Physical Examination
The physical examination is the process by which a health care professional examines the body of a patient for signs of disease. It follows the taking of a medical history, which is an account of the symptoms experienced by the patient as well as questions regarding the patient’s current and past health history.
Either prior to or during the physical examination, blood may be drawn for tests to assist the physician in determining the patient’s current overall status. Please see our explanation of the more common blood tests used to evaluate WM patients.
A complete physical examination of a WM patient includes evaluations of general appearance and of specific organ systems, especially the liver, spleen and lymph nodes. A systematic examination generally starts at the head and finishes at the extremities. The main organ systems are investigated by inspection, palpation (feeling with the hands), percussion (tapping of the thorax and abdomen), and auscultation (listening to internal sounds with a stethoscope).
The frequency of physical examinations for WM patients depends on disease status. Patients with smoldering WM who are stable may not need to see a hematologist-oncologist more than once or twice a year. Newly diagnosed patients or those with progressing disease will be followed at more frequent intervals, perhaps once every 2-3 months. Patients in treatment may be monitored even more frequently (possibly weekly) during the treatment period because of side effects that need to be recognized early to be effectively managed.
Dilated Eye Examination
Dilated eye examinations are recommended for WM patients at least once a year. They should be performed more frequently if a patient has blurring or loss of vision or if hyperviscosity (excessive thickening of the blood) is suspected. It is preferable to have an ophthalmologist who is knowledgeable about WM and its effects on the eye perform the examination. The back of the eye (fundus) is examined with an ophthalmoscope, which magnifies the blood vessels, nerves, and retina.
Maureen Hanley, OD, has written an article for the IWMF Torch about WM and eye complications.
It is recommended that the ophthalmologist send a report of the eye examination to the patient’s hematologist-oncologist, and the two specialists should communicate with each other about any potential WM-related visual problems.
Other Examinations
Some studies have suggested that WM patients may have increased risks for certain other cancers, including skin, colon, breast, and prostate. These risks are difficult to verify because of the small number of WM patients. Nevertheless, WM patients should be vigilant about continuing with regular recommended screening examinations for these and other cancers.
Because peripheral neuropathy is present in about 20-30% of WM patients, a neurological examination at diagnosis should be considered to evaluate whether or to what degree peripheral neuropathy is present. Depending on the findings, regular follow-up neurological examinations may be of benefit.
