Take-home Message 

Patient support program

(Fictional narrative by the doctor)

James Fleck, MD, PhD: Anticancerweb 24 (05), 2020

Alex, a 29-year-old publicist, came to my office accompanied by his wife. They had been married for two years and were thinking about starting a family. Alex has always been very careful with his health, exercising regularly and consuming mostly natural foods. His wife Sue, revealing oriental traits, used to encourage his lifestyle.

About a month ago, Alex noticed a lump on the right side of his neck. He sought a doctor who described the lesion as a hardened lymph node, three centimeters in diameter. The rest of his clinical examination, including a complete ENT endoscopic evaluation, showed no further findings.  Alex was referred to a head and neck surgeon and, since there were no signs of infection, an excisional lymph node biopsy was performed. He removed the entire lymph node, taking special care not to pinch or crush the material. The lymph node is a delicate structure and the pathological diagnosis depends on its physical integrity.

A week later, Alex was diagnosed with a non-Hodgkin's lymphoma.

Sue was very disappointed. She couldn't understand how a young man with healthy habits could get cancer. In addition, Alex had been a recognized athlete in the 100-meter race at the University Games.

I explained that healthy habits are very important and should be encouraged, as they effectively prevented many tumors, promoting DNA stability. However, this was not an absolute rule, as some tumors could occur even in young and previously healthy people. Ironically, non-Hodgkin's lymphoma was one of these malignant diseases.

When I examined Alex, I found no problems with his physical examination. There was only the surgical scar resulting from the previous excisional biopsy. Alex had an athletic build, reported no weight loss, and had no B symptoms.

Alex was also surprised by the diagnosis and asked me if it could be a mistake.

I told him it was unlikely, but that I would personally double check the pathological examination. Some laboratory tests had already been requested by a previous doctor and included an increase in lactate dehydrogenase (LDH). This is a general tumor marker, usually found in lymphomas. Although LDH alone could not diagnose lymphoma, the elevated blood level of LDH combined with an enlarged lymph node was quite consistent with the positive biopsy result. Unfortunately, there was a low probability for a diagnostic error. Nevertheless, they insisted on reviewing the pathological examination.

Alex wanted to resume his activities and would like to know the implications of the disease and treatment on his lifestyle. He proposed an interesting analogy. He said that during his training program as an athlete, he had a very dedicated teacher, who helped him a lot to achieve his goals. He asked me to be his coach, preparing him to face cancer challenge. Coach is the expression in English to describe a person committed to adult education (andragogy). Alex's proposal was a non-formal, practical and self-directed education, towards a problem-solving strategy. I thought it was an interesting idea, since Alex would have to understand how doctors think.

Alex agreed and asked me to develop a tutorial.

To be continued in PLOT 2 (raising action) …

* Attention: The story 6 will be published sequentially from PLOT 1 to PLOT 6 and you will always see the most recent posting. To read Story 6 from the beginning, just click in the numbered links located at the bottom of the homepage. 

© Copyright Anticancerweb 2020

James Fleck, MD, PhD: Full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil 2020