诊断
Diffuse large B-cell lymphoma diagnosis often begins with a physical exam that checks for swollen lymph nodes in the neck, underarms and groin and an enlarged spleen or liver. Other tests and procedures include blood tests, imaging tests and taking a sample of tissue for lab testing.
Blood tests
Blood tests can sometimes show whether lymphoma cells are present. Blood tests may be used to test for viruses, including Epstein-Barr virus, HIV, hepatitis B and hepatitis C. Blood tests also measure levels of lactate dehydrogenase (LDH), which is often higher in people with lymphoma.
Imaging tests
Imaging tests make pictures of the body. They can show the location and extent of diffuse large B-cell lymphoma. Tests might include MRI, CT and positron emission tomography (PET) scan.
Biopsy
Your healthcare professional may suggest a lymph node biopsy or a biopsy of other tissue to look for cancer cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A lymph node biopsy involves removing all or part of a lymph node. A sample may be taken from other parts of the body depending on symptoms and imaging test results. In the lab, tests may show whether you have diffuse large B-cell lymphoma.
Bone marrow aspiration and biopsy
Bone marrow aspiration and biopsy are procedures to collect cells from the bone marrow for testing. Bone marrow is the soft matter inside bones where blood cells are made. Bone marrow has a solid part and a liquid part.
In a bone marrow aspiration, a needle draws a sample of the fluid. In a bone marrow biopsy, a needle collects a small amount of the solid tissue. The samples are typically taken from the hip bone. The samples go to a lab for testing. For DLBCL, a bone marrow aspiration and biopsy may not be needed if imaging tests show bone involvement. However, they are sometimes used to help determine the cancer's extent.
Lumbar puncture
A lumbar puncture is a procedure to collect fluid from around the spinal cord. A lumbar puncture, also called a spinal tap, uses a needle. A healthcare professional inserts the needle between two bones in the lower back and draws out some of the fluid that surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid. The fluid goes to a lab where it's tested for cancer cells.
For diffuse large B-cell lymphoma, a lumbar puncture may be done if you have any neurological symptoms. It also may be done if you are at higher risk of lymphoma of the central nervous system.
Testing lymphoma cells in the lab
Lymphoma cells collected from a biopsy or a bone marrow aspiration and biopsy go to a lab for testing. In the lab, specialized tests look for specific things about the cells. The healthcare team uses the results to decide on the type of lymphoma that you have.
To decide whether the cells are diffuse large B-cell lymphoma cells, the healthcare professionals in the lab look for:
- Proteins on the surface of the cancer cells. Diffuse large B-cell lymphoma cells have certain proteins on their surfaces that help identify them. These proteins are known as markers. Common markers found in diffuse large B-cell lymphoma are CD20, CD19, CD22, CD79a and CD10. These markers can help identify the type of diffuse large B-cell lymphoma.
- Changes in the cancer cell DNA. Cancer happens when cells get changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In diffuse large B-cell lymphoma, the cells may have a gene change that changes the arrangement of their DNA. This is known as translocation. This gene change causes the cells to multiply rapidly. The genes often involved with DLBCL include BCL2, BCL6 and MYC.
Diffuse large B-cell lymphoma staging
If you're diagnosed with diffuse large B-cell lymphoma, the next step is to determine the cancer's extent, called the stage. Imaging tests, blood tests and biopsies may be used to determine the stage of diffuse large B-cell lymphoma. Your healthcare team uses the cancer stage to help create your treatment plan.
The stages of diffuse large B-cell lymphoma range from 1 to 4:
- Stage 1 diffuse large B-cell lymphoma. At this stage, only one lymph node region or one site outside of the lymph nodes is affected.
- Stage 2 diffuse large B-cell lymphoma. Stage 2 involves two or more lymph node regions on the same side of the diaphragm.
- Stage 3 diffuse large B-cell lymphoma. At stage 3, lymph node regions on both sides of the diaphragm or lymph nodes above the diaphragm and the spleen are affected.
- Stage 4 diffuse large B-cell lymphoma. At stage 4, diffuse large B-cell lymphoma has spread outside of the lymph nodes to organs including the bone marrow, liver, lungs, kidneys, digestive tract or nervous system.
Diffuse large B-cell lymphoma prognosis
The cancer prognosis tells you how likely it is that the cancer can be cured. Your personal prognosis may depend on:
- Your age.
- Your overall health.
- The cancer's stage. Lymphoma that is stage 3 or stage 4 may be harder to cure.
- Blood test results. A higher LDH level may be a sign of a poorer prognosis.
- How many sites outside of the lymph nodes are involved.
Talk with your healthcare team about your prognosis if you want to know what to expect. Your healthcare team can explain what they consider when thinking about your prognosis.
Diffuse large B-cell lymphoma survival rates
The chance of surviving diffuse large B-cell lymphoma is quite good for most people. To understand diffuse large B-cell lymphoma survival rates, experts study many people with diffuse large B-cell lymphoma to see how many are living five years after their diagnosis.
For stage 1 diffuse large B-cell lymphoma, the chance of surviving at least five years is 80%. As the cancer spreads, the chances get lower. For stage 4 diffuse large B-cell lymphoma, the chance of surviving at least five years is about 55%.
Keep in mind that survival statistics take five years to collect. The most recent survival rates include people who had diffuse large B-cell lymphoma treatment more than five years ago. These people may not have had access to the latest treatments. Over the last few decades, diffuse large B-cell lymphoma death rates have been falling and survival rates have been increasing.
治疗
Diffuse large B-cell lymphoma treatments may include immunotherapy, chemotherapy, radiation therapy, targeted therapy, CAR-T cell therapy and bone marrow transplant, also called bone marrow stem cell transplant. Which treatment is best for you depends on the extent of your cancer, called the stage. Your healthcare team also considers how quickly the cancer is growing, your overall health and what you prefer.
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
Immunotherapy may be used as a first line treatment for diffuse large B-cell lymphoma. It is usually combined with chemotherapy. Immunotherapy also may be combined with other medicines in people with advanced cancer or cancer that has come back after treatment, known as relapsed diffuse large B-cell lymphoma.
Chemotherapy
Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.
Chemotherapy may be used as a first line treatment for diffuse large B-cell lymphoma. It is usually combined with immunotherapy. Chemotherapy may be combined with other medicines in people with advanced cancer or cancer that has come back after treatment, known as relapsed diffuse large B-cell lymphoma. High doses of chemotherapy may be used to treat DLBCL of the nervous system.
Radiation therapy
Radiation therapy for cancer is a treatment that uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.
Radiation therapy is often combined with chemotherapy and may be used for people with early-stage diffuse large B-cell lymphoma. Radiation therapy also may be used to relieve symptoms and improve quality of life for people with DLBCL that has come back after treatment.
Targeted therapy
Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.
For diffuse large B-cell lymphoma, targeted therapy may be used as a first line treatment. It also may be used when cancer comes back after treatment, known as relapsed diffuse large B-cell lymphoma. Targeted therapy also may be an option when other treatments haven't worked. This is known as refractory diffuse large B-cell lymphoma.
CAR-T cell therapy
Chimeric antigen receptor (CAR)-T cell therapy trains the immune system cells to fight diffuse large B-cell lymphoma. This treatment begins with removing some white blood cells, including T cells, from the blood.
The cells are sent to a lab. In the lab, the cells are treated so that they make special receptors. The receptors help the cells recognize a marker on the surface of the lymphoma cells. Then the cells go back into the body. They find and destroy the DLBCL cells.
CAR-T cell therapy might be an option for advanced DLBCL that has not responded to other treatments, called refractory diffuse large B-cell lymphoma. It also may be an option for DLBCL that has come back after treatment, called relapsed diffuse large B-cell lymphoma.
Bone marrow transplant
A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments. Stem cells can come from your own body, called an autologous transplant.
For some diffuse large B-cell lymphomas, a bone marrow transplant can be used for cancer that has come back after treatment, called relapsed diffuse large B-cell lymphoma.
A bone marrow transplant is only an option for some people who are younger and in good health. Chemotherapy is typically done before the transplant to suppress the immune system and bone marrow.
临床试验
探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法，旨在预防、检测、治疗或控制这种疾病。
妥善处理与支持
With time, you'll likely find what helps you cope with the uncertainty and worry of a cancer diagnosis. Until then, you may find that it helps to:
Learn enough about diffuse large B-cell lymphoma to make decisions about your care
Ask your healthcare team about your cancer, including your test results, treatment options and, if you want, your prognosis. As you learn more about diffuse large B-cell lymphoma, you may become more confident in making treatment decisions.
Keep friends and family close
Keeping your close relationships strong can help you deal with diffuse large B-cell lymphoma. Friends and family can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.
Find someone to talk with
Find someone who is willing to listen to you talk about your hopes and worries. This person may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.
Ask your healthcare team about support groups in your area. Other sources of information include the National Cancer Institute, the American Cancer Society, the Leukemia & Lymphoma Society and the Lymphoma Research Foundation.
准备您的预约
Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.
If your healthcare professional thinks you might have diffuse large B-cell lymphoma, you may be referred to a doctor who specializes in diseases that affect blood cells, called a hematologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.
Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.
What you can do
- Be aware of anything you need to do ahead of time. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
- Write down important personal information, including major stresses or recent life changes.
- Make a list of all medicines, vitamins and supplements you're taking and the doses.
- Take a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
- Write down questions to ask your healthcare team.
Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For diffuse large B-cell lymphoma, some basic questions to ask include:
- Do I have diffuse large B-cell lymphoma?
- What is the stage of my diffuse large B-cell lymphoma?
- Has my diffuse large B-cell lymphoma spread to other parts of my body?
- Will I need more tests?
- What are the treatment options?
- How much does each treatment prolong my life or increase my chances of a cure?
- What are the potential side effects of each treatment?
- How will each treatment affect my daily life?
- Is there one treatment option you believe is the best?
- What would you recommend to a friend or family member in my situation?
- Should I see a specialist?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
Don't hesitate to ask other questions.
What to expect from your doctor
Be prepared to answer questions, such as:
- When did your symptoms begin?
- Do your symptoms happen all the time or do you have them now and then?
- How bad are your symptoms?
- What, if anything, seems to make symptoms better?
- What, if anything, seems to worsen your symptoms?
- Have you had any fevers, night sweats or weight loss?
- Have you noticed any lumps, swelling or pain anywhere in your body?
- Have you had any chest pain, coughing or trouble breathing?
- Have you had any recent infections?
- Do you have any other health conditions, such as diabetes, heart disease or kidney disease?
- What are your biggest worries about your diagnosis or treatment?