Lymphoma

Diagnosis Lymphoma:

What To Expect

Todd E. Siuta

Communications III Ð'- ENG320

Professor Jon D. Holstine

May 23, 2002

On Thursday, December 16, 1993 my life changed forever. I was in my third semester of college and had just finished my last final exam. Having studied all night, I headed to the university game room to shoot some pool and relax. After a few games I felt painful spasms in my neck and shoulder. At first I thought it was a "pinched" nerve, and I tried to ignore it, but the pain just got worse. I wanted to go home, but I had promised my girlfriend we would meet. As I walked to her building the pain shifted to my chest and I grew short of breath. I remember sitting out on the steps, waiting, and thinking, "What the hell is going on?" Never had I experienced such fear. I thought I would die. Shari and I had been dating for only a month, and I did not want to alarm her. So when she appeared, I said nothing. She, her girlfriend, and I walked over to the cafeteria for lunch. I sat there quietly wearing my best poker face. No one suspected anything. After lunch, the girls left to go to their next exam and I went home. Looking back, I should have asked for help, but I did not. It took me over forty minutes to walk to my car. With each step, the pain was more crippling. I felt like an elderly man inching along with a walker. Foolishly, I drove myself home. I was nineteen years old, but never in my life did I need my mother more. When I walked in the door my younger brothers and sister were there, but mom wasn't. I collapsed on the couch, but before I could explain mom arrived home. She could hear the desperation in my voice as I told her, "Mom, I have to go to the hospital, something is wrong!" and explained what was happening. She rushed me to the Emergency Room where we waited in the lobby for hours. The nurses had already performed their initial assessment. They thought maybe I had a chest cold or perhaps sprained the muscles in my sternum. They wanted to take an x-ray, but I had to wait. Mom was worried about my brothers and sister being alone. My stepfather had met us at the hospital, so he stayed with me while she went home to care for them. Finally, the staff performed a quick chest x-ray and we waited for the results. When the doctor came in she wore a serious look. She hung the x-ray film on the viewer and pointed to a large white cloud. "Do you see this white area here", she asked?" "Yes", I replied. "It's not supposed to be there." "What is it?" I asked. "We think it's a tumor. It might be Hodgkin or non-Hodgkin's disease. We won't know until further testing can be done." "What is that?" I asked slightly puzzled. "They are types of lymphoma", she replied. "Is it serious?" "Yes" she said, "people die from it!" The doctor turned to my dad and said, "Sir, I think you'll want to call your wife now. She will want to be here." So he picked up the phone and called home. I remember hearing him say, "They think it's a tumor. You need to come right away!" With that phone call life with cancer began.

After receiving the Emergency Room physician's preliminary diagnosis our minds were flooded with questions. What is lymphoma? What is Hodgkin's disease? What is non-Hodgkin's lymphoma? What are the causes? How did I get it? Over the next three or four days these questions would be answered.

According to the Lymphoma Research Foundation, lymphoma is a general term covering a wide variety of cancers. These cancers develop when an error occurs during one of the transitional phases of a lymphocyte. The results are abnormal cells. These abnormal cells can accumulate in two ways; they can either duplicate faster than normal cells or live longer. The rapid abnormal accumulation causes a tumor to develop. Most lymphomas are classified as Hodgkin's disease or non-Hodgkin's lymphoma (NHL). Both are serious conditions that can be difficult to detect. They are elusive because many of the symptoms of lymphoma are common to less threatening illnesses. 1

What are the major signs and symptoms of lymphoma? The most common indicator is a painless swelling of the lymph nodes located in either the neck or armpit. In addition, swelling of the lymph nodes may also occur in the chest, abdomen, or pelvis. It is possible, but uncommon, for a patient to experience no swelling of the lymph nodes. Other symptoms include fever, night sweats, rapid unexplained weight loss, constant fatigue, or itching. These symptoms are not a cause for panic. Many common illnesses such as an infection, the flu, or a cold will present the same signs. Usually there is no pain involved with preliminary symptoms, especially if the lymphoma is in the early stages.

So, what explained my symptoms? The answer was more than interesting; it was vital. My cancer was not in an advanced stage thank God; however, the tumor was enormous, filling most of my chest cavity. Unlike other cancers, lymphomas do not invade organs; they push against them. In this case the tumor was exerting pressure on my trachea, which is responsible for transporting air to the lungs. This pressure was the cause of my severe chest pains and shortness of breath. In addition to the tracheal pressure, the tumor had shifted my esophagus. Normally it is vertical, allowing ease of movement through the digestive tract. In my case, an elliptical curve had been introduced to the digestive path making it very difficult to swallow. This obstruction caused regular violent choking episodes. Four months prior to my diagnosis I had gastrointestinal diagnostic procedures performed. They failed to detect the abnormality. An enlarged lymph node caused the pain in my neck and shoulder. Pressure on a nerve caused by an enlarged node can cause pain or even paralysis.

Once I understood my symptoms, I wanted to know what caused the disease. I wasn't a smoker. I didn't take drugs. I was a strong, virile, young man in perfect health. I could bench press 250 pounds and carry a half-keg of beer around on my shoulder. How did I get cancer?

In truth there is no simple answer. The number of lymphoma cases has increased significantly over the last twenty years. Medical experts cannot explain why one person gets lymphoma rather than another. They do know that it is not caused by injury, nor is it contagious. By studying patterns of cancer in the population, researchers