Non-hodgkins lymphoma

[Mariejill]

Mu dad had NHL a few yrs ago; had some chemo treatments -- was then ok for a few yrs.  It has recently come back and has had a few Rituxin treatments, still needs one more.  Had one lump on neck, now has another and just found another one under his chin.
Before starting the Rituxin, had pet scan and it was only showing in the neck.
He's been starting to also feel itchy all over which in reading on NHL that itching is one of the side effects.  He has other health issues, he's 84. His overall health is not so great.
Has another dr appointment next week, but am curious as to what to expect, being the cancer has come back and his health is not so good.  Will he be able to beat this again?

Thx

[Ken_PA]

I'd think about getting a second opinion on that pathology report. It seems very odd, unless previous chemo for NHL caused the HL.

For any treatment, there will be figures about the "response rates", that is if the treatment does any good. There is a percentage for Complete Response (which gives remission) and for a Partial Response (partial remission) and the total Overall Response. You can ask the doc for the figures on whatever treatment is discussed, to at least get some idea of the chances that it will work.

If he gets the Gemzar, I believe the greatest risk is from infection if the immune cells get wiped out too much.

Good luck to you both.

[Mariejill]

Well we had the biopsy done and it turns out that he now has hodgkin's lymphoma and not non-hodgkin's lymphoma.  Doctor even seemed surprised by these results.  Unfortunately due to the many other issues he has, the standard chemo treatment of ABVD cannot be used as 2 of the 4 of the medicines they use are toxic to the heart and lungs and my dad has both a bad heart and has copd/emphysema.  The dr wants to discuss his case with his fellow collegues but has suggested possibly using a chemo treatment called Gemzar.  Even using that dr is not sure it will work.  My dad is leaning towards at least trying it and see what happens...if it makes him really sick, he can always stop it.  Doctors prognosis is not too good due to his other issues.  Guess we will see what happens from here.

[Ken_PA]

SUV = Standardized Uptake Value which is just a measure of how much of the radioactive sugar has been absorbed by the tumors. Cancer cells like to grab as much sugar as they can, to use for fuel, more so than normal cells.

Those numbers aren't incredibly high. But what really matters is the behavior of the cancer - how fast it grows and how fast it spreads. I'd think the next step is to biopsy, to determine the type (if it transformed) and then start some treatment specific to that type, ASAP.

[Mariejill]

Just received the petscan results and does not look too good.  Dr. Says he has enlarged lymph nodes on right side of face and neck, also in shoulder, chest and arm pit, middle of chest and near his intestines.  Says it is super aggressive.
Unfortunately this dr we were seeing turned out to be an idiot so have made an appointment with another dr at the end of this week.  He has been given a copy of the petscan so will see what happens now. The sample suv#'s are 8.68-right neck; 7.07-right supraclavicular; 10.11-right paratracheal; 10.97-right lower quadrant mesenteric; 4.67-left lower quadrant.  Not sure what these numbers mean?   Do you?

Thanks

[Ken_PA]

the nodular (aka follicular) type of NHL is usually slow growing, so since it is now behaving aggressively that hints that is has unfortunately 'transformed' to another more aggressive type.

Ideally, there will be other suitable drugs besides the Rituxan that are less-harsh to use than the typical chemo drugs. One that comes to mind is Velcade.

[Mariejill]

Believe it is B cell NHL, dr called it nodular NHL.  
He's gotten another lump under his chin within the past few weeks which has also gotten bigger over the last few days.
He finally got in to see a new oncologist here in NJ .... He is scheduled for another petscan this week and will also have to have a biopsy done as well once the petscan is done.  They also did a whole bunch of blood work on him too.
Dr did not want to say anything yet as he said it could be a different cancer than from before, wants to wait for tests to be done first.  He did seem concerned that he is getting new lumps in the midst of having treatments done, said that's not so good..said it means that the Rituxan may not be working?  That doesn't make me too happy.
Thanks for your response.
Marie

[Mochadelicious]

Hello and welcome.  Do you know what kind of NHL your father had?  There are many types and can range from indolent (slow growing) to very aggressive.  Also, some lymphomas can tranform so it's really hard to say what his prognosis is.  How did he withstand the first set of chemo treatments?  Did he have any serious complications?  If not, he may be able to do more if his doctor thinks he can handle it (and if your dad is willing to do it again).