Oncologist Interview - 2nd Opinion

I met with Dr. Eric J. Seifter today for approximately one hour. This is my second opinion/consultation to talk about my enlarged cervical (neck) lymph node. The initial discussion took place in his office. It was a 30 minute review of the medical records package I sent him via email. The conversation almost seemed like an interview to be his patient, given that I had requested an appointment without a profesional referral. We had a wide ranging conversation that included lymphoma, our respective education, and Bayesian analysis for cancer diagnoses. His corner office is comfortable and adorned with modern sculpture and ancient fossils and geologic specimens including a trilobite.

What is curious to Dr. Seifter about my case is I don't have a single additional indicator for lymphoma, my blood work is spot on and I am otherwise very healthy. Once the initial consult was complete it was as if I had passed the entrance exam. 

We walked next door and he performed a physical examination of me. Interestingly the larger of the two (2cm x 2cm), it's about an inch under my left ear, is not the one that can cause concern. Dr Seifter told me the left supraclavicular lymph node (by my collarbone, 2cm x 1cm) is a statistical indicator of infection or malignancy. He quoted Dr. Paul Auwerter (JHU Medical Grand Rounds, Oct. 2000) by saying in every case an enlarged supraclavicular lymph node indicates infection or malignancy. I'm hoping to be that rare anomaly! It also turns out that the deep lymph node under my right armpit is also active. Given that three are active something is going on and we need to go to the next step. Choices for the most immediate course of action are:

1. PET/CT scan will be a good indicator or road map of what's going on the body. The downsides are exposure to x-rays, ingesting a radio active chemical, and insurance companies will know there's an indicator of cancer based on how the test is ordered. So it will be impossible to get life insurance for 5 years after a test. 
2. Excision of one or more neck lymph nodes that could include the upper cervical or supraclavicular.

The biopsy is the only method to provide the pathology to figure out what the lymphocyte cells are doing, so that's my choice for the next step. We wrapped up the exam and went back to his office.

Dr. Seifter then called Dr. Wayne Koch's office - he's the director of the Head and Neck Center at JHU. Dr. Seifter politely spoke to Dr. Koch's Medical Office Coordinator. I sat there while he briefly explained my situation, added a couple nice compliments and managed to get me a biopsy appointment in the next two weeks. I'm waiting for them to call, hopefully tomorrow. 

Dr. Seifter then ordered additional blood tests, to look at how some of my other internal systems are doing and to look for the presence of other indicators even though you can't diagnose lymphoma through a blood test. These tests, and an EKG, were all accomplished before I left the medical offices.  These also complete my pre-op requirements so we are fast tracking to get the incisional biopsy done quickly...I like the way he works! 

Dr. Seifter prefers Dr. Koch and other JHU teams because there are more than a dozen cancer specialists who wil provide an excellent pathology and will work with Dr. Seifter to diagnose my results. The biopsy should be an outpatient procedure with a local.

Dr. Seifter reiterated that it is still possible that nothing serious is going on. It could be a low grade lymphoma that might not require treatment, an infection or sarcoid/sarcoma. I can only hope.