Q: I am a 55 years old man diagnosed with non-Hodgkin's lymphoma (NHL) two years back. I recently had a CT scan to monitor the progress. The doctor found a spot on my pancreas of 1.5 cm which is also revealed on MRI and ultrasound. I have no symptoms of pancreatitis. I have adhesions from several previous abdominal surgeries. The NHL was found because of very frequent obstructions. My weight is 200 kg and height is 5.4 feet. How can the spot on my pancreas be treated?

A:I understand from your query that you are a NHL survivor and on routine check up on follow up a spot 1.5 cm diameter has been picked up over the pancreas on radiological examination. Are you weighing ~200 kg as you have mentioned in your history form along with the query? You are grossly overweight then and need to have some corrective measures for that. You have not mentioned anything about your habits of alcohol intake and whether you are diabetic because they have a bearing on pancreatic problems. You have also not mentioned anything about your treatment history, as it would have helped me in narrowing down my diagnosis.

It could be anything ranging from a simple cyst to a pseudo cyst to a recurrence of NHL. You need to sort out this matter fast. I would suggest you consult your oncologist for PET CT scan. If it lights up on a PET scan also then you need some intervention - either a guided FNAC or a laparoscopic biopsy to diagnose the problem correctly and to rule out any disease recurrence.

When you mention that your disease was diagnosed at an early stage, then do you mean stage or grade? Both of them have a bearing on the natural history of the disease. I presume that you mean a low-grade tumour because it is highly unlikely for a High Grade NHL to have remained silent for more than two years. Low grade NHL is known for persistent disease and late recurrences.

Your oncologist, surgeon and your radiologist will be able to guide you much better about the right path to diagnose your problem.