Extranodal NK’T-cell Lymphoma
43 year old woman – Oriental Medicine Cancer Center, (now IIOI)
Before introducing this next case, I thought to briefly explain this very rare disease, I’ve only come across seeing two patients with diagnosis of Extranodal NK/T-cell lymphoma, Nasal type in my entire oncology professional life.
Extranodal NK’T-cell Lymphoma (ENKTL), nasal type, by the World Health Organization, is a non-Hodgkin lymphoma that is almost always associated with Epstein-Barr virus. For patients with disseminated and extranasal disease, either at initial presentation or at relapse, the prognosis is poor. The disease does not show durable response to aggressive chemotherapy and other treatment modalities. This case is a disseminated Case.
A 43 year old woman (Asian), with newly diagnosed disseminated ENKTL, came to see me at my Oriental Medicine Cancer Center on April 13, 2007. She initially presented sore throat, nose bleeding, swelling and difficulty swallowing. She was treated with antibiotic by other doctors, but her condition was getting worse. She then underwent CT scan on March 26, 2007. The findings of the CT, showed a large soft tissue mass centered around the nasopharynx and extending inferior into oropharynx, which is slightly centered to the left. The palatine tonsils are also enlarged bilaterally. There is also complete obliteration with the soft tissue density of bilateral nasal passages, with accompanying bilateral lymphadenopathy.
On March 27, 2007, Biopsy of tonsil and lymph nodes; Showed Extranodal NK/T cell lymphoma, Nasal type. On March 30, 2007, Bone marrow biopsy showed involved EXKTL. Patient was diagnosed Stage IV disease. She then start her first cycle Ontak/Chop, on April 7, 2007.
On my exam, Patient appeared very thin, when she speak with very stuffy nose sound. there were adenopathy peripherally. there were swelling on her nasal passages and a large ulceration lesion seen on her soft palate. Patient asked, if I could treat her in support her chemotherapy. I suggested that during the chemotherapy to stop taking herbal, in between chemotherapy, she can take herbal for decrease her chemotherapy toxicity, to improve her immunity and healing process. After two cycles of Ontak/Chop. with following herbal medicine, the Patient was doing better, she reported having a good appetite and good energy, and was very glad that she gain one lb of her weight. Her bowel movement and urination are normal. In order to avoid the toxicity of Chemotherapy, we were discussed to ask her Medical Oncology to reduce the dose of chemotherapy.
On May 15, 2007, Her soft palate lesion was smaller, and On May 22, 2007, Her Soft palate lesion was nearly gone. We were all happy about that result. On June 6, 2007 patient return for follow up visit, she reported her right eye was red with some pressure, and was admitted to the Hospital, had MRI of H&N/ chest, showed tumor respond well and the patient gained weight up to 89lbs. (She was still very thin, considering her height was 165cm).
But somehow, later, she was admitted to Hospital for Chemotherapy, she was then not able to continue her herbal medicine. Her general condition started to decay. During her hospitalization, I visit her one time, certainly, her condition declined, several days later, she died at hospital.
(This case make me wonder, what if this patient was brave enough to decline chemotherapy and continue to be treated by me? Would there be a different outcome? Like my other patient? I am confident to say, Yes! Would I be able to cure patient like this? Maybe or Maybe not, but I am able to prolong patient’s life, improve patient’s quality of life and reduce the toxicity of treatment, as well as reduce the Cost.)
- Metastatic Breast Cancer
- Therapy Comparison
- Case 1: Esophageal Cancer
- Case 2: Nasopharyngeal Cancer
- Case 3: Nasopharyngeal Cancer
- Case 4: Breast Cancer w/ Liver & Bone Mets.
- Case 5: Breast Cancer w/ Bone Mets.
- Case 6: Extranodal NK’T-cell Lymphoma
- Case 7: Breast Cancer Survival w/ Thyroid Tumors
- Case 8: GBM- Glioblastoma-multiform
- Case 9: Recurrent Adenocystic Carcinoma