I saw an 85 year old gentleman who was referred to me because he had excessive night sweats and fatigue. He also lost 15 pounds. He had so much night sweats that he sometimes had to change his clothes at night.
He was 85 but was active until about last month. He wanted to gain his strength to the baseline. He also had pain in his stomach or stomach.
During my examination, I found that his spleen was markedly enlarged. He was anemic and had mild leukocytosis (elevated leukocytosis). I advise him to have a bone marrow biopsy. This is an outpatient procedure and I practice it regularly in my practice. This is done under local anesthesia.
He was a little worried because he had heard that it was very painful, but he accepted. He tolerated the procedure very well. He could drive home.
His bone marrow biopsy confirmed my suspicions: he has non-Hodgkin lymphoma or NHL. This is the reason for his night sweats, his fatigue and his markedly enlarged spleen. It is cancer of the lymphatic system.
Since lymphatic tissue is found all over the body, NHL can start almost anywhere and spread. It often starts in the lymph nodes, liver, spleen, or bone marrow. In my patient, it started in his spleen. There are many types of lymphoma, and all of them have different treatment and prognosis.
In most cases, we cannot find the cause of NHL. However, the risk increases with age. NHL is mainly divided by grade or rate of growth. The lower the grade, the slower its growth.
My patient has slow growing NHL. This is the most common kind.
He is old, but he is very symptomatic. He obviously wanted to avoid chemotherapy as much as possible.
His lymphoma expresses a marker called CD-20. We have a drug that targets this marker and only kills cells that express CD-20 and spares other normal cells. It is the foundation of precision medicine, and we use it extensively in our Florida Cancer Specialists office in Lecanto.
It doesn’t cause hair loss, nausea, vomiting, or significantly lower blood counts.
He starts this therapy. His night sweats have already improved significantly. He tolerates therapy very well. His quality of life has improved very much, and that is also extending his life.
Advances like this make cancer therapy not only very effective, but it also makes it accessible to many of my elderly patients.
Dr Sunil Gandhi is a hematologist and oncologist. He is the volunteer medical advisor for the Citrus Unit of the American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email [email protected] or call 352-746-0707.