Lymphoma is a type of cancer that starts in infection-fighting white blood cells called lymphocytes which are part of the body’s immune system. There are two primary types of lymphocytes: B cells and T cells. Both are designed to recognize and destroy infections and abnormal cells. Lymphoma occurs when either lymphocyte B or T cell undergoes a malignant change and multiplies, eventually crowding out healthy cells and forming tumours. These tumours can form anywhere in the lymphatic system and affect the normal functioning of the immune system.
There are two principal kinds of lymphoma – Hodgkin and non-Hodgkin lymphoma:
The different types of lymphoma will in turn determine the symptoms and ultimately the treatment prescribed.
*People who think they may be at risk should discuss this with their doctor.
Patients who have lymphoma may not pay attention to some of the signs that are presented at the beginning as the warning signs are so subtle that it may take some time before they realise that there is anything seriously wrong. Below is a list of the common symptoms of lymphoma:
If you experience any of the symptoms mentioned, the doctor will need to run some tests to find out what is causing the problems. Your doctor may ask about your personal and family medical history.
You may have one or more of the following tests.
Your doctor checks for swollen lymph nodes in your neck, underarms and groin. He/she may also check for a swollen spleen or liver.
Your doctor will do a complete blood count to check the number of white blood cells, other cells and substances such as lactate dehydrogenase (LDH). Lymphoma may cause a high level of LDH to be detected.
Your doctor will look out for X-ray pictures indicating swollen lymph nodes or other signs of the disease in your chest.
A biopsy is the removal of tissue or fluid to look for cancer cells. Your doctor may suggest to either a bone marrow aspiration (removing samples of the bone marrow fluid) or a bone marrow biopsy (removing a small piece of tissue or bone). After the samples are taken, the tissue will be checked for lymphoma cells.
Your doctor may remove an entire lymph node (excisional biopsy) or only part of a lymph node (incisional biopsy). The doctor will then check the lymph node for lymphoma cells through a microscope. Reed-Sternberg cells which are large, abnormal cells may be found in people with Hodgkin lymphoma. People with non-Hodgkin lymphoma do not have Reed-Sternberg cells.
Your doctor will place a spinal needle (a long, thin needle) into the lower part of your spinal column to remove cerebrospinal fluid (CSF), a liquid around the brain and spinal cord. The fluid drawn will be sent to the lab to look for signs of cancer or if lymphoma has affected the central nervous system.
If lymphoma cells are found, the next step is to run other tests to determine what type and stage of lymphoma. Staging of lymphoma is necessary as the doctor will find out the extent of the cancer spread and this will impact the treatment options prescribed and the patient's outlook for survival.
The doctor may do one of the following imaging tests to learn how widespread lymphoma is in your body:
There are different treatments available for depending on the type and stage of lymphoma. Other factors include your age, your overall health, and your own preferences. The types of treatment that may be prescribed are as follows.
Chemotherapy is the use of drugs to help kill lymphoma cells. It is also called systemic therapy as the drugs travel through the blood stream. For lymphoma, usually more than one drug is given. Depending on the type of lymphoma you have, the drugs are given into a vein, by mouth or through the space around your spinal cord. Once the drugs enter our system, they will spread throughout the body.
Chemotherapy is usually given in cycles. Each treatment cycle is followed by a rest period. You may have your treatment in a clinic or at the doctor's office. Some patients may need to stay in hospital for treatment.
People with certain types of non-Hodgkin lymphoma may have biological therapy. Biological therapy is the use of substances that bolster one's immune system and helps it to fight cancer. Monoclonal antibodies, a form of protein that binds to cancer cells, is the type of biological therapy used for lymphoma and can be administered through the vein at the clinic.
Radiation therapy is a cancer treatment that uses high energy x-rays or other types of radiation to kill lymphoma cells or keep them from growing. In this case, the radiation will only take place in the part of your body where the lymphoma is located.
If lymphoma recurs after treatment, your doctor may recommend stem cell transplantation. A stem cell transplant is the replacement of the abnormal bone marrow with stem cells or marrow free of lymphoma from a compatible donor.
Before the stem cell transplant, you will receive either chemotherapy or radiation therapy in high dosages. In some cases, even both may be prescribed. This will destroy all your lymphoma cells and normal blood cells in your bone marrow. After which, you will receive the healthy stem cells through a large vein.
The healthy stem cells may come from you or from someone who donates their stem cells to you:
Treatment Team at NCIS is spearheaded by Lead Clinician Dr Michelle Poon, and
accompanied by her team of medical professionals spanning over
multi-disciplinary tumour groups, the team is committed to delivering
uncompromised and dedicated clinical research, expertise and care in the
prevention, management and cure of Lymphoma.
Getting diagnosed with lymphoma can be both worrying and stressful for you and your caregiver. Listen to our specialists and healthcare professionals in this podcast series as they answer questions on lifestyle, diet, coping strategies for the psychological/emotional health as well as sources of financial and emotional support. Click on the links below to listen to the individual podcast or download the transcipt here.
*This patient education podcast series is a joint collaborative project in 2018 between the National University Cancer Institute, Singapore and National Cancer Centre Singapore and is supported by Takeda Pharmaceuticals Singapore.