Synopsis of mayor's diagnosis, prognosis

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What's the diagnosis?
Mayor Bob O'Connor has primary central nervous system lymphoma, or CNS lymphoma, an uncommon cancer of the lymph tissue of the brain and/or spinal cord. He has the T-cell type, which is very rare. Of the 800 annual cases of the cancer nationwide, less than 5 percent are T-cell.

What are the symptoms?
The mayor had headaches and neck pain that suggested meningitis, or inflammation of a brain covering called the meninges. The cancer can cause other neurological symptoms, including nausea, weakness and vision changes.

How is it diagnosed?
When doctors did an MRI scan of the mayor's brain, they saw lesions that fit the characteristics of primary CNS lymphoma. Instead of biopsying a lesion, which can be very challenging, they tested a sample of his spinal fluid. It tested positive for the cancer cells.

How is it treated?
Primary CNS lymphoma is treated primarily with high, intravenous doses of a chemotherapy agent called methotrexate. Mr. O'Connor will be hospitalized for three or four days every two weeks for a total of perhaps six doses of the drug. If he goes into remission, he will continue to take the drug once a month for a year, his doctors said.

About 24 hours after getting methotrexate, the mayor will take leucovorin, a "rescue" agent that will help protect his bone marrow and the rest of his body from the toxic effects of chemo. He will also take agents to help him better excrete methotrexate and avoid kidney failure.

In addition to methotrexate, Mr. O'Connor will take Temodar, a cancer drug that research indicates is effective in CNS lymphoma. It's given as a pill, so he can take it at home.

His doctors expect that he will be able to continue to work.

What are doctors watching for?
His symptoms should resolve quickly as the drugs kill the cancer. Doctors will do follow-up MRI scans of the mayor's brain and eventually do another spinal tap to check for abnormal cells.

What's the prognosis?
Untreated, survival is measured in months. With chemotherapy after diagnosis, 70 percent of primary CNS lymphoma patients are alive three years later and 40 percent five years later, said Dr. Jane Raymond, an oncologist at Allegheny General Hospital's cancer center.

Patients lived for about four years before high-dose methotrexate therapy, and experts believe the treatment has extended survival, said Dr. Stanley Marks, director of clinical affairs for UPMC Hillman Cancer Center and one of Mr. O'Connor's doctors.



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