splenic marginal zone lymphoma

Max Former Hodgkins Stage 3 said:

Choice

Crixy,

Why is treatment an either/or ?  Why not do both Rituxan and surgery ? While SMZL is very complex, I'm pretty sure that "both" is the choice I would make.

In most cancers (organ cancers unrelated to lymphoma and leukemia) cutting out a tumor or organ that is massive is termed "debulking," and can assist other modalities (chemo or radiation) toward a cure.  The reasoning is sort of: "Patient x has this rogan cancer, with about 5 trillion cancer cells in the body. If 4 trillion are in organ y, then removing organ y will have us 80% toward removing the cancer from the body. Better muchless cancer than more."  A weakness in this regarding lymphoma is of course that the lymphatic and circulatory systems are systemic -- they go everywhere.

Debulking is very common in most non-blood cancers, perhaps the norm. It is also frequently highly pallatative.  Again, I do not see why surgery would in any way preclude the use of Rituxan.  It may be that stategically it would be better to do some Rituxan to see how much reduction it casuses, which might assit in making surgery easier.  It might also potentially, so cure the spleen that it need not be removed.   Ask the oncologist.

If forced to choose one or the other, I would start Rituxan yesterday and avoid the surgery.  As Po suggested, in the world of chemos and chemo-like IV drugs, Rituxan is the mildest and easiest to tolerate.  Technically, it is not "chemo" at all, but a biologic "monoclonal antibody."  It will not cause hair loss or most of the other side-effects wrought by most chemotherapy drugs.

max

According to what I've read and according to my hematologist. the medical world is evenly split as to what route to take, thus the either or choice. I am currently on the chemo route with great initial results, my spleen went from 25 cm to normal size after 2 treatments. I chosed this in consultation with my specialist because I did not want to complicate things with any invasive surgery, although surgery was initially plan B. The only drawback is that despite pro-active treatment, I am experiencing some of the more severe side effects such as chills (shaking), vomiting, joint stiffness and swelling but still no regrets.