The details... by Dr Chris

     No, I'm not a doctor and nor do I understand all the intricacies of NK-cell lymphoma. But as some people are interested in the details of Ben's diagnosis, here is what I understand. But if you don't want the details, feel free to browse elsewhere!

     Ben had a small lump on his calf in May which was first thought to be a cyst of some sort. It grew a little and he was given antibiotics in case it was an infection. It grew more and a trip to hospital resulted in a biopsy and diagnosis of some form of lymphoma - a cancer of the white blood cell system (lymphocytes) which protects against infection and disease. Initially it was thought that Ben had the uncommon T-cell lymphoma but it's almost definite that it is the extremely rare NK-cell variety.

     NK-cell lymphoma has a grim prognosis and if it spreads throughout the body the only real hope of combatting it is with a bone marrow transplant (more on that another day.) Radiotherapy can be used on one part of the body and chemotherapy can reduce the cancer activity inducing a time of remission, hopefully long enough for a bone marrow transplant to occur.

     By the time the lump was the size of an apple Ben started on daily radiotherapy. The hope was that the cancer was limited to his leg and that the radiotherapy would knock it off. Then chemotherapy would do any 'mopping up'. But there were also worrying signs of activity in the spleen which we hoped were unrelated. Following radiotherapy Ben started chemotherapy at a hospital much closer to home. But by this stage he was having classic symptoms such as night sweats and fevers. Then the initial chemotherapy seemed to hit the cancer quickly and his enlarged spleen decreased in size.

     Chemotherapy is a potent mix of drugs designed to kill off rapidly growing cells. This means the cancer cells are targeted. But so are all blood cells, which in turn means that the immune system is depressed and the patient is very prone to infections. In Ben's case he has had a number of infections (the first symptom being a high temperature), which mean returning to hospital immediately. Infection also means a delay of chemotherapy until the patient is strong enough. But the lymphoma itself causes fevers so it is often hard to know if the lymphoma is at work (in which case it's important to continue with chemotherapy) or if infection is the cause (in which case delaying chemo is necessary.)

     A principal effect of the lymphoma is that it destroys blood cells. In Ben's case his blood cell levels (especially neutrophils which fight infection and platelets which are responsible for clotting) have been very low at times. This means constant blood checks and lengthy hospital stays... Ben has now been in hospital about 4 weeks due to various combinations of bleeding, infection, pain and low blood levels.

     Last week, as Ben didn't seem to be recovering enough to go on with chemotherapy, the consulting doctor recommended taking out his enlarged spleen (and gall bladder too). A lot of blood flows through the spleen and the hope was that removing the spleen would remove a large source of the blood destruction. But there were also negative considerations such as the ongoing problem of being spleenless as well as the danger of surgery when blood levels are so low. But the result has been encouraging so far: Ben's levels are the best in a long time and there is no fever. Yesterday the surgeon said the spleen was not 4 times normal size, but 5 or 6!

     Enough details for one day... more on bone marrow transplants another time.

     We hope for chemotherapy to restart tomorrow and we hope Ben will be back at home next week before another round starts. Thank you for your prayers and many signs of care.