lymphoma and why statistics lie

Monday, October 26, 2015

Numbers lie and cancer isn’t fair. Those two truths cannot ease the passing of Flip Saunders this past weekend as he lost his battle against Hodgkin’s lymphoma. Mr. Saunders was diagnosed just a couple of months ago and initially planned to continue his job running the NBA’s Minnesota Timberwolves. Sadly, complications of chemotherapy kept him hospitalized until his death.

Lymphoma is a disease of the lymph system, where mutation makes normal white blood cells abnormal, causing them to become malignant and grow out of control. The lymph system attacks and protects the body against infection. B-lymphocytes (a type of white blood cell) make antibodies that kill bacteria, while T-lymphocytes act as messengers to help turn on the immune system against a variety of invaders and predators. The cells are born in the bone marrow, mature in he spleen but are activated in the lymph system, the lymph nodes and lymphatic vessels that help scavenge the body for waster products and debris. Arteries and veins get all the press, but the lymphatics do the dirty work.

Lymphomas are categorized as either Hodgkin’s or non-Hodgkin’s lymphoma based upon what type of white ell is involved and what the cells look like under the microscope. Hodgkin’s affects the B cells and can start anywhere within the lymph system from the lymph nodes, (the swollen glands that can be felt in the neck after a throat infection but that also exists everywhere in the body and enlarge when the body fight infection) to the spleen to the bone marrow.

Symptoms may be few initially, like a virus that doesn’t get better or a backache or swollen glands that don’t go away, so the diagnosis may not be made in its early stages. Lymphoma tends to spread through the lymph system and does not invade the blood stream until later stages of the disease, and for a time spares organs like the liver, lung or brain.

Treatment is individualized to the patient, and depends upon the patients underlying physical health and the stage of the cancer. Chemotherapy, radiation therapy, immunotherapy, monoclonal antibody use, stem cell transplantation and surgery are in the armamentarium that doctors have access to in treating this canner. But this is where numbers matter.

For all comers, the prognosis for surviving Hodgkin’s lymphoma is pretty good. There is a 92% one-year survival rate after the cancer is found and 85% of patients are alive at 5 years. But every patient is unique, and while the statistics say that the odds favor survival, those same numbers also say that 15% will die within 5 years.

There are prognostic factors that adversely affect survival including being male, being older than 45, red blood cell, white bod (including lymphocyte levels) and the cancer stage (whether it has spread). Regardless of the blood test results, Mr. Saunders had the deck somewhat stacked against him just being male and 60 years old. Just those two statistics may have dropped his 5-year survival rate to 67%

(http://emedicine.medscape.com/article/201886-overview#a6)

All those who surround him, just as other families and friends will mourn other cancer victims, will miss Mr. Saunders. It is a disease that doesn’t play fair, that ignores the numbers and that ignores the rulebook. And regardless of the statistics and percentages, whatever happens to the individual patient 100% happens. They don’t 85% survive or have a partial complication. Life happens in whole numbers and isn’t always fair.

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