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FNA showed suspicious cells possible lymphoma. What would you recommend?

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Oncologist, Surgical
Practicing since : 2008
Answered : 576 Questions
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I am awaiting the results of an excisional biopsy of right supraclavicular node. The FNA did show suspicious cells possible lymphoma. I am a 71 yr. old female. I am looking for a top oncologist in the Washington, D.C. / Northern VA, or Johns XXXXXXX - Baltimore area. Who / what would you recommend?
Posted Fri, 30 Aug 2013 in Lymphoma
 
 
Answered by Dr. Rohan Khandelwal 11 hours later
Dear Sir,

Sorry to hear about your problem. You can contact Dr. Mukund Didolkar. He is a very good oncologist working at Sinai Hospital and is attached with Johns XXXXXXX as well.

Hoping for the best.
Above answer was peer-reviewed by
 
Follow-up: FNA showed suspicious cells possible lymphoma. What would you recommend? 8 hours later
I question the attention paid to my query, being addressed as Sir. I am a 71 yr. old white female. I would have felt the response to be more satisfactory had it given a brief general commentary concerning lymphoma. Also, where exactly is Sinai Hospital? It appears that Dr. Khandelwal's specialty is not limited to hematological / lymphoma disease. When I "clicked" specialist, that was my expectation.


Upon further and more careful reading, I see that I erred in my assessment concerning Dr. Khandelwal. The physician I should have been looking into is in fact Dr. Mukund Didolkar who I have learned is into hematological oncology. Thank you for the recommendation.
Also, in the meanwhile, another physician has been suggested for consideration, a Dr. XXXXXXX Ambinder of Johns XXXXXXX With two references, I feel I now have something more definite to go on.
 
 
Answered by Dr. Rohan Khandelwal 18 hours later
Dear Ma'am,

Really sorry for addressing you as sir. I recommended Dr. Didolkar because I have personally worked with him and seen his work and he does deal with hematological malignancies.

Hoping for the best. Please feel free to clarify any other query.
Above answer was peer-reviewed by
 
Follow-up: FNA showed suspicious cells possible lymphoma. What would you recommend? 6 hours later
Dear Dr. Khandelwal,

Thank you for your recommendation. As you would understand, I am seeking the best information I can obtain in order to help me avail myself of the best care. When you are in the early stage of any illness, you are busy formulating the questions. If you have any suggestions regarding good questions to put to the oncologist, I would appreciate knowing what they are. Thank you.
 
 
Answered by Dr. Rohan Khandelwal 14 hours later
Dear Ma'am,

Thank you for asking your query. The following questions might be helpful:

1. If it is a lymphoma, what is the stage?
2. If not, what is the alternate diagnosis?
3. Which chemotherapy regime Will be suitable for you and what are the side effects.
4. What are the chances if recurrence.

Hope these questions Will help you know more about your condition. Hoping for the best.
Above answer was peer-reviewed by
 
Follow-up: FNA showed suspicious cells possible lymphoma. What would you recommend? 2 days later
Today I received the pathology report with the diagnosis of Follicular lymphoma, low grade (grade 1 to 2). Tomorrow I will be making an appointment to begin a more detailed diagnostic workup. Do you have any additional questions that I should be asking the oncologist or any recommended reading that will help to guide my quest for the best possible care and outcome? I know my time with the Healthcare questions to you, is just about up. Thank you.
 
 
Answered by Dr. Rohan Khandelwal 2 hours later
Dear ma'am,

Thank you for asking your question. Low grade follicular lymphoma carries a good prognosis provided it is localized. There are no new questions other than the ones i pointed out earlier.

Hoping for the best.
Above answer was peer-reviewed by
 
Follow-up: FNA showed suspicious cells possible lymphoma. What would you recommend? 11 hours later
It will not, of course, be known if this follicular lymphoma is localized or not until after a diagnostic work up is done. I know one test will be a PET scan which I presume will reveal the presence of any additional affected nodes. If there are more nodes in other parts of the body, it seems logical to assume there may be a need for more treatment. Your statement implies a poor prognosis if it is not localized. That is not altogether consistent with what I have been reading, and needless to say, I am reading about this condition rather extensively. I also am interested in any comments you might make regarding Rituxan. Thank you.
 
 
Answered by Dr. Rohan Khandelwal 18 hours later
Dear Ma'am,

The prognosis does depend on the extent of spread and yes, that will be clear on the PET scan which you are scheduled to have.

Rituximab is a monoclonal antibody, which is used in combination with chemotherapeutic agents (like CHOP regime) to enhance their effect against lymphoma cells. It is very effective but is associated with side effects as well. The most common being the depletion of white blood cells in the blood, which can lead to repeated infections.

Hoping for the best. Please feel free to clarify any other query.
Above answer was peer-reviewed by
 
Follow-up: FNA showed suspicious cells possible lymphoma. What would you recommend? 6 hours later
I have also been reading that follicular lymphoma is almost always stage IV when first detected. In addition, this type of lymphoma is not subject to cure but is subject to decent results with treatment. Do you concur with this information? I am wondering, what the likelihood of bone marrow testing is as part of the diagnostic work-up.
Somewhat off the subject here, but not really, is how do you weigh in regarding the use of artificial sweeteners such as Splenda and Truvia? What do you think regarding any carcinogenic effect they might have. My diet is fairly good but I do use these sweeteners for certain things. It seems to me that bringing my diet to an even better standard is one of the things I might do for my general health while facing this new situation. What lifestyle factors do you consider the more important when considering the likely treatments ahead?
 
 
Answered by Dr. Rohan Khandelwal 14 hours later
Dear Ma'am,

As I mentioned previously, the prognosis of the tumor depends on the spread of the disease, which will only be revealed after the PET scan. chemotherapy. Few suggestions are:

- Regular exercise - 30 mins walk everyday
- Balanced diet- preferably organic food
- Keep your sugar under control, as uncontrolled sugar can predispose to infections.
- Join a cancer support group to keep your morale high.

Hoping for the best. Please feel free to clarify any other query.
Above answer was peer-reviewed by
 
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