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I saw a 75-year-old gentleman. His primary care physician did a routine CBC and it showed mild lowering of his blood counts.
His WBC, or white blood cell count, was 3,200 (normal is greater than 4,000), his hemoglobin was 12gm (normal is 13-14gm) and platelet count was 118,000 (normal is greater than 150,000). This is very mild and most family physicians would just follow the patient. He had no symptoms.
This doctor made a good decision to refer the patient to me. On close questioning, I realized that lately his appetite is decreasing and he was losing some weight.
I got very concerned about occult malignancy.
Unexplained or unintentional weight loss needs to be taken seriously. This is because one of the common presenting symptoms of cancer can be weight loss. My patient had no other problem.
I did a CT scan of his abdomen and I found that he has many enlarged lymph nodes and his spleen was enlarged too. This is highly suggestive of a cancer called lymphoma or cancer of the lymph node. This can be Hodgkin or non-Hodgkin’s lymphoma. In senior citizens, later is much more common.
Many non-Hodgkin’s lymphoma or NHL tends to involve bone marrow. Therefore, I did a bone marrow biopsy in my patient. This is an outpatient procedure done in my office and takes about 10 minutes.
I found that he has mantle cell NHL This is one of the subtypes of NHL. It comprises about 5 percent to 10 percent of all NHL. It is more common in men than women and it commonly affects senior citizens. Almost 70 percent of patients have advanced stage IV diseases at the time of diagnosis.
Presenting symptoms can be one of the following:
+ B symptoms, which include fever, night sweats, and weight loss, in 40 percent of patients.
+ Generalized lymphadenopathy.
+ Fatigue from anemia or bulky disease.
+ Less common symptoms caused by involvement outside lymph nodes.
Still, most patients respond well to chemotherapy. Unfortunately, recurrence rate is extremely high in this cancer. Patients tend to live for many years. Newer therapies are available and will likely help these patients more.
We need to realize that my patient had a relatively earlier diagnosis because he was referred to me with mild lowering of his blood cell count.
If he was not referred to me early, his prognosis would have been a lot worse.
Also, do not ever ignore weight loss.
Remember to see a blood specialist if your blood counts are not normal.
Dr. Sunil Gandhi is a hematologist and oncologist. He is the 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. com or call 352-746-0707.