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577395 tn?1277401364

Is it cancer?!?

Hi, my father is 77. He is diabetic. He had chest and abdominal ct scan in august, that showed some lymph nodes slightly enlarged (11 mm). Last week his doctor sent him for another CT, which showed chest and abdominal lymph nodes enlarged to 2 cm. Any ideas? Can it be from rescent infection in his foot? Or is it cancer?
I am really worried....
Best Answer
1081992 tn?1389903637
COMMUNITY LEADER
Well, first off I need to point out that the only way to know for sure if he has lymphoma is with a biopsy of a node. Everything else just deals with tendencies and odds.

Sorry to say, but there are some things that seem to make a biopsy necessary here. Having 2 nodes greater than 3cm is the most worrisome. Having enlarged nodes in various places, rather than just being localized to one area, is also worrisome. I don't know if a non-cancerous condition such as tuberculosis can cause results like that or not.

A PET Scan puts radioactive sugar into the patient, then scans to see what areas "light up" from that. But as far as I know, a PET scan can't reliably distinguish between cancer and infections anyway. If a PET scan shows nothing new, then that doesn't rule anything in or out. But a biopsy is far more likely to give a definitive answer. (But a PET scan doesn't require surgery, so is a much safer test.)

Points 2 and 3 describe other abnormalities seen on the CT which don't have to do with nodes, but which might have to do with changes that occur when lymphoma spreads outside of nodes... maybe fluid in the lungs or ascites.

So, it's not known yet if it is lymphoma; but you should be aware that some types of lymphoma are very easy to knock down with treatment. Other types of lymphoma grow so slowly that treatment isn't even begun at first - that's called "watch and wait". But if this is lymphoma, it doesn't seem to be a slow growing kind. Also be aware that the newer kinds of chemo for some lymphomas are very mild.

On the other hand, spots seen on scans from infections can grow very quickly. I would call and ask his GP if tuberculosis or some other "granulomatous" disease is a possibility - that's very especially true if your dad has a cough, but a cough isn't always present in tuberculosis anyway.

Also in the lungs: https://en.wikipedia.org/wiki/Granuloma#Sarcoidosis

I'll keep an eye out for if/when you write back. Good luck to you and your dad.
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1081992 tn?1389903637
COMMUNITY LEADER
Hi, it's not likely to be related to anything with his foot, but it can be from a chest infection. It doesn't have to be from cancer.

Can you post what was written in the report of his latest CT scan?
Helpful - 0
577395 tn?1277401364
Thank you so much for your answe. Just got his CT report. Here is the summary:
IMPRESSION:
1. abnormal enlarged mediastinal, bilateral axillary and upper abdominal lymphadenopathy. Multiple abnormally enlarged lymph nodes especially in right paratracheal region, with 2 cm dominant right paratracheal node. Enlarged upper abdominal lymphdenopathy including superior to pancreas with 2 dominant nodes mesuring grater than 3 cm. PET scan recommended, as lymphoma may have this appearance
2. 11 mm ground glass density in the right lower lobe
3. 2 cm nodular infiltrate left lower lobe


I will appretiate ANY explanation!!!!
Helpful - 0
577395 tn?1277401364
In August he was admitted to the hospital because he had infection in his foot - 1 toe was amputated. I am sure they did all the blood work, and if they would find TB they would tell. If lets say PET scan will show some abnormalities - do you think that biopsy will still be needed?
He is diabetic, and any surgery is a risk for him...

Thank you so very much for your detailed answer. I will definately post the results of PET scan.

Praying for my dad...................
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Yes, I'd think that a biopsy is needed regardless. They have to know for sure if it is lymphoma before giving chemo. They also need to have tissue samples in order to know the subtype of lymphoma, because treatment can differ according to the subtype.

Maybe they could choose to take out an axillary (underarm) node instead of doing an arthroscopic biopsy into the chest. They typically choose to take the most suspicious node (in his case one of the largest ones) to have the maximum chance of finding lymphoma cells, but that choice can be modified by how accessible any node is for surgery.

There are such things as needle biopsies. Those have the possibility of a false negative where they just didn't happened to withdraw any cancer cells because they didn't hit the right spot inside the node. (If you just randomly poked around inside a loaf of raisin bread, you might by chance just not hit any raisins.)

Maybe they can draw fluid from the two areas that showed abnormality on the CT scan.


What prompted the docs to do the CT of his chest? No coughing or wheezing?

You deserve a lot of praise for how your helping your dad. It's very difficult at first to absorb it all, especially under high stress. Everything will be less mystifying before long.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
In a needle biopsy, they push a long needle into a node, pull back the plunger and repeat that a few more times. Sometimes they use a sonogram or CT to guide the needle to the right spot.

Also: a scan can tell a lot about the internal "architecture" of a node. E.g., if there is the "fatty hilum" still present, then that almost always means that it is not cancerous. Maybe they can do an ultrasound of an underarm node.

Btw, tuberculosis results in enlarged paratracheal nodes, which is mentioned on his CT report. But then so does sarcoidosis - and lymphoma can, too.

Helpful - 0
577395 tn?1277401364
I am not sure why they did his first CT scan in the hospital (08/15/14), I was under impression that they needed it before surgery. He has no coughing or wheezing. When he was in the hospital, they said that the machine shows that he gets not enough oxigen (possible sleep apnea). Also he is complaining that ocasionally he has tightness in his chest and it is hard to breath. This doesn't happen all the time, but sometimes.

I will wait till PET scan results... Really hope nothing horrible....
THANK YOU again and again for your answers - it is huge support for me
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Okay, let me know about any developments. I'm glad to have been of help.

So they did the CT because of his breathing problems. Keep on guard for pneumonia. The very worst cancers can kill in a month or two. Pneumonia can kill in a day or two, for someone his age. What about his pneumonia vaccine? Up to date? (Not referring to the useless flu vaccine.)
Helpful - 0
577395 tn?1277401364
I didn't keep track of any vaccination. Didn't even know of existance of  pneumonia vaccine.  His pulmanologist sent him for CT and PET scans. Probably would mention pnemonia if would suspect it...
I will let you know when hear any news
Helpful - 0
577395 tn?1277401364
Hello,
Here I am again. For some reason the doctor didn't order biopsy for my father and decided just to watch. My father had another ct scan of the neck on 08/18/2015. Here is the result, can you please comment?

Numerous mildly enlarged bilateral cervical lymph node involving all of the levels including bilateral  posterior triangles on the right greater extent than left as well as bilateral supraclavicular regions. This represents new findings compared to PET/CT from 01/22/2015.

Thank you!!!!

Helpful - 0
7052683 tn?1392938795
Hi Lana,
Your dad is very lucky to have you advocating for him. Since his present doctor just likes to watch , I would suggest you see another doctor for some answers. New findings are always a concern!!

Please keep us posted.

Thanks,
CML
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Sorry to say, Lana, but it seems that the most likely explanation is lymphoma. He should have a scan to see if that 3cm node is now even larger. And/or a sonogram of the largest underarm node. And/or he should have a biopsy. Other causes, like sarcoidosis, are still possible but don't seem very likely. The newly swollen nodes on the back of the neck are very troubling, because that's not part of the respiratory tract.

You should know that the classical chemo drugs that are very harsh might not be allowable for him -- but there are newer, much milder drugs like Rituxan that can be given alone. Rituxan encourages the body's own immune system to fight the lymphoma and works pretty well.

As CML mentions, I wouldn't trust that doctor. If your dad won't get a new one, then I'd try to push this one into referring to an oncologist/hematologist.

Good luck to both of you.

Helpful - 0
577395 tn?1277401364
Thank you very much for your answers. Here is a plan that I have. My dad will go to his PCP tomorrow and ask for referral to PET CT. We made an appointment with oncologist/hematologist for 09/17 (should we push for earlier appointment or there is no rush?).

Now this is just my worries - he is 78 and far from the best health condition. If this is a lymphoma, do we have a hope for cure? what is life expectancy? complications? Sorry, I am panicking right now, but any additional information will help. Thank you again for your time  
Helpful - 0
577395 tn?1277401364
I also forgot to mention that my dad had bone marrow aspiration done in June - the result was good
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Here's how I'd look at it: the hema/onc will want some tests done, so ideally you'd have them done before the 1st visit --  so then you won't have to wait to get the opinion. That might be the PET/CT, or just the CT of the largest node. That might include the sono, because a sonogram can tell best about the inside "architecture" of a node. If the architecture has been wiped out/destroyed that usually means lymphoma.

A PET doesn't actually tell the difference between cancer or other causes of swollen nodes, like inflammation. It just shows the spots of "increased metabolic activity".

If the biggest (was at 3cm) node hasn't grown, that might mean the lymphoma is slow growing and maybe they'll decide to do "watch and wait". But if it's grown a lot, then probably treatment begins immediately.

As far as cure or life expectancy, that depends on the type - which is only found out from examining the biopsy sample. Different types vary according to how fast they are expected to grow and to how well the treatment works.

"bone marrow aspiration done in June - the result was good"
That tends to explain somewhat why the doc wasn't in a hurry to do anything. But I'd still push to get the diagnosis ASAP.

Yes, you can also ask for the hema/onc appt to be sooner. I would.

Did he have a blood test for LDH?
Helpful - 0
7052683 tn?1392938795
Hi Lana,

Ken is so good with the answers to your questions and I have to agree with his answers based on his extensive research and experience.

The one thing I would like to reiterate is yes move up the 9/17 apt. Time is important here because of your fathers age,and YOUR need    to know what your dealing with the prognosis. The one thing I regret with my mom was not pushing the oncologist for a more definitive answer to "How much time" once we found palliative care was all she could receive.

I was in denial so much I do not think I really wanted to hear  2 yr, 1yr, 6 mo,3mo etc--I would have just dismissed it and continued to live in my dream world of My mom living forever. Don't do that talk to your dad once you have the prognosis and timeline---what he wants IS the most important thing when it comes to how you deal with it.

I am so hoping your dad will escape any serious illness and a prognosis will not even be needed .

God Bless you both,
Keep us posted, if you would.
CML
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Well, I'm going to take a cue from CML and lay out the best possible outcomes (while still being realistic), which is what I generally did with my father those years ago.

If it is a slow growing (aka "indolent") lymphoma, then there might not be a rush for treatment. When the time for treatment does arrive then using Rituxan alone is very mild - almost unbelievably so because of what we've all heard about harsh chemo drugs. There is typically no vomiting, hair loss, being laid up in bed, or weakened immune system. They just sit in a recliner chair for a few hours then go home. Maybe get some chills or flushing, that's it.

Some people get a "remission" (the cancer cells can't be found anymore) from Rituxan alone, or else at least it can halt progress of the lymhoma.

P.S. I would get the LDH test done ASAP, it's just a matter of a blood draw and can be ordered over the phone. The results might get him moved up in appt time.



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