NCCN Guidelines for Patients® | Diffuse Large B-cell Lymphoma

20 NCCN Guidelines for Patients ® : Diffuse Large B-cell Lymphoma, 2017 Spinal fluid tests DLBCL can spread into the fluid around the brain and spinal cord. This fluid is called cerebrospinal fluid or spinal fluid. Cancer is very likely in your spinal fluid if 4 to 6 of the following factors describe you: † † Older than 60 years of age, † † Your level of lactate dehydrogenase is high, † † Your performance status score is 2 or greater, † † The cancer is stage III or IV (see page 21) , † † The cancer has spread to more than 1 site beyond your lymph nodes, † † The cancer has spread to your kidneys or adrenal glands. To confirm that cancer is in spinal fluid, a sample must be removed and tested. A lumbar puncture is a procedure that removes spinal fluid. It is also called a spinal tap. A lumbar puncture may also be used to inject cancer drugs into spinal fluid. During a spinal tap, you will be lying down or sitting on an exam table. If lying down, your knees must be tucked up near your chest. If sitting, you must lean slightly forward and down toward your knees as shown in Figure 7 . The lower part of your back over your spine will be numbed with a local anesthetic. Next, a thin needle will be inserted between the bones of your spine and into the space around your spinal cord. You may feel some pressure during the procedure. The fluid sample will then be sent to a lab for testing. Figure 7 Lumbar puncture A lumbar puncture is used to remove a sample of spinal fluid so it can be tested for cancer. A lumbar puncture may also be used to inject cancer drugs into spinal fluid. Illustration Copyright © 2017 Nucleus Medical Media, All rights reserved. 2 Treatment planning Spinal fluid tests