explains Dr. Sai Pingali, a medical oncologist at Houston Methodist Hospital in Houston, Texas, who specializes in treating non-Hodgkin lymphoma.

According to Dr. Pingali, “[Bispecifics] target the CD20 target on the lymphoma cells and the CAR T-Cell Therapy targets the CD19 on the lymphoma cells.”

Because CAR-T and bispecifics attack cancer cells in different ways (CAR T-Cell Therapy often targets CD19, while bispecifics often use CD20), there is a real opportunity to sequence or combine them. For instance, a physician might use a bispecific antibody first to reduce tumor burden (making the disease smaller and more controllable), then move to CAR-T when ready, or use a bispecific as a “bridge” while waiting for CAR-T to be manufactured.

Approved bispecific drugs, such as epcoritamab (Epkinly) and glofitamab (Columvi), simultaneously bind lymphoma cells and immune system T cells, bringing T cells into proximity with cancer cells to trigger targeted immune-mediated killing.

WATCH: How Do Biospecific Antibodies Work?

In clinical studies of relapsed or refractory DLBCL, overall response rates range from 50-65%, with complete response rates of 35-45%, depending on the specific drug and patient population. Among patients who have previously received CAR T‑Cell Therapy, a group historically with very limited options, bispecific antibodies demonstrate meaningful activity, with overall response rates of approximately 50-60% and complete response rates of 30–40%, though smaller studies in selected patients have reported this.

Better Understanding Non-Hodgkin Lymphoma

“Non-Hodgkin lymphoma is a big category,” Dr. Julie Vose, chief of hematology/oncology at the University of Nebraska Medical Center, previously told SurvivorNet.

All non-Hodgkin lymphomas begin in white blood cells known as lymphocytes, which are part of your body’s immune system. From there, doctors separate these cancers into types depending on the specific kind of lymphocytes they grow from, B-cells or T-cells.

WATCH: The type of lymphoma you have matters.

Knowing which of these you have can help steer you to the most appropriate treatment.

One way doctors divide up these cancers is based on how fast they’re likely to grow and spread. “The two main classifications I think of in terms of non-Hodgkin lymphoma are lymphomas that are more indolent and those that are more aggressive because those are treated very differently,” Dr. Crombie says.

Once you’ve been diagnosed with non-Hodgkin lymphoma, the next question your doctor will want to answer is whether you have B-cell or T-cell lymphoma. That answer is important because it will help determine your treatment.

B-cells and T-cells are two kinds of lymphocytes. They’re both infection-fighting cells, but they work in different ways.

About 85% of non-Hodgkin lymphomas affect B cells. These cells produce antibodies, proteins that react to foreign substances like viruses or bacteria in your body. The antibodies attach to another protein on the surface of the invading cells, called an antigen, to target and destroy them.

Types of B-cell lymphoma include:

• Diffuse large B-cell lymphoma
• Follicular lymphoma
• Small lymphocytic lymphoma (SLL)/chronic lymphocytic leukemia (CLL)
• Mantle cell lymphoma
• Marginal zone lymphomas
• Burkitt lymphoma
• T-cell lymphomas make up only 15% of non-Hodgkin lymphomas. Unlike B-cells,
• T-cells directly destroy bacteria and other invaders.

Types of T-cell lymphoma include:

• T-lymphoblastic lymphoma/leukemia
• Peripheral T-cell lymphomas
• Cutaneous T-cell lymphoma

In most cases, doctors cannot pinpoint exactly why someone develops lymphoma. However, there are some known risk factors:

• Age: It’s more common in older adults, though it can occur at any age.
• Immune system problems: People with weakened immune systems — from HIV, autoimmune diseases, or certain medications — have a higher risk.
• Family history or previous cancers: These can slightly increase risk, though lymphoma isn’t typically inherited.
• Infections: Rarely, chronic infections such as H. pylori or hepatitis C may play a role.

Why Self-Advocacy in Healthcare Can Be Life-Saving

When patients actively advocate for their health, it can lead to earlier diagnoses, broader treatment options, and ultimately better outcomes—especially when initial symptoms are overlooked or dismissed.

Part of this advocacy means not settling for a single medical opinion. Persistence matters: revisiting your doctor, pushing for answers, and seeking additional perspectives from other healthcare providers can be crucial steps in the journey.

WATCH: The value of getting a second opinion

Dr. Steven Rosenberg, Chief of Surgery at the National Cancer Institute, underscored this point in a conversation with SurvivorNet:

“If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care. Because finding a doctor who is up to date with the latest information is important,” Dr. Rosenberg said.

His words are a powerful reminder that having the right medical team can make all the difference—and that begins with being your own strongest advocate.

Getting another opinion may also help you avoid doctor biases. For example, some surgeons own radiation treatment centers. “So there may be a conflict of interest if you present to a surgeon who is recommending radiation because there is some ownership of that type of facility,” Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.

Other reasons to get a second opinion include:

• To see a doctor who has more experience treating your type of cancer
• You have a rare type of cancer
• There are several ways to treat your cancer
• You feel like your doctor isn’t listening to you, or isn’t giving you sound advice
• You have trouble understanding your doctor
• You don’t like the treatment your doctor is recommending, or you’re worried about its possible side effects
• Your insurance company wants you to get another medical opinion
• Your cancer isn’t improving on your current treatment

Some health insurance companies will cover the cost of a second opinion. Still, it’s a good idea to find out if yours does before you visit a new doctor, as some insurance companies have stipulations on the extent of coverage they will provide.

Keep in mind that you don’t need to stop at a second opinion. Provided that you have the time and financial resources, you may want to consider getting a third or a fourth opinion. Just don’t get so many opinions that your treatment options overwhelm you.

With each new doctor you visit, bring a copy of your:

• Pathology report from your biopsy or surgery
• Surgical report
• Imaging tests
• The treatment plan that your current doctor recommended

WATCH: The Importance Of Getting A Second Opinion: Tara Lessard Shares Her Cancer Story.

Questions for Your Doctor

If you are dealing with a lymphoma diagnosis, it’s important to ask your doctor a series of questions so you will have an idea of what your next steps will look like. To help you during this difficult time, SurvivorNet has some questions to kickstart your conversation with your physician.

• What type of lymphoma do I have?
• What does my pathology report say about my diagnosis?
• Should I get a second opinion before I explore possible treatment options?
• Based on my diagnosis, what do you anticipate my treatment path?
• What common side effects should I expect when I begin treatment?
• Will I be able to continue working and performing normal daily activities during treatment?
• Where can I get help working with the insurance company regarding treatment costs?
• Who do you recommend I get mental health help from during my treatment?

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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