Questions: What Is Going On Here?
Q: What is cancer?
A: Cancer is a disease that can affect any of the body's cells. It starts to develop when the deoxyribonucleic acid (DNA) in your body's cells becomes disrupted or damaged. DNA contains specific instructions that tell your cells when to divide and multiply which allows them to grow in a controlled manner. If the DNA becomes disrupted then these instructions become distorted your cells start to grow in a rapid and uncontrollable way. This uncontrolled growth causes a lump to form which is referred to as a tumor. This tumor can ultimately become cancerous and start to affect other areas of the body. The article at the link below describes the three of the major types of cancer in greater detail: (1) Carcinoma, (2) Leukemia and Lymphoma, and (3) Sarcoma.
Article Source: 3 Major Types of Cancer Explained
Q: What is Hodgkin's Lymphoma (HL)?
A: A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell is called a Reed-Sternberg cell.
Q: What are the symptoms?
A: Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats (see more below). Also called Hodgkin disease. (from the National Cancer Insitute)
Q: What are HL subtypes?
Q: What are the symptoms?
A: Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats (see more below). Also called Hodgkin disease. (from the National Cancer Insitute)
Q: What are HL subtypes?
A: There is a lot of confusing and contradicting information on the Web about this topic. Many differentiate between Nodular Lymphocyte and "Classical" HL. Below the latest from the World Health Organization, International Classification of Diseases (ICD 2010).
A: Staging occurs only after additional testing. This can be a CT (or CAT) scan, a PET/CT scan or a bone marrow aspiraton and biopsy. In my case this was a PET/CT scan to see where the "hot spots" are in my body. In general, the stages are:
Stage I: Cancer is found in one or more lymph nodes in one lymph node group.
Stage II: Cancer is found in two or more lymph node groups, and both are either above or below the diaphragm.
Stage III: Cancer is found in one or more lymph node groups above and below the diaphragm
Stage IV: Cancer is found outside the lymph nodes throughout one or more organs (a); or outside the lymph nodes in one organ and has spread to lymph nodes far away from that organ (b); or in the lung, liver, or bone marrow.
Stages of Adult HL (from the NCI)
Q: What are the "A" and "B" designations?
A: Once staged, the you will also be given a designation.
Type A: The patient has no symptoms.
Type B: The patient has symptoms such as:
C81.0 Nodular lymphocyte predominant Hodgkin lymphoma
C81.1 Nodular sclerosis classical Hodgkin lymphoma
C81.2 Mixed cellularity classical Hodgkin lymphoma
C81.3 Lymphocytic depletion classical Hodgkin lymphoma
C81.4 Lymphocyte-rich classical Hodgkin lymphoma
(Excludes Nodular lymphocyte predominant Hodgkin lymphoma C81.0)
C81.7 Other BU Hodgkin lymphoma - Classical Hodgkin lymphoma, type not specified
C81.9 Hodgkin lymphoma, unspecified
Q: Now that I am Diagnosed with HL, What "stage" am I?A: Staging occurs only after additional testing. This can be a CT (or CAT) scan, a PET/CT scan or a bone marrow aspiraton and biopsy. In my case this was a PET/CT scan to see where the "hot spots" are in my body. In general, the stages are:
Stage I: Cancer is found in one or more lymph nodes in one lymph node group.
Stage II: Cancer is found in two or more lymph node groups, and both are either above or below the diaphragm.
Stage III: Cancer is found in one or more lymph node groups above and below the diaphragm
Stage IV: Cancer is found outside the lymph nodes throughout one or more organs (a); or outside the lymph nodes in one organ and has spread to lymph nodes far away from that organ (b); or in the lung, liver, or bone marrow.
Stages of Adult HL (from the NCI)
Q: What are the "A" and "B" designations?
A: Once staged, the you will also be given a designation.
Type A: The patient has no symptoms.
Type B: The patient has symptoms such as:
- Fever
- Painless swelling of the lymph nodes in your neck, armpits or groin
- Persistent fatigue
- Night sweats
- Unexplained weight loss
- Coughing, trouble breathing or chest pain
- Loss of appetite
Questions from My Chemotherapy Consultation
Q: Can we go through PET/CT results in more detail? Are my abdomen nodes small? Is the largest node in the chest?
A: In general a PET measurement above a specific uptake value (SUV) of 5 is indicative of cancerous activity. The abdominal nodes show SUV above 2.0 which is low. However they show some activity. The largest growth is in the chest but it is in the early stages.
Q: How fast can it spread? Any idea how long it's been growing?
A: The only way to track spread is with multiple PET/CT scans so we don't know right now. This lymphoma could have been present 3-4 years ago. It looks to be slow growing which is good. We still "found it early".
Q: How were the results from my last CBC and complete metabolic panel?
A: CBC was and results were in normal ranges.
Q: ABVD - is there a lifetime max dose for each? What factors determine dose amount or recommended ratios of each or is it an art/science to determining "optimal" balance of each.
A: There is a lifetime maximum for Adriamycin. During my chemo I'll get about 300 (25mg/m2 per dose). The lifetime max is 550. Dosing is based initially on height and weight. I hold the distinction of being prescribed highest dose of anyone he's ever treated. Once we get through the first treatment we check biological blood levels and will adjust based on blood levels. Trying to achieve a target value for ??? (RBC and Platelets I think).
Q: Do you use Neulasta or something else to fight infection?
A: A resounding no. In particular Neulasta and related drugs can be dangerous with Bleomycin.
Q: Have you seen a case where the initial chemo shrunk a chest tumor that drained into lungs?
A: Not with any of my patients.
Q: Thoughts on anti-nausea meds or appetite aids?
A: There are a number of anti-nausea drugs we use including Aloxi and Emend. There's really no need for appetite aids.
Q: How to administer ABVD? Through a port or IV?
A: My veins look very good. No need for a port. It is administered through an IV.
Q: When do you recommend or what cases cause you to do a bone marrow biopsy?
A: That's a much discussed topic. Still plan to use the ABVD therapy regimen for Stage 3A HL. Spread to the bone marrow might be 15% chance. Usually don’t consider it necessary because I'm an A type. If I was going into study they might request it and then administer the same treatment. Also my bones (hip) are large and it would likely cause a lot of discomfort for me. At this point there is no upside.
Q: Can I schedule off-Fridays and what about Friday after Thanksgiving? How does this get setup?
A: Yes, the nurse will set it up and there is some flexibility.
Q: Can we meet the chemo team? What is a typical session like?
A: Yes you can meet them . Typical session lasts 2-3 hours. Dacarbazine is the first and takes an hour as an IV drip. The other three pushed through by the nurse over the next 30-45 minutes. You will be relaxing in a chair and talking with relatives, reading or listening to music. You can use a cell phone. The key thing to watch for after you leave chemo is a fever. If so, call right away! Do not exceed a temp of 100.4 max.
Q: When is next PET/CT? How often or after how many cycles?
A: Next PET/CTis 4th dose and then at end of chemo.
Q: Blood test each week?
A: After the first dose and then every two weeks with each dose.
Q: Are the follow-up echocardiogram tests or pulmonary tests?
A: There is another pulmonary after two doses. Most likely no other echo until the end.
Q: Dietary recommendations, Alcohol? exercise, or can I drive home after chemo?
A: Eat healthy and drink in low moderation. No getting drunk! Most likely will be able to drive home but depends on energy level.
Q: How about supplements? Acupuncture?
A: Supplements have no proven value to chemo so you can take them if you want. But don't take day before, day of, or day after. Antioxidants can block effect of chemo.
Q: Can I take Advil or Sudafed if needed?
A: No problem
Q: Other educational or reading material?
A: JHU Patients Guide to Lymphoma is given to you. Other material is based on my judgment.
Q: What is your patient base currently? How many other HL patients have you treated? Success rate for them?
A: He has treated 70-80 patients while at Park Medical for Hodgkin's disease and 20-30 prior to that. He has not had a single relapse of Hodgkin's although it's statistically possible. He has been using ABVD since 1987. Healthy, motivated patients always do the best.
Q: Any patients similar to my circumstances?
A: Some of his Hodgkin's patients have been similar. He's seen all stages. Wide variation in reactions from none (played organized soccer) to feeling like they were "hit in head with mallet".
Q: I may need to travel in a couple month, any problem.
A: No problem if you want to.
Q: Dental work?
A: Use your judgment on dental work. It is possible to get an infection from any kind of invasive dental work and we don’t want that.
Q: Can I get a flu shot?
A: Flu shots are not a problem since they only contain dead or deactivated flu virus. So I got a flu shot at the facility after the consultation.
Q: Can I Exercise?
A: Need to parcel out your reduced energy level. If you exercise you may need more sleep. See what works.
Q: How can we communicate over the next 6 months? Email? Cell phone? What times?
A: Email is fine any time. Tuesday is hospital day from 10am on so a response might not happen until later in the day/evening. There are office hours and on call all week. We have a home phone number.
Q: How fast can it spread? Any idea how long it's been growing?
A: The only way to track spread is with multiple PET/CT scans so we don't know right now. This lymphoma could have been present 3-4 years ago. It looks to be slow growing which is good. We still "found it early".
Q: How were the results from my last CBC and complete metabolic panel?
A: CBC was and results were in normal ranges.
Q: ABVD - is there a lifetime max dose for each? What factors determine dose amount or recommended ratios of each or is it an art/science to determining "optimal" balance of each.
A: There is a lifetime maximum for Adriamycin. During my chemo I'll get about 300 (25mg/m2 per dose). The lifetime max is 550. Dosing is based initially on height and weight. I hold the distinction of being prescribed highest dose of anyone he's ever treated. Once we get through the first treatment we check biological blood levels and will adjust based on blood levels. Trying to achieve a target value for ??? (RBC and Platelets I think).
Q: Do you use Neulasta or something else to fight infection?
A: A resounding no. In particular Neulasta and related drugs can be dangerous with Bleomycin.
Q: Have you seen a case where the initial chemo shrunk a chest tumor that drained into lungs?
A: Not with any of my patients.
Q: Thoughts on anti-nausea meds or appetite aids?
A: There are a number of anti-nausea drugs we use including Aloxi and Emend. There's really no need for appetite aids.
Q: How to administer ABVD? Through a port or IV?
A: My veins look very good. No need for a port. It is administered through an IV.
Q: When do you recommend or what cases cause you to do a bone marrow biopsy?
A: That's a much discussed topic. Still plan to use the ABVD therapy regimen for Stage 3A HL. Spread to the bone marrow might be 15% chance. Usually don’t consider it necessary because I'm an A type. If I was going into study they might request it and then administer the same treatment. Also my bones (hip) are large and it would likely cause a lot of discomfort for me. At this point there is no upside.
Q: Can I schedule off-Fridays and what about Friday after Thanksgiving? How does this get setup?
A: Yes, the nurse will set it up and there is some flexibility.
Q: Can we meet the chemo team? What is a typical session like?
A: Yes you can meet them . Typical session lasts 2-3 hours. Dacarbazine is the first and takes an hour as an IV drip. The other three pushed through by the nurse over the next 30-45 minutes. You will be relaxing in a chair and talking with relatives, reading or listening to music. You can use a cell phone. The key thing to watch for after you leave chemo is a fever. If so, call right away! Do not exceed a temp of 100.4 max.
Q: When is next PET/CT? How often or after how many cycles?
A: Next PET/CTis 4th dose and then at end of chemo.
Q: Blood test each week?
A: After the first dose and then every two weeks with each dose.
Q: Are the follow-up echocardiogram tests or pulmonary tests?
A: There is another pulmonary after two doses. Most likely no other echo until the end.
Q: Dietary recommendations, Alcohol? exercise, or can I drive home after chemo?
A: Eat healthy and drink in low moderation. No getting drunk! Most likely will be able to drive home but depends on energy level.
Q: How about supplements? Acupuncture?
A: Supplements have no proven value to chemo so you can take them if you want. But don't take day before, day of, or day after. Antioxidants can block effect of chemo.
Q: Can I take Advil or Sudafed if needed?
A: No problem
Q: Other educational or reading material?
A: JHU Patients Guide to Lymphoma is given to you. Other material is based on my judgment.
Q: What is your patient base currently? How many other HL patients have you treated? Success rate for them?
A: He has treated 70-80 patients while at Park Medical for Hodgkin's disease and 20-30 prior to that. He has not had a single relapse of Hodgkin's although it's statistically possible. He has been using ABVD since 1987. Healthy, motivated patients always do the best.
Q: Any patients similar to my circumstances?
A: Some of his Hodgkin's patients have been similar. He's seen all stages. Wide variation in reactions from none (played organized soccer) to feeling like they were "hit in head with mallet".
Q: I may need to travel in a couple month, any problem.
A: No problem if you want to.
Q: Dental work?
A: Use your judgment on dental work. It is possible to get an infection from any kind of invasive dental work and we don’t want that.
Q: Can I get a flu shot?
A: Flu shots are not a problem since they only contain dead or deactivated flu virus. So I got a flu shot at the facility after the consultation.
Q: Can I Exercise?
A: Need to parcel out your reduced energy level. If you exercise you may need more sleep. See what works.
Q: How can we communicate over the next 6 months? Email? Cell phone? What times?
A: Email is fine any time. Tuesday is hospital day from 10am on so a response might not happen until later in the day/evening. There are office hours and on call all week. We have a home phone number.
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