Lymphoma

Lymphoma is a type of blood cancer that originates in the lymphatic system. It happens when infection-fighting cells of the immune system, known as lymphocytes, undergo abnormal changes and begin to grow uncontrollably.

Lymphocytes are present in various parts of the body, including the lymph nodes, spleen, thymus, and bone marrow.

Types of Lymphoma

There are two primary types of lymphoma:

• Non-Hodgkin lymphoma

  Non-Hodgkin lymphoma accounts for over 90% of lymphoma cases in Singapore. There are more than 60 subtypes of non-Hodgkin lymphoma. Most subtypes fall into two main groups - B-cell lymphomas or T-cell lymphomas. Some of the subtypes include: follicular lymphoma, diffuse large B cell lymphoma (DLBCL), MALT lymphoma, Mantle cell lymphoma, cutaneous b-cell lymphoma, cutaneous t-cell lymphoma, peripheral T-cell lymphoma, anaplastic large cell lymphoma and Waldenstrom macroglobulinemia.

• Hodgkin lymphoma

  Hodgkin lymphoma, on the other hand, is less common. Symptoms may be similar between non-Hodgkin and Hodgkin lymphoma but when put under a microscope, cells known as Reed-Sternberg cells are visible only in Hodgkin lymphoma. These abnormally large cells are B cells that are malignant.

Each type of lymphoma involves different types of lymphocyte cells and exhibits different growth rates and responses to treatment.

Lymphoma Causes & Risk Factors

The causes of lymphoma are not yet fully understood. However, there are certain risk factors that have been identified. These lymphoma risk factors include:

• Age

  Non-Hodgkin lymphoma is more common in individuals aged 60 and above, while Hodgkin lymphoma is frequently diagnosed in individuals between 15 and 40 years old or those over 55.

• Gender

  Although lymphoma can affect both males and females, certain subtypes may be more common in one gender than the other.

• Compromised Immune System

  Individuals with compromised immune systems, such as those with HIV/AIDS, organ transplant recipients, or individuals with autoimmune diseases, have an increased risk of developing lymphoma.

• Viral Infections

  Infections caused by viruses such as Epstein-Barr, hepatitis C, or human T-cell leukemia/lymphoma (HTLV-1) have been linked to an elevated risk of lymphoma.

• Family History

  Having a close relative who has had lymphoma may increase an individual's susceptibility to the disease.

• Exposure to certain chemicals

  Benzene and pesticides, which are commonly found in some work environments, have been associated with an increased risk of lymphoma.

While all these factors may increase the likelihood of developing lymphoma, it is important to note that the cancer can still develop in individuals without any known risk factors.

Signs & Symptoms of Lymphoma

Lymphoma presents with some signs such as:

Swollen lymph nodes, typically painless and commonly found in the neck, armpit, or groin.

• Persistent cough
• Shortness of breath
• Fever
• Night sweats
• Fatigue
• Unexplained weight loss
• Itching

It is crucial to remember that these symptoms can also be indicative of other illnesses. Therefore, it is essential to consult with an oncologist for an accurate diagnosis.

To diagnose lymphoma, a comprehensive evaluation is conducted and typically includes one or more of the following:

• Physical Examination

  The doctor performs a physical examination, paying particular attention to swollen lymph nodes. However, swollen lymph nodes do not necessarily indicate cancer, as they can also be a result of infections.

• Lymph Node Biopsy

  If lymphoma is suspected, a lymph node biopsy may be conducted. This involves the removal of all or part of a lymph node for further examination to determine the presence of cancer cells.

• Diagnostic Tests

  Tests may be performed to aid in the diagnosis, staging, and management of lymphoma. These tests can include:

  • CT scan

    A computerised tomography (CT) scan produces detailed images of the structures inside the body such as location or size of tumour.

  • MRI

    Magnetic resonance imaging uses magnets and radio waves to produce detailed images of organs and structures within the body.

  • PET scan

    A PET scan utilises a radioactive substance to detect cancer cells throughout the body.

The treatment for lymphoma depends on the type and stage of the disease. Treatment options may include one of more of the following:

• Chemotherapy

  Chemotherapy involves the use of drugs to kill cancer cells. It can be administered orally or intravenously. Given at regulated intervals, chemotherapy is the one of the most common treatment modality and patients need recovery time between each interval.

• Radiation Therapy

  Radiation therapy employs high-energy rays to target and destroy cancer cells. Radiation therapy may be administered on its own or combined with chemotherapy.

• Immunotherapy

  Immunotherapy such as chimeric antigen receptor (CAR) T-cell therapy or using monoclonal antibodies, allows the body's immune system to recognise and eliminate cancer cells.

• Targeted Therapy

  Monoclonal antibodies can also be used in targeted therapies to impede the growth of lymphoma cells.

• Stem cell or bone marrow transplant

  Healthy stem cells from the bone marrow or from a donor, which are capable of producing new blood cells, are extracted and infused into the patient’s blood and reintroduced into the body to help rebuild the immune system.

It is important for individuals experiencing any persistent symptoms or concerns related to lymphoma to seek medical attention for proper diagnosis and treatment. Early detection and intervention can greatly improve the prognosis and quality of life for those affected by this disease.

Prognosis of Lymphoma

The prognosis for individuals with lymphoma depends on several factors, including the type of lymphoma, the stage of disease, the patient's age, the treatment received, and any pre-existing health conditions. With advancements in treatment, more lymphoma patients are experiencing better quality of life due to more tolerable side effects, and optimistic outcomes.

There are no routine screening tests or direct blood tests for lymphoma.There are no proven measures to prevent lymphoma. To reduce any cancer risks, adopting a healthy lifestyle, such as the steps listed below, is important:

• Maintain a healthy and balanced diet
• Quit smoking
• Limit alcohol consumption
• Exercise regularly