Friday, October 1
primary osteolymphoma
I wasn't planning on writing this post. However, I received a copy of the Titahi Bay Gospel Chapel newsletter by email the other day, and was slightly startled to see an entry not just advertising this blog, but also stating that readers should refer here for research on Primary Osteolymphoma. A recent spike in my (small) readership also suggests that between that and Jenny's email, someone was following the link. So here's what I've learned over the last week or so...
Primary Osteolymphmas represent only 5% of Non-Hodgkins Lymphomas. The “Primary” part of the name indicates that this is a form of tumour that from the outset develops in the bone, rather than spreading from another cancer elsewhere in the body. These tumours can develop in any of the bones of the body, though the femur and the pelvis were the most common sites found in one study (Gianelli et al., 2002), perhaps partly simply due to their relative size. Their appearance can be near-normal on standard x-ray images, making more sophisticated imaging such as CT scanning and MR imaging an important step (Krishan et al., 2003). A definitive diagnosis requires a biopsy with a reasonable-sized sample to enable accurate identification of the tumour type. For this reason they usually do surgical rather than needle biopsies.
The causes of these tumours remain somewhat of a mystery, with some research indicating that a compromised immune system may contribute, while there are indications that in some cases an injury to the bone site can lead to the subsequent development of the tumour (Stein et al., 2003). Regardless of cause, the treatment of choice is clearly chemotherapy (e.g., Zinzani et al., 2003) with radiotherapy being used as an adjunct in some cases. And while you would never want a malignant tumour of any kind, in comparison to other forms of bone cancer Primary Osteolymphoma has a good prognosis when treated with chemotherapy (De Carmargo et al., 2002).
De Camargo, O.P., Dos Santos Machado, T.M., Croci, A.T., et al. (2002). Primary bone lymphoma in 24 patients treated between 1955 and 1999. Clinical Orthopaedics and Related Research, 397, 271-280.
Gianelli, U., Patriarca, C., Moro, A., et al. (2002). Lymphomas of the bone: A pathological and clinical study of 54 cases. International Journal of Surgical Pathology, 10(4), 257-266.
Krishan, A., Shirkhoda, A., Tehranzadeh, J., et al. (2003). Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics, 23(6), 1371-1383.
Stein, M.E., Lewis, D.C., Gershuny, A.R., et al. (2003). Trauma as an etiological factor of primary bone lymphoma: A report of 4 cases. Journal of B.U.ON, 8(2), 163-166.
Zinzani, P.L., Carrillo, G., Ascani, S., et al. (2003). Primary bone lymphoma: Experience with 52 patients. Haematologica, 88(3), 280-285.
What none of this literature describes is the human at the centre of this condition, and the family and friends that surround them. It is frightening to have this happening to someone we love. How can we reduce this human experience to statistics, to facts, to hazard ratios and figures for “Actuarial Disease–Free Survival (DFS) at five years"? This is David. Yes, we look forward with hope. But we are also scared, and we wish we were with you.
At times like this, we understand what it means to put our trust in God.
