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Mr. Smith was in severe pain and so he initially went to see his primary-care physician. After an initial workup, a CT scan of his abdomen was ordered and it showed a large 18-cm (7-inch) mass. This was and enlarged lymph node. The normal size of a lymph node is usually 1 cm.
He also lost his appetite and so did not eat much. He also felt very weak. He was on a large dose of narcotics and still he was in significant pain. I saw him on an emergency basis and started a workup. He had a CT-guided biopsy of the mass at the hospital as outpatient. I also did a PET/CT scan, which showed enlarged lymphadenopathy. The biopsy showed he had diffuse large cell Non Hodgkin’s Lymphoma (NHL).This is a cancer of the lymph nodes.
Groups of tiny, bean-shaped organs called lymph nodes are located throughout the body at different sites in the lymphatic system. The largest areas of lymph nodes are found in the abdomen, groin, pelvis, underarms, and neck. Because lymph tissue is found in so many parts of the body, NHL can start almost anywhere and can spread to almost any organ in the body. It most often begins in the lymph nodes, liver, spleen, or bone marrow.
NHL has many different types and subtypes and the exact diagnosis is very important. It can be either low grade or intermediate or high grade, depending on what pathologists find under the microscope. My patient’s NHL was intermediate grade or an aggressive one.
These types of lymphoma usually need more intensive chemotherapy. Treatment is usually started immediately. These lymphomas are often curable.
He was in agony from his pain when I started the treatment with chemotherapy. He was on RCHOP chemotherapy, which is a combination of five different drugs. This is very aggressive treatment.
One week after I started his treatment, his pain was markedly better and he needed very little narcotics. Two weeks later, he was completely pain free, his appetite markedly improved and he felt a lot better. He lost his hair from chemotherapy but he overall felt much better because the cancer responded to treatment.
After two months, I checked his PET/CT scan again. His cancer which was 18 cm in size before treatment, now shrunk to only 1 cm. He is finishing remaining chemotherapy of a total course of 18 weeks. I am very optimistic that his cancer is in complete remission and he has an excellent chance of cure.
Remember, there are many new remarkable treatments for cancer. In the modern era, do not get scared of cancer and do not lose hope.
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 firstname.lastname@example.org or call 352-746-0707.