Source: delfi.lt, 6 December 2015

One year later, Justas’ mum decided to speak: enlarged lymph nodes were a tell-tale sign

“Even today, as I think back on this year, I am surprised by my own reaction. I seemed to understand what was happening but I couldn’t grasp the meaning of it all: how can it be that my child has cancer? I tried not to say that out loud. You are going with the flow, with this illness, and pushing it away from your thoughts at the same time”, Džiuljeta said. Mum of 15-year-old Justas is still afraid to jump with joy, but it looks like they managed to battle the cancer that so suddenly changed the life of her son one year ago.

One year ago, on the 22^nd of November, Justas turned 14.

“That day Justas felt his lymph nodes swelled up considerably. He immediately looked up information online. In the evening, after the party, I saw them too and got really scared. He told me what he learned and we went to our family doctor immediately”, Džiuljeta recalls.

The doctor suspected right away that the reason behind this was Hodgkin’s lymphoma, one of the blood cancer forms. Justas was brought to Klaipėda for tests. Blood tests did not show anything irregular. Nevertheless, he was hospitalised overnight for more detailed check-ups.

“I work at a gas station all day, so after bringing my son to the hospital I had to return to work. In the evening my son called and said I need to come to the hospital in the morning to sign for some test. After a 24-hour shift I was so tired I could hardly comprehend what the doctor said. I asked her to explain again what she suspected. Then the doctor admitted that a focus of enlarged lymph nodes is visible in my son’s thorax. According to her, it was not extensive but a CT scan needs to be done to confirm. After several hours, when the CT scan and a biopsy where performed, the doctors confirmed Hodgkin’s lymphoma, stage II”, Džiuljeta recalls a devastating moment.

It was decided to transfer Justas to the hospital in Vilnius, Santariškių klinikos.

 “I did not explain him everything in detail. Justas thought his lymph nodes will be removed and that’s it. I told him we needed to go to Vilnius for an operation. We tried our best to stay calm but my son still suspected something was wrong, asked what was wrong with me and his granny, why we looked so grim. I used to strain my eyes trying not to cry because my son was watching me. Doctors helped a lot by repeating that Hodgkin’s lymphoma is one of the luckiest tickets drawn in the cancer lottery. This cancer form is very susceptible to treatment. This was what helped me cope”, Justas’ mum admits today.

The boy stared his chemotherapy sessions. “I saw even more seriously ill children around us. So many small children with bald little heads. I was also encouraged by the fact that Justas is already big and strong, both physically and emotionally. When he heard his full diagnosis in Vilnius it did not break him. The only time I saw him sad and depressed was when he gained a lot of weight due to hormone therapy. He cried and was really upset; he couldn’t fit in any of his old clothes. Chemotherapy treatment was not an easy thing to endure”, Džiuljeta is frank.

At first it affected Justas’ digestion, he was always sick and restless at night.

“Hair loss was also a shock. It wasn’t very long, but it still was strong and beautiful. We knew that hair loss is inevitable, we saw the patients around us. But when you have to face this yourself, when your son shows chunks of hair in his hands, there’s so much you can do not to cry”, Justas’ mum said. Later on his hair had to be shaved off entirely. When he returned home, Justas avoided socialising. He felt the attention and sympathy were too much. He seemed to be embarrassed.

One year has passed since the day of the dreadful diagnosis. On the 22^nd of November Justas celebrated his 15^th birthday. It is true that the fear still lingers. His thorax still contains some enlarged lymph nodes. Today Džiuljeta still avoids saying out loud that her son had cancer. She fears the disease may return and that the second time around could be harder. A visit to the doctors is scheduled for the 8^th of December. They grow increasingly confident that cancer cells are gone and his lymph nodes should diminish too.

“Justas matured considerably during this year. Our relationship grew stronger. We were entirely dependent on one another. Upon returning to school in April Justas got to work immediately and prepared for the 8^th grade tests. Before his illness he took football classes and now took up dancing and is serious about his studying”, Justas’ mum proudly said.

On the 8^th of March the Support and Charity Foundation Mamų unija organised an event for the mothers of children with cancer and preserved fleeting moments in beautiful pictures. The picture you see today still hangs on the wall in Džiuljeta’s home.

Doctor: if swelling does not diminish, it is a reason to worry

Head of the Satariškių klinikos Centre for Haematology, Oncology and Transfusion Prof. Laimonas Griškevičius reassured that enlarged lymph nodes may not always be a sign of a malignant blood disease. “Lymph nodes are the safeguards that lymph and blood flow through, and that contain a lot of immune cells. They are an important part of our immune system and are located throughout the entire body: in the thorax, abdomen, lesser pelvis, groin, neck and other areas. There are a number of lymph node groups. The majority of enlarged lymph nodes are not malignant”, the specialist said. He stated that lymph nodes usually react to a viral or bacterial infection. “In that case they are soft and rather small, sometimes painful and frequently related to an inflammatory process that occurs around them. For example, if a person has teeth problems, his or her lymph nodes at the jaw or in the upper part of the neck may swell up. If an infection is in the arm, armpit lymph nodes may swell up. Most importantly, after the inflammatory process subsides, the lymph nodes return to their normal size”, Dr. Griškevičius explained. 

However, if swelling does not diminish, it is a reason to worry.

“If lymph nodes swell up for no apparent reason, they are hard or several lymph nodes cluster into one or occur in a place not related to any inflammation, it’s time to be worried. Especially if this happens to patients who are of advanced age. Lymph nodes not reaching 1.5 cm in size are not considered enlarged, however, even small lymph nodes may be affected by cancerous processes. Size is not the main factor. Many different factors have to be taken into account and the final result can be obtained by biopsy”, the head of the Haematology Centre said.

If lymph nodes in the chest area swell up, it may be a sign of lymphoma.

“Every blood cancer diagnosis carries a different clinical expression. Each cancer form has its own characteristic blood cell composition, genetic deviations and other markers. Hodgkin’s lymphoma is a malignant lymph node disease usually affecting young patients (aged 20–30). It is less frequent in children and elderly”, the specialist explained. The good news is that when it occurs in young age this form of cancer is treatable in 90 percent of cases, even when it has spread. Unfortunately, people over 60 years of age have lower chances of survival. “The administered treatment depends on the stage of the disease at the time of diagnosis. Approximately half of the patients are diagnosed already into the third or fourth stage, when the disease has already spread beyond lymph nodes and spleen and damaged other organs. The treatment with chemotherapy for the first and second stages is less aggressive, while more intensive chemotherapy is applied in the cases of a more advanced stage, treatment sometimes also involves radiation therapy, if required.

Around 40–50 patients in Lithuania are diagnosed with Hodgkin’s lymphoma each year.