The GP organises the blood requested urgently.

Hb 110

wbc – normal

plt – normal

blood film – normocytic anaemia

Urea – 18 mmol/L

creat- 320 mmol/L

LDH – 765

You admit the patient urgently for staging CT.

CT shows – 10cm x3.5cm retroperitoneal mass invading the right kidney.  Splenomegaly. Widespread lymphadenopathy is present – bilateral inguinal lymph nodes, intra- abdominal lymphadenopathy, as well as a 2 cm lymph node in the right axilla.

Radiology have agreed to undertake a biopsy under USS guidance of the axillary  lymph node.

PET appt is in 3 days.

how would you manage this patient currently?