Lymphadenopathy and Cancer Treatment Options

Q: Lymphadenopathy and Cancer Treatment Options

Ms. <br>Tiffany： The organizational report you provided is not a true pathological diagnosis; it only describes the clinical signs listed on the application form. <br>If you have a pathological report, you could consult a physician nearby regarding the pathological diagnosis ment

Is it correct?

Hello Doctor: My father underwent right nephrectomy and right ureterectomy about four years ago, diagnosed with malignant tumor of the right ureter.
However, after the surgery, he was monitored, and the doctor advised that he only needed to have annual check-ups starting from June.
My father is also a pneumoconiosis patient and has been experiencing increasingly labored breathing and occasional pain in the right chest for about six months.
Recently, he went to the hospital for an examination and found multiple lymph node-like tumors in both sides of his neck, for which a biopsy was performed.
The tissue report indicated lymphadenopathy, with a CEA level of 51.5.
A whole-body bone scan showed 3-4 areas of increased uptake in both shoulders and the pelvis.
He underwent abdominal, thoracic, rectal, and gastroscopic examinations, as well as ENT evaluations, but no primary source could be identified.
Therefore, we were informed that he would need to undergo systemic chemotherapy.

1.
Is it correct that we can only proceed this way since the primary source cannot be identified?
2.
If this is a metastasis, could it have been present before the nephrectomy?
3.
If it has metastasized to the bones, shouldn't there be pain? He currently has no discomfort.

tiffany, 30~39 year old female. Ask Date: 2002/07/08

Dr. Fan Sheng reply Oncology

Ms.
Tiffany: The organizational report you provided is not a true pathological diagnosis; it only describes the clinical signs listed on the application form.
If you have a pathological report, you could consult a physician nearby regarding the pathological diagnosis mentioned therein, which would make it easier for me to respond.
However, I suspect the pathological diagnosis is metastatic cancer, as the doctor has recommended chemotherapy.
Based on the current situation, the CEA level is as high as 51.5, which is less indicative of metastatic cancer in the urinary system.
Therefore, I believe there should not be any lymphatic involvement prior to kidney removal.
The doctors have put considerable effort into locating the primary site, indicating they also suspect the presence of a second cancer in your father.
A bone scan can indeed detect clinically asymptomatic skeletal metastases, so the absence of pain does not rule out the possibility of bone metastasis.
Medically, there can be metastatic cancer of unknown primary origin, and chemotherapy is generally the correct treatment choice.
If I were to guess, I would still lean towards lung cancer, but I would first discuss with a pathologist to see if it could possibly be a lymphoma that resembles cancer.
Additionally, there is a rare type of thyroid cancer that can also elevate CEA levels.
I wonder if your father has any thyroid tumors? Wishing your father effective treatment!

Reply Date: 2002/07/08

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your father's health. It sounds like a complex situation, and I will do my best to address your questions regarding lymphadenopathy and cancer treatment options.

1. Understanding the Diagnosis and Treatment Options: The presence of lymphadenopathy, especially in the context of a history of malignancy, raises concerns about potential metastatic disease. The elevated CEA (Carcinoembryonic Antigen) level of 51.5 is significant, as it can indicate the presence of cancer, particularly in cases of colorectal, lung, breast, or other cancers. The fact that multiple imaging studies (bone scan, abdominal, and thoracic imaging) did not reveal a primary source of the cancer does complicate matters. In such cases, systemic chemotherapy is often recommended as it can address undetected metastatic disease throughout the body. While it may seem like a broad approach, it is sometimes necessary when the origin of the cancer is unknown.

2. Potential for Metastasis: Regarding your question about whether the metastasis could have been present before the kidney and ureter were removed, it is indeed possible. Cancers can spread (metastasize) before they are diagnosed or treated. The absence of symptoms does not always correlate with the absence of disease. In some cases, cancer can remain asymptomatic for extended periods, which can lead to late-stage presentations. The lymph nodes in the neck could be reacting to a systemic issue, potentially related to the previous malignancy or a new primary cancer.

3. Bone Metastasis and Pain: As for your question about bone metastasis, it is important to note that not all bone metastases cause pain. Some patients may have metastatic lesions that are asymptomatic, particularly if they are not causing any structural damage or pressure on nerves. However, as the disease progresses, pain can develop. The fact that your father currently does not experience discomfort is not uncommon, but it is crucial to monitor his condition closely.

In summary, your father's situation requires careful management. The decision to proceed with systemic chemotherapy is a common approach when the primary tumor is unknown, especially in the context of elevated tumor markers and lymphadenopathy. It is essential to maintain open communication with his healthcare team, who can provide tailored recommendations based on his overall health, cancer history, and current symptoms.

Additionally, I encourage you to discuss any concerns about the treatment plan, potential side effects, and the rationale behind the chosen approach with his oncologist. They can provide clarity on the expected outcomes and any alternative options that may be available.

Lastly, supportive care is vital during this time. Ensure that your father has access to palliative care services if needed, as they can help manage symptoms and improve quality of life.

Thank you for your inquiry, and I wish your father the best in his treatment journey.

Sincerely,
Doctor Q&A Teams

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