What tests will I need to do for my DLBCL and how often?

What tests will I need to do for my DLBCL and how often? A comprehensive staging evaluation is always needed when somebody is diagnosed with the disease and this involves laboratory blood tests and the most important tool that we use to treat aggressive lymphomas is a form of imaging study called as the PET scan. So the PET scan is a modified or sophisticated CT scan where we get to image the patient's body to look for whatever are the sites of lymph nodes and other involvement because of the disease. So that kind of gives you the stage as I was talking about before and that kind of lets us follow the patients along also during treatment in between like maybe after two or three rounds of chemo you can get another scan to see how they're doing and at the end of treatment you get another scan. So that kind of tailors us as to how we know the patient is going to do. And once they're done with treatment then the question comes do I need to keep getting scans every month or like every week. It's usually like we don't really have to scan people. The guidelines again which are suggestions recommend at least for high risk patients we could consider CT imaging maybe every six months for the first two years and thereafter patients basically as I said most of them are survivors and then you know it's about like maintaining healthy lifestyle then you know watching cardiovascular health, diabetes, other side effects of chemotherapy, risk of second cancers. Those are the things that you know kind of built into the aspects of survivorship what happens after two years. So everyone needs to have something called PET CT if possible before they start treatment. That is the best modality we have to determine the stage before starting the treatment and staging could make changes in the treatment algorithm so it's important to do all the staging workup completely prior to initiation of treatment. Some patients if they are considered at a high risk of central nervous system involvement they will require MRIs of their brain and spine and a lumbar puncture to see if there is any involvement of lymphoma in their cerebrospinal fluid. Once they start treatment we do an interim PET scan and then an end of treatment PET scan. The treatment for DLBCL is usually four to six cycles of chemotherapy. Different practices have different timing preferences for the interim PET scan it could be after the second cycle, third cycle or fourth cycle. Everyone should get a PET scan done at the end of treatment whether it is four cycles or six cycles to assess their final response to treatment. There are some prognostic markers that we look at when the people get diagnosed initially. We look at blood counts, we look at their kidney function, their liver function, we look at a marker called LDH which stands for lactate dehydrogenase that's also a prognostic marker diagnosis. And again one other exciting thing that you were alluding to before in the field is we are kind of going into more molecular diagnostics even from the blood. So in terms of what we call a CT DNA or circulating tumor DNA if we can detect low levels of circulating disease in the blood and we could track them along with a PET scan that could be even more sensitive to know that patients are getting deep enough responses and they are going to stay in remission for longer. This is still not prime time but that is possibly going to be. One other question comes is do I need a bone marrow biopsy when I get diagnosed with DLBCL? The answer is not for everybody. Again this is not a leukemia where you know many major treatment decisions are based on a bone marrow biopsy. But if you suspect the bone marrow is involved or like you know the patient's blood counts are low for some reason or you worry that they could have some other problem going on in the bone marrow then you potentially get a bone marrow biopsy diagnosis.