診斷慢性淋巴細胞白血病(CLL)

診斷慢性淋巴細胞白血病(CLL)

如何診斷慢性淋巴細胞白血病?7

身體檢與病史:檢查身體的狀況,包括疾病的徵兆,如腫塊或其他異常狀況,包括是否有發燒、盜汗,體重減輕,以及患者過去的疾病和治療史。

血液測試:以檢查血液內各種血球的數量,包括紅血球、血小板和白血球,尤其是淋巴細胞有否出現異常。

流式細胞術:透過辨認癌細胞上的標記,醫生能檢驗出患者血液內的淋巴細胞有否包含癌細胞。

基因測試:能檢查患者的染色體異常,從而判斷處理患者治療的困難程度。若患者只有第13對染色體缺失,則屬低風險,治療相對容易;若出現第11或第17對染色體缺失,則屬高風險,治療相對困難。

影像測試:透過電腦斷層掃瞄(CT scan)等影像測試,醫生能夠觀察患者體內的狀況,例如淋巴結及各器官有否出現腫脹。

骨髓活體檢驗:檢驗骨髓有助醫生掌握病情的嚴重程度。醫生會先用刺針從患者的髖骨抽出骨髓樣本,然後在顯微鏡下觀察樣本有否出現異常細胞。

如何判斷CLL病情的嚴重程度?8,20

醫生會透過以下三個現象來診斷病人的CLL的嚴重程度:

  • 血液中淋巴細胞的數量
  • 淋巴結、脾臟及肝臟脹大現象
  • 貧血或血小板減少現象

醫生可透過Rai 系統或Binet系統斷定癌症的分期,並預測患者的存活期8

例如Rai系統將CLL分為5期,並將患者分為高風險組別8,20

期數 臨床特徵 風險 存活期中位數(年)
第0期 血液中淋巴細胞增多
沒有其他白血病的徵兆或症狀
>15
第1期 血液中淋巴細胞增多
淋巴結有腫大情況
9
第2期 血液中淋巴細胞增多
肝臟或脾臟腫大
淋巴結未必腫大
5
第3期 血液中淋巴細胞增多
貧血
淋巴結、肝臟或脾臟未必腫大
2
第4期 血液中淋巴細胞增多
血小板過低
淋巴結、肝臟或脾臟可能腫大
可能貧血
2

參考資料

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