Cancer that doctors can mistake for a minor bug
Polly got antibiotics — but needed a stem-cell transplant
POLLY DEMETRIOU knew that, one day, the heavy stab vest she put on before every shift as a policewoman might save her life — and it did, but in a way she could never have imagined.
In May 2011, Polly was applying fake tan when she noticed a pea-sized lump just under her left collarbone. ‘I knew it wasn’t there before, or I would have noticed it,’ she says.
The tiny ball of tissue was painless, but it kept catching the edge of her stab vest, and soon became enough of an irritation for Polly, now 29, to book an appointment with her GP a few days later.
The doctor did some blood tests and prescribed antibiotics, thinking that the swelling was probably down to a bacterial — or possibly viral — infection. Swollen lymph glands are a common sign someone is ill. They can occur with anything from a bad cold to dental problems, and tend to go down as you recover.
The GP advised Polly to come back if the lump was still there after she had finished the course of antibiotics ten days later.
It was. After returning to her GP, Polly was referred for an ultrasound scan and then told she must see an ear, nose and throat (ENT) consultant.
She had no other symptoms, and her blood tests had found nothing, so she assumed her doctor was playing it safe. ‘I felt fine. I was a bit tired, but I just put that down to work and life,’ says Polly.
Polly was due to travel to a friend’s hen party in Morocco straight after her ENT appointment, so she drove to the hospital with her suitcase in her car boot.
But she never caught her flight. Instead, she was told she probably had cancer.
WHEN the results of a lymph gland biopsy came back a week l ater, s he was diagnosed not with a viral infection but with Hodgkin lymphoma.
This is a cancer of the lymphatic system, the network of tissues and glands that runs throughout the body and helps eliminate waste products, toxins, bacteria and viruses.
‘It was all a bit of a blur,’ says Polly. ‘I cried for two days straight, then the anger came. Why was this happening to me? You don’t expect, at the age of 25, to be told that you have cancer.’
Hodgkin lymphoma is, in fact, one of the most common cancers in young people. Diagnosis peaks between the ages of 15 and 29 and, in Ireland, an average of 101 people were diagnosed a year between 1994 and 2011.
Polly was fortunate her GP was so vigilant. ‘ As cancer is rare in young people, diagnosis of lymphoma can take a while,’ says Dr Graham Collins, a consultant haematologist.
‘GPs are bombarded with all sorts of things but, in a lifetime of fulltime practice, they will see between five and ten cases of lymphoma and thousands of cases of viral infection with similar symptoms.’
Not surprisingly, then, Hodgkin lymphoma is sometimes mistaken for a viral infection.
There are several reasons behind the difficulty in diagnosis, says Jonathan Pearce, chief executive of the Lymphoma Association in Britain. ‘Lymphoma can present in many different ways,’ he says. ‘It’s not like a traditional cancer, which starts with a solid mass in one specific site.
‘Symptoms can be quite vague, or replicate other diseases and conditions — some of which are relatively benign.’
The most common sign of Hodgkin lymphoma is one or more painless swellings in the groin, armpit or neck, like Polly had. These are caused by an excess of affected lymphocytes (white blood cells) collecting in a lymph gland.
But these tumours may grow very slowly, and many everyday infections can produce similar swellings in the lymph glands.
Around one in four people will have other warning signs, such as heavy sweats and high temperatures overnight, sudden weight loss, generalised pain after drinking alcohol (perhaps because alcohol irritates the cancer cells, triggering inflammation), a persistent cough, breathlessness or itching.
Another challenge is that the cancer takes different forms. There are two types of Hodgkin lymphoma — although, in each case, a biopsy from the cancer will contain a particular type of cell, the ReedSternberg cell.
The nebulous nature of lymphoma symptoms and complexity of the cancer mean Polly’s rapid referral and treatment are far from typical.
‘In some cases, it can take years of going back and forth to their GP before someone is diagnosed,’ says Mr Pearce.
DETECTION is also complicated by the fact that common infections such as glandular fever share some of the symptoms, such as swollen glands.
Having had glandular fever is also a risk factor for developing this cancer. Other risk factors i ncl ude l owered i mmunity, autoimmune conditions such as rheumatoid arthritis and having a parent or sibling with Hodgkin lymphoma.
Doctors acknowledge there is a problem, and a recent poll of 1,000 GPs in Britain found three out of four would welcome more training on the diagnosis and treatment of lymphoma.
Survival rates are among the highest for all invasive cancers and according to the National Cancer Registry Ireland, more than 80 per cent of patients will still be alive five years after diagnosis. As with any cancer, early diagnosis is the best hope of a cure.
New drugs such as rituximab and brentuximab have proved effective against some forms of lymphoma. Moreover, improved surgery, chemotherapy, radiotherapy and stem cell transplants have transformed the outlook for many patients. Polly says: ‘Everyone said to me: “You have the ‘good’ one.” Lymphomas are generally easy to treat and it’s really curable.’
There is, however, a risk that chemotherapy will impact fertility. Having got engaged t o her boyfriend, Jon, six months before her diagnosis, a family was very much part of Polly’s plans.
So she had fertility treatment to freeze her embryos before starting what should have been six months of chemotherapy.
A string of infections caused by her lowered immunity — due to the cancer, as well as the treatment — meant the chemotherapy stretched into nine months.
But in March 2012, scans showed no trace of the cancer and, in the April, Polly was given the all-clear — just weeks before the May wedding she had been determined would go ahead.
Polly had lost her long blonde hair due to the side- effects of chemotherapy, so wore a wig on her wedding day.
The couple also had to postpone their honeymoon, as Polly was still suffering severe back pain due to the cancer and subsequent treatment.
Then, the following March, Polly developed a niggling cough and had noticed that it sometimes hurt when she drank alcohol. Her doctor suggested an X-ray.
ON APRIL 5, a year to the day since she had been told she was free of cancer, she was given the devastating news the lymphoma was back.
‘That was the first time I saw Jon cry,’ she says.
Hodgkin lymphoma returns in around one in four cases and, when it does, chemotherapy at standard doses alone is not enough. Polly was told she needed a stem cell transplant.
Fortunately, her elder brother, Dave, was a match and, after a course of very high- dose ‘ salvage’ chemotherapy, she received an infusion of life-saving stem cells extracted from his bone marrow. This works in two ways — first, it helped her immune system to withstand the very toxic salvage chemotherapy.
Second, unlike her own immune system cells, her brother’s stem cells recognised the cancer as a threat, and continued to seek out and destroy any stray cells that had survived the chemotherapy.
Studies suggest that stem cell transplants are effective in seven out of ten cases.
Every check and scan Polly has had since the transplant has been clear, and she and her doctors are now quietly confident the cancer is gone for good.
She is back at work as a community police officer, in a desk job until she is fit enough to get back on the beat.
Polly says: ‘ I’m still alive and kicking — just a little gentler.’