I'm sorry to hear that news, but on the plus side HL is generally more treatable than NHL.
Yes, you're right that they'll want to examine the biopsy to look for Reed Sternberg cells (and even to confirm lymphoma, though at over 3cm and with the other nodes enlarged nearby that probably will be confirmed). The onc might be assuming HL because that has a much higher probability than NHL at his age.
Your assistance will be invaluable in helping him be on top of everything that happens from now on. You'll want to learn about "response rates" and so on. I'd look heavily into minimizing side effects of treatment. Good luck to both of you.
I don't believe his kidney was affected and I haven't been able to get a copy of his CT report. He has been negatively tested for lyme.
He got another CT scan this morning and his 3 cm lymph node has gotten bigger and about a dozen other lymph nodes around it are also considerably swollen. He will be getting a more invasive biopsy later this week or next. And on Friday he's getting scoped to check for internal bleeding.
However, the oncologist told him this morning it looked like lymphoma. I'm feeling really devastated. I'm taking it especially hard because we're in a long distance relationship. He has no one to take him to these appointments.
I'm confused why the oncologist feels this would only be hodgkin's lymphoma and not non-hodgkins lymphoma. I thought they could only tell after getting the biopsy results?
Welcome to the forum. Sorry to hear about your boyfriend, this must be scary for both of you. Ken has made some very good points and hopefully this is just a reaction to the antibiotics. I'd also like to add that swollen nodes from lymphoma are usually painless unless directly pushing against other organs, so the pain he's experienced is hopefully a good sign. I think the excisional biopsy and the CT scan will be very helpful in leading you to a correct diagnosis. Please keep us posted on the results.
Hi, some thoughts:
It sounds very possible that he had an allergic reaction to the antibiotic. Very important to know for future safety. Corticosteriods in high dose (maybe 80mg prednisone) would be the Tx. Was his kidney function (BUN etc) affected?
Can you post the CT report? This is very important. Hopefully, it gives more than just the size, e.g preserved architecture or not.
What about Lyme?
Your thinking re Lloyd Morgans' Canon is correct. It could be that cancer has invaded the marrow and is crowding out normal blood cell production. But it could be that a hemolytic pathogen is causing everything, even if indirectly by provoking autoimmuntiy. Or maybe a gut pathogen is inhibiting iron absorption. What he has is likely going to turn out to be rare, so I wouldn't blame the docs for not knowing.
Or a drug allergy can create autoimmune hemolytic anemia.
An FNA is like inserting a needle into raisin bread, looking for raisins - hit or miss. They probably are not talking about doing a full resection because of danger to nearby structures, nerves or blood vessels, e.g.
No, you wouldn't normally associate elevated lymphocytes with lymphoma as you would with leukemia (though a lymphoma might possibly have a leukemic phase in advance stage).
3cm is pretty big, getting at the upper limit to be reactive. If it was cancer, you'd expect fast growth also in the inguinal nodes.
"Now it's been about a month and his lymph node still hasn't gone down." Not necessarily a big deal at all - not to be fixated on.
Will know better once you post the CT report.