April 28th, 2011
09:16 AM ET
Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.
Question asked by Diana of Norfolk:
My husband has non-Hodgkins lymphoma, stage 4, and has been treated with chemotherapy. His doctor says it is under control. He wonders does that mean it is gone or just being held at bay? He has been having "hot flashes" since he began his treatment for his prostate cancer (cannot remember the Gleason score, but tumor was in both lobes of prostate, without changes to his bone marrow.) He was treated with hormones, brachytherapy and radiation for this. We can't seem to get an answer for the question of the "hot flashes." Are they a symptom of ongoing disease, the hormone therapy or will he just continue to have them for the rest of his life?
I worry that you and your husband cannot get information from his physician. Ideally, doctors should have time to sit down and explain things to their patients. I am sorry that is not happening. I encourage you to try again, but I do realize that you may not be able to get a good conversation with him/her. I also know that you may not be able to change doctors, which is what I recommend when patients find that they cannot communicate with their doctor.
I do not have a lot of details about your husband, but I can tell you a few things. Lymphomas are cancers of the immune system. They are first categorized as Hodgkin's lymphomas or non-Hodgkin's lymphoma (NHL). There are at least five types of Hodgkin's lymphoma and in some systems more than 20 types of non-Hodgkin's lymphomas. Stage 4 means the lymphoma has spread to places far from its origin. Some NHLs will respond to chemotherapy by totally disappearing, meaning there is no evidence of disease when we do radiologic imaging with X-rays, CT scans, or MRI.
If the disease was initially in his bone marrow, no evidence of disease also means the bone marrow has been re-biopsied and it appears not to have disease in it. In all cases, no evidence of disease means "no evidence." There may be some disease that is not detectable. Some patients with this status will relapse, meaning the disease grows back and it will eventually be a size in which it can be seen. They will have to be retreated with a different chemotherapy.
There are some NHLs that never really go away. These cancers are generally slow growing, sometimes referred to as indolent or nodular lymphomas. These cancers are often observed for a time after diagnosis and are treated with chemotherapy or radiation if they seem to be threatening the function of a vital organ or seem to begin growing quickly. These cancers frequently do not go away with treatment, but they can just quiet down and still be seen on radiologic imaging for sometimes years.
The prostate cancer is a different cancer altogether. It is not related to the NHL. Locally advanced prostate cancer, meaning cancer in the prostate that may have spread to the area just outside the prostate but is still confined to the pelvis, is often treated with radiation and hormonal therapy.
Doctors use a combination of external beam radiation with hormonal therapy and they may add brachytherapy, in which radioactive material is inserted into body cavities or tumors. A few are treated with brachytherapy and hormonal therapy without external beam radiation. One of the few areas in prostate cancer where we have good studies is the treatment of locally advanced prostate cancer. Several studies show an improved outcome in these men when they get radiation therapy along with hormonal therapy.
External beam radiation involves a radiation machine shooting radiation at the prostate for several minutes on a daily basis for a number of sessions over three to sometimes eight weeks.
Brachytherapy is sometimes done after the external beam radiation. It uses radioactive rice-sized seeds (usually made of radioactive iodine or palladium). Generally, 80 to 120 seeds are permanently placed in the prostate in a one-time surgical procedure. Hormonal therapy is given, generally by an injection, starting two to three months before the radiation begins and is continued for six months to two years after the radiation ends. The hormonal injection can be monthly, or every three or four months or longer.
The hormonal injection commonly causes hot flashes and sweating, breast tenderness, muscle loss, osteoporosis, headache and depressed mood. Indeed, hot flashes are seen in the majority of men getting hormonal therapy for prostate cancer. They also increase risk of diabetes mellitus, myocardial infarction and stroke.
There are some therapies that can be administered to alleviate the hot flashes. I have especially been impressed by acupuncture for the treatment of hot flashes. Several drug therapies are also used with some success. Also, a patient taking hormonal therapy for prostate cancer should be considered for treatments to prevent osteoporosis, cardiovascular disease and stroke.
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