Worried

Neo,

Like the radiologist, it sounds like it is very likely lymphoma to me.  The radiologist is obviously of the opinion that it is most likely lymphoma, and is recommending a biopsy ("Impression 1").  My sister-in-law has the scarcoidosis he mentions, also under "Impression 1."  Scarcoidosis, a widespread swelling of the lymph nodes that is non-cancerous, and which does not improve with antibiotics, is actually worse in many ways than lymphoma, since it is essentially untreatable, whereas lymphoma is usually very treatable.  NOTE: The radiologist's Report constitutes a "Referral," which some doctors require. He is a doctor saying that you need a biopsy in this medical document. This is relevant for insurance purposes.

I would do a consult wtith a general surgeon and schedule a biopsy. Only a biopsy can confirm cancer, and only a biopsy will say definitively what is causing the swelling.  It will require a general surgeon to determine which nodes to extract, and how.

I would get to a surgeon. In general, one month is insignificant when fighting lymphoma. Many patients here have been told they had lymphoma for years before being successfully treated after diagnosis.  But I would not drag my feet either. There are over 40 common forms of lymphoma, and a few are aggressive.

Many dozens of people here over the years have written about how this or that doctor treated them indefinitely with antibiotics, rather than doing a biopsy and finding out the truth. Blood panels are often normal or close to normal, even for patients whith advanced lymphoma.  I had advanced Hodgkin's "all over" at diagnosis (collar bone to pelvic region, and across both sides; numerous organs wrapped by the nodules) following a biopsy, but my CBC panels were nearly perfect, so clean lab results are close to worthless.  There are more specialized labs that better indicate and track lymphoma, but family doctors are often unfamiliar with them. 

Also, many lymphomas, until they are very advanced, are asymptomatic: Fatigue is the most common, universal symptom that virtually all patients report.  In other words, normal labs and few symptoms are no argument against the disease.  I never felt an enlarged node, ever.  In fact, I  have never felt an enlagred node in my life, despite the advanced disease that I described.

I have a saying: "Don't let a doctor antibiotic you to death."

max

sometimes this is performed by a thoracic surgeon. Advise you talk to your primary about who in your area performs this procedure.

As the radiologist pointed out lymphoma is certainly a possibility and a worry here.  There are other etiologies possible but they would be

for example, atypical infections. I suspect you will need a biopsy and the technical approach is more the question.

Good luck!

Would not get bogged down in defining what type of lymphoma it is until more tissue is obtained and you have seen your oncologist.

Steve.

If your doctor is not an oncologist i would see one immediately.  I had CLL that transformed into NHL.  Had I not been under the right care precious time would have been lost  just my 2 cents.

Your route to diagnosis was slower than most, but at last over.  Conversely,  some patients are told at diagnosis that they had most likely had lymphoma for many years. My own oncologist said that I had had it "at least a year, maybe longer." My next door neighbor took three years for proper diagnosis, although he was late Stage IV (he is cancer free today).

Since there is no ambiguity in your results, and it does not suggest an odd or extremely rare strain, I myself would not bother with another pathology study. Usually when people need a second pathology study, it is the first lab itself recommending the second review, and it is usually because they know that the findings are not clear.  Your CT, this biopsy, and the aspirational biopsy have all pointed in the same direction. What you needed was confirmation of strain, which you now have.

Your disease, in the US, is almost always treated with the combination ABVD, except in some cases of very limited, Stage I involvement, in which radiation alone was at times employeed in the past. Studies have shown that adding chemo to radiation in extremely early stages improves long term prevention of relapse dramatically.  You will not receive Rituxan, since Rituxan kills only the CD-20 cell, which classical HL tests negative for. Your CT results make me believe you will be staged as an early Stage II.   You will almost definitely be given a bone marrow biopsy nonetheless, which is a good and necessary inconvenience.

Knowledge is power, and not-knowing is often the hardest part of the cancer fight.  You should achieve complete remission rapidly, and never see this pest again.  Your age, limited involvement of the disease, and overall good health make full recovery very likely.

I think you are advanced beyond this level of information, but youmight find it useful: 

http://www.lymphoma.org/site/pp.asp?c=bkLTKaOQLmK8E&b=6300137

max

i know its hard to do but you will be better off for it. Take comfort in knowing your condition is very, very treatable and curable. It took me four years to get fully disgnosed. I credit that to seeing non-cancer specialists. Get to the experts. And remember that with lymphoma, except for very limited stage I, the stage has almost nothing to do with the probability of successful treatment. Take charge. Seek support from family and friends. Be strong. May the best of good fortune come your way.

Pete is right but thne you are faced with nausea and lack of appetite. I am not a big veggie eater so I have a can of V8 every day. Not to replace eating veggies but to added to the low volume of veggies I do eat. Many people find something they will eat no matter how bad they feel. It usually isn't the leathiest of foods but something in the stomach is better than nothing. A couple of people I know ate french fries. I couldn't eat potatoes but I could eat mac & cheese. 

My husband makes great soups and would give me homemade vegetable soup at least 2 or 3 times a week. Haven't been able to eat it since I went into remission. (Oh well.) I also avoided sweet things like candy & soda as much as possible. I only took supplements approved by the Drs. Exercise, well walking is an exercise. One thing I did almost everyday was to make a plan for the next day. I did a lot of working form home that helped in that regard but on days I didn't work I still planned. Even it it was something as simple as get out of bed, get dressed, read the paper, work the crossword puzzle, watch the program I saved the night before because I was too tired to watch it then.  You get the idea. Just don't make the plan the same every day.