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Understand the unique aspects of these significant diseases, along with the challenges they present.

While blood cancer may not be as well-known as other cancers, it ranks among the top 10 most prevalent cancers in Singapore. This fact highlights the crucial need for increased public awareness about the disease.

Blood cancer originates from disruptions in the development of blood cells, particularly white blood cells. Dr Lee Yuh Shan, Senior Consultant in Haematology at Parkway Cancer Centre (PCC), notes that the specific causes of these cellular abnormalities are not completely understood. However, identified risk factors include radiation exposure, genetic predispositions and family history.

Dr Lee categorises blood cancer into three main types: leukaemia, lymphoma and myeloma. Each type presents unique symptoms, requires different treatment approaches and has distinct implications for patient prognosis, underscoring the need for specialised knowledge in managing these diseases effectively.

LEUKAEMIA

The disease manifests in several forms, impacting both children and adults with varying intensities. Acute Myeloid Leukaemia and Acute Lymphoblastic Leukaemia are notably prevalent, the former seen in both children and adults, while the latter is most common in young children. Adults are also typically affected by Chronic Myeloid Leukaemia and Chronic Lymphocytic Leukaemia. Acute leukaemia progresses rapidly, whereas chronic forms develop more slowly, sometimes remaining undetected for extended periods.

Signs and Symptoms: Patients often experience anaemia and fatigue due to a reduced red blood cell count, compromised immunity and frequent fevers from abnormal white blood cell counts, and increased bleeding from low platelets. Some individuals show no symptoms, with blood cancers only detected through routine screenings that reveal extreme deviations in white blood cell counts.

Diagnosis: When leukaemia is suspected early in the diagnostic process, a Full Blood Count (FBC) test is pivotal, particularly to examine neutrophil (a type of white blood cell) levels. “Extremely low neutrophil counts often indicate severe bone marrow issues,” says Dr Lee. Diagnosis is further refined through bone marrow studies, where cells are extracted, examined under a microscope and analysed with advanced techniques like flow cytometry and Next Generation Sequencing to identify genetic mutations and guide treatment strategies.

Treatment: Treatment varies, from chemotherapy and targeted therapies to stem cell transplants. Targeted therapies are particularly effective, targeting specific genes and proteins that cancer cells need to survive and are generally better-tolerated than traditional chemotherapy, making them suitable for patients unable to withstand intense treatment regimens. In cases of relapse or when initial treatments fail, innovative approaches like Chimeric Antigen Receptor (CAR) T-cell Therapy and bispecific antibodies are employed to harness the body’s immune system to fight the cancer directly.

LYMPHOMA

Lymphoma, a type of blood cancer that can strike anyone from teenagers to the elderly, is primarily divided into Hodgkin lymphoma and the more common Non-Hodgkin lymphoma, which represents over 90% of lymphoma cases in Singapore.

Signs and Symptoms: The most frequent sign of lymphoma is lymph node swelling in areas such as the neck, armpits or groin. Other symptoms include unexplained fevers, significant weight loss and severe night sweats — sometimes so intense that patients need to change their sleeping attire or bedding during the night. Lethargy, difficulty in breathing (especially if the tumour is located near the chest wall), alcohol intolerance and associated rashes are also possible symptoms of lymphoma. “Lymphoma’s manifestations are diverse; we’ve observed cases ranging from skin tumours in the rectal area to thyroid nodules that are actually lymphoma,” says Dr Lee, adding that some patients do not have any symptoms other than raised liver enzymes.

Diagnosis: The diagnostic process often begins with a lymph node biopsy — removing part or all of a lymph node to check for cancer cells. Additional assessments may include bone marrow studies and advanced imaging like PET/CT scans to determine the extent and precise location of the disease. “Achieving the best outcomes in lymphoma treatment depends heavily on quality biopsies and expert pathological evaluation,” emphasises Dr Lee.

Treatment: Treatment strategies for lymphoma vary based on the aggressiveness of the disease. Options include chemotherapy, advanced immunotherapies like CAR T-cell therapy and bispecific antibodies, radiotherapy and stem cell transplants for particularly aggressive forms. For slow-growing lymphomas (indolent B-lymphomas), treatment is generally deferred until it becomes necessary to manage symptoms or progression.

MULTIPLE MYELOMA

Predominantly seen in the elderly, multiple myeloma is becoming more common in Singapore due to the ageing population. This type of cancer — characterised by genetic mutations that accumulate over time — can significantly impact various organs, particularly the kidneys.

Signs and Symptoms: Often, multiple myeloma may not present any symptoms in its early stages. As the disease progresses, however, symptoms such as proteinuria (protein in urine), kidney failure, increasingly severe back pain, unexplained bone fractures and fatigue caused by anaemia can occur. These symptoms highlight the disease’s systemic impact on the body.

Diagnosis: The diagnosis of multiple myeloma typically involves a comprehensive approach, including a full blood count (FBC), bone marrow studies and imaging tests like X-rays, MRI and PET/CT scans. These diagnostic tools help medical professionals assess the full scope and progression of the disease.

Treatment: Treatment options for multiple myeloma include targeted therapy and stem cell transplants, which are aimed at managing the disease and prolonging life. For patients who are not eligible for transplantation, targeted therapy alone remains highly effective in managing symptoms and maintaining quality of life, as well as improving organ function affected by myeloma. These therapeutic strategies are tailored to each patient’s specific condition and stage of the disease, ensuring the best possible management of their symptoms and health outcomes.

“To get the best lymphoma outcome, it’s important to have a good biopsy and a good pathologist review.