Dr. Sunil Gandhi, Cancer & Blood Disease, 09/18/12

I saw a 75-year-old gentleman. He went to see his family physician because he had worsening abdominal pain. The pain was severe for the past few days.

The physician ordered a CT scan and it showed an almost 7-inch mass in the left side of his abdomen.

The physician called me, and I saw him right away on the same day.

My examination confirmed a large mass. I ordered a PET/CT scan and did a bone marrow biopsy. I also ordered a biopsy of the mass under CT guidance at Citrus Memorial.

This is an outpatient procedure done under sedation.

The radiologist finds the mass on the CT scan and places a needle in the mass, under direct visualization in the CT scan. This is a very accurate and fairly safe procedure.

The biopsy was then sent to a pathologist for review. It showed the patient has aggressive non-Hodgkin’s lymphoma — diffuse large-cell variety.

Non-Hodgkin’s lymphoma (NHL) is cancer of the lymphatic system, which is part of the immune system. The lymphatic system is found throughout the body. When you have this disease, cells in the lymphatic system either grow without control or do not die as cells normally do. These are groups of many different cancers.

In general, NHL can be slow-growing or low-grade, or it can be fast-growing or intermediate/high-grade. My patient’s cancer was in the latter group. This type of cancer grows very quickly.

The cause of NHL is not known. The abnormal cell changes may be triggered by an infection or exposure to something in the environment. It is not contagious. It is not hereditary, either.

Common symptoms include fatigue, night sweats, fever or weight loss. Of course, as in my patient, a large mass can cause symptoms, too.

This type of aggressive NHL grows quickly. That is why my patient developed a 7-inch mass in his abdomen. At the same time, it responds well to chemotherapy. He was in excruciating pain, requiring a large dose of narcotics. I started him on chemotherapy right away.

His chemotherapy is somewhat aggressive; it is given as outpatient in my office for two days and it is repeated every three weeks.

His pain completely subsided after starting the treatment in a few days, and he does not need any more pain pills. He is feeling a lot better, too. He needs to complete a total 18 weeks of treatment, but he has an excellent chance of cure.

In general, lymphoma is a spectrum of disease. Treatment and prognosis depend on multiple factors, such as type of lymphoma, stage, grade, etc. Overall, most lymphoma responds well to chemotherapy and carries a good long-term prognosis.

Dr. Sunil Gandhi is a hematologist and oncologist. He is volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@tampabay.rr.com or call 352-746-0707.