hello and thank you for submitting your question.

Your question is a good one and I will work on providing you with some information and recommendations regarding what is going on.

Based on your laboratory studies I do not see any obvious signs that there is lymphoma involved in your bone marrow.

You do have a history of a type of lymphoma which usually responds very well to chemotherapy and radiation. There is a good chance that this can be cured with chemotherapy and radiation but a small percentage of patients may have a relapse

In your case it is very difficult to determine if the symptoms you're having including the swelling of your lymph nodes represents a recurrence of your lymphoma or some type of other process such as a mild infection or mild inflammation.

The only way to adequately find out what is going on would be to perform the biopsy procedure and then have a pathologist analyze the tissue under a microscope.

I want to reassure you know that even if the biopsy result is positive for lymphoma there are still treatment options for you. It would be premature to discuss the treatment right now until a final diagnosis is made.

For now I would worry about maintaining good general health including getting adequate exercise, eating a well-balanced diet and sleeping every day for at least 6 to 8 hours. This type of lifestyle will support your immune system and will enable you to overcome any challenge which comes in your direction.

I thank you again for submitting your question. Again it is impossible to predict what the results of the biopsy procedure will be and as I mentioned earlier there does not appear to be any active lymphoma in your bone marrow. If there was lymphoma in your bone marrow we would see significant changes in your blood counts.
At the same time just does not completely rule out the possibility that there still could be some active lymphoma in your lymph nodes.

Again I thank you for Submitting your question. I hope you found this response to be helpful and informative. If you have additional concerns I would be happy to address them as well.

Sincerely,

Dr. Robert

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Hello again and thank you for your question.

I completely understand that you're dealing with a high degree of anxiety related to what is going on. I would discourage you from speculating regarding what things could be going on until we have a real answer.

You are correct that usually tender lymph nodes are related to infection. this is not always the case however. I am not trying to ignore the concern regarding some type of malignancy or some type of lymphoma going on but I preferred that you remain optimistic. Maintaining a good positive state of mind will serve you very well both psychologically and physically.

Again if this happens to be lymphoma there are many possible treatment options. You are a very healthy person and I want you to really focus again on maintaining and preserving your health right now while your physicians do the best that they can to accurately characterize and diagnose what is going on.

I will await additional information if you can provide it related to results from a possible biopsy. We can then discuss what is going on and possible treatment if indeed any treatment is indicated.

I thank you again for submitting your question. I am sorry you're dealing with this degree of stress and anxiety. I am optimistic that in the future things will be better for you.

Sincerely,

Dr. Robert.

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Hello and thank you for your follow-up question.

The radiologist commented that the lymph node appeared abnormal. This is not a conclusive statement which indicates the presence of malignancy. It does however provide us with a reason to investigate this further with the biopsy. Again even in the worst case scenario there will be treatment options. In a best case scenario this is a benign enlargement of lymph nodes. I know this provide you with hardly any degree of comfort right now but I am trying to help you beat both realistic and somewhat optimistic at the same time.

I again remain available for discussion of the upcoming results.

Dr. Galamaga

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Thanks again for your question.

The swelling could possibly be related to swelling of the lymphatic system but I suspect that also your senses are heightened and you are likley very sensitive to even slight symptoms. It is a fine choice to ask the oncologist for advice. If he is not able to respond, maybe one of his nurses might be available to help you.

Only a radiologist can interpret the lymph node. An ultrasound of a node can look very irregular under ultrasound. Again - patience is important here. Nothing more to add until a biopsy is obtained.

Thanks again,

Sincerely,

Dr. Galamaga

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Hello again and thank you for your follow up with additional information.

Again as you know it is difficult to assume anything from your CBC. The numbers all look fine. Regarding the sedimentation rate I would regard this result as essentially the same as the last one.

You are correct that we cannot assume anything at this point but again I don't want you to focus on the negative prospects. Again even if there is evidence of lymphoma this is extremely extremely treatable.

Please let me know the schedule of your follow-up appointments and any additional questions you might have.

Sincerely,

Dr. Robert

PS I see you are from the great state of Rhode Island. That is where I spent the first 18 years of my life. It's a beautiful state!

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