Question

My father is 74 years old and has recently been diagnosed with non-Hodgkin's large cell lymphoma. Since the diagnosis, he has had 3 spells, lasting up to an hour, in which he has become disoriented and confused. Is this related to his condition and what are his chances of survival?

Answer

The clinical and histopathological features of non-Hodgkin's lymphomas are diverse. For example, there is large cell lymphoma and also intermediate grade or high grade lymphoma. The grading system is further complicated by which classification is being used, the extent of spread, the extra nodal involvement and the general condition of the person's health. In many older people with a limited normal life expectancy anyway, the thrust should perhaps be more on the quality of life rather than the duration of survival. Chemotherapy for lymphoma sometimes needs to be fairly aggressive and will cause some upset to the person. A cure is possible in a few patients, but so much depends on the factors that we have mentioned above, as well as the presence and absence of systemic symptoms. Only a patient's own doctor could give any indication of chances of survival. We would however emphasise that in older people, quality of life is often more important than quantity. So family members should find out what the patient actually wants, and whether they would like to undergo further courses of aggressive treatment if they are necessary.

Once a person has a diagnosis such as lymphoma, one is inclined to believe that everything they then suffer from is related to that lymphoma. Of course, it may well be, or to the treatment of that condition, but in an older man, who is likely to have health problems anyway, they may be coincidental. It may well be that your father is having transient ischaemic attacks, the major cause of which is atherosclerosis (furring up of the arteries), which would explain his confused episodes. However there are many other causes which in their own right need to be investigated by his physician, and perhaps a neurologist.