Cancers are staged by severity and spread of tumor

Dear Dr. Roach: I recently completed six cycles of chemotherapy to treat nonHodgkin’s diffuse large B-cell lymphoma and found out that it was stage 4. I need help understanding the significance of stages. My scans have been clear, and I am regaining a normal life. W.S.

Answer: All cancers are staged from 1 through 4 based on characteristics specific for that tumor. With solid tumors (like lung cancer), the size of the primary tumor, the presence or absence of lymph nodes, and any disease outside of the primary tumor (metastatic) are used to stage the cancer. With lymphomas, which are usually based in the lymph nodes, staging depends on how many nodes are affected and where they are.

If it is just one node or one group of nodes affected, it is considered stage 1; stage 2 is two affected and separate groups of nodes, both of which are either above or below the diaphragm; stage 3 signifies affected nodes on both sides of the diaphragm; and stage 4 shows involvement outside of the lymph nodes.

In general, the more advanced the stage is, the worse the prognosis. Many people think that stage 4 cancer of any type is incurable, but that is absolutely not the case. With diffuse large B-cell lymphoma, the prognosis is based not only on stage, but also on age, bodily function and blood test results.

If all factors are on your side, the likelihood of complete remission from chemotherapy is over 90%, while people with less favorable characteristics have at least a 36% chance of complete remission from initial chemotherapy. Although

I can’t say exactly what your prognosis is, the fact that the scans are clear and that you are regaining a normal life is excellent news.

Even in people who do not get complete remission from chemotherapy, or in those who relapse after complete remission, there are therapies like a stem cell transplant, which provides an additional chance for a cure.

Finally, new therapies such as CAR Tcell therapy have much less toxicity than a stem cell transplant and have a good chance for complete remission.

Dear Dr. Roach: I recently had catheter ablation surgery, and when I woke up, I had a very bad bruise on my right eyelid. It looked like I was in a fight. I was told that the anesthesiologist taped my eyelids shut. I am on Eliquis and Plavix and was told that my doctor gave me more blood thinners during surgery. Seems unusual to me. Do you have any thoughts?

F.B.

Answer: Eyelids are sometimes taped closed during surgery to prevent damage to the sclera if your eye opens during surgery. I was able to find reports of people who developed spectacular bruising following removal of the tape. The tissues in the eyelid are loose and prone to easy bruising. This is even more likely in people who are on medications that prevent blood clotting, such as Eliquis and Plavix (and possibly heparin given during surgery).

There is usually nothing more that needs to be done for it, since the bruise will resolve on its own as the blood is slowly absorbed. An ice pack can be used during the first 24 hours to help reduce swelling, while warmth a few days later will help the blood get reabsorbed.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Send questions to ToYourGood Health@med.cornell.edu or 628 Virginia Drive, Orlando, FL 32803.