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Lymphoma

  • What is lymphoma?

    What is Lymphoma?

    Lymphoma is a type of blood cancer that affects lymphocytes, the white blood cells that form part of the immune system to help fight infections.

    In lymphoma, either the B lymphocytes (B-cells) or T lymphocytes (T-cells) undergo a harmful change and grow out of control. These abnormal lymphocytes crowd out the healthy cells, affecting the normal functioning of the immune system.

    The main subtypes of lymphoma are:

    • Hodgkin's lymphoma – common in young adults 15 – 30 years old and adults over 50
    • Non-Hodgkin's lymphoma – common in older people

    Lymphoma can affect the lymphatic system, which includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow, as well as other organs in the body.

    Hodgkin's lymphoma:

    Several types of Hodgkin's lymphoma exist, which may include rarer forms that are difficult to identify. The subtypes of lymphoma include:

    • Nodular sclerosis – more common in young adults than in other age groups
    • Lymphocyte-rich – more common in men
    • Lymphocyte-depleted – more rare and aggressive
    • Mixed cellularity – more prevalent in adult men

    In developing a treatment plan, accurate diagnosis and staging is important in shaping a treatment plan. The general stages of lymphoma are:

    • Stage 1 – Lymphoma occurs in 1 lymph node, a group of lymph nodes, or 1 organ
    • Stage 2 – Lymphoma occurs in 2 or more lymph node regions, or when it has invaded an organ and the nearby lymph nodes. The cancer sites are still limited to the same side of the diaphragm.
    • Stage 3 – The cancer occurs on both sides of the diaphragm
    • Stage 4 – The cancer occurs in several sites in 1 or more organs and tissues. This is the most advanced stage of Hodgkin's lymphoma, and affects not only the lymph nodes but also other parts of the body, such as the liver, lungs or bones.

    Non-Hodgkin's lymphoma:

    This is a heterogeneous group of malignancies of the lymphoid system. The most common non-Hodgkin's lymphoma is the diffuse large B-cell lymphoma.

    The staging of the non-Hodgkin's lymphoma is similar to Hodgkin's lymphoma.

  • While the exact cause of lymphoma is unknown, some risk factors may include:

    • Age – some types of lymphoma are more common in young adults, while others are most often diagnosed in people aged 5 and above
    • Being male
    • Having an impaired immune system
    • Infections (eg. Epstein-Barr virus and Helicobacter pylori infection)
    • Genetic disorders (eg. Wiskott-Aldrich syndrome)

    Lymphoma occurs when a lymphocyte undergoes mutation and causes the lymphoid cells to behave abnormally and to multiply and expand uncontrollably.

    Lymphoid cells are autonomously proliferating cells, and have longer life spans as compared to normal cells. They have also the tendencies to invade into the surrounding normal tissue and are capable of metastasising to other parts of the body.

  • While the signs and symptoms of lymphoma may not be easily noticeable, some common symptoms include:

    • Enlarged (swollen) lymph glands
    • Chronic tiredness
    • Fever
    • Night sweats
    • Shortness of breath
    • Unexplained weight loss
    • Skin irritation or itchiness
  • Your doctor may recommend the following tests and procedures to diagnose lymphoma:

    Physical examination

    To check for lymphoma, your doctor will start with a physical examination. Your neck, groin and underarm will be checked for any swollen lymph node. Your doctor will also look for any signs of a swollen spleen or liver.

    Blood tests

    Blood tests are necessary to look for irregularities in your blood that suggest the possibility of cancer. Aside from a complete blood count (CBC), there will also be tests for different types of white blood cells, as well as liver and kidney function tests.

    Computerised tomography (CT scan)

    CT scan is a diagnostic test that makes use of a series of X-rays to create a three-dimensional picture of the body. Your doctor will require you to undergo CT scan to look for signs of lymphoma in other areas of your body.

    Magnetic resonance imaging (MRI)

    This imaging tool makes use of strong magnetic field and radio waves to create a more detailed picture of body. Your doctor may recommend MRI to look for more signs of lymphoma in other areas of the body.

    Lymph node biopsy

    During a lymph node biopsy, all or part of a lymph node will be removed and sent to the laboratory for thorough examination. The lymph node will be checked for abnormal cells (Reed-Sternberg cells).

    Bone marrow biopsy

    Bone marrow biopsy is a procedure that removes a sample of bone marrow to search for Hodgkin lymphoma cells. The procedure, which takes about 10 minutes, involves making a small incision on your skin wherein the needle can easily pass through. Local anaesthesia will be given to numb the area where the biopsy will be done.

  • Lymphoma treatment is dependent on the type of lymphoma diagnosed and its severity. Very often, it involves a combination of two or more treatments. These options include:

    Chemotherapy

    In chemotherapy, strong medicines are used to destroy cancerous cells and prevent them from reproducing and growing. However, these drugs can also damage the normal cells of the body.

    Immunotherapy

    Immunotherapy is considered as a second line of treatment. It uses the patient’s own immune system, or medications made from components of the immune system to fight the disease. They include monoclonal antibodies and injections known as checkpoint inhibitors.

    Stem cell transplantation

    A patient with recurrent lymphoma may receive stem cell transplantation as a second line of treatment. This is a transplant of blood-forming stem cells and will allow the patient to receive chemotherapy, radiation therapy, or both. Through transplanted stem cells, new blood cells develop. These stem cells may come from the patient or from a healthy donor.

    Radiation therapy

    Radiation therapy uses high-energy rays to kill the lymphoma cells. It will shrink the tumours and help control the pain. Radiation is sometimes used as the first-line therapy in patients who have very large lymph node masses.

    Targeted therapy

    In targeted therapy, drugs are used to target the genes and proteins that contribute to the growth, progression and spread of the cancer cells. Targeted therapy reduces the effect of treatment on healthy cells. However, this may not be a permanent solution as the cancer may evolve and become immune to the drug, so this is where immunotherapy may come in.

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    Ref:
    https://www.parkwaycancercentre.com/sg/learn-about-cancer/types-of-cancer/cancer-details/hodgkin-lymphoma
    https://www.parkwaycancercentre.com/sg/news-events/news-articles/news-articles-details/lymphoma-treatment-targeted-therapies-immunotherapy

  • Lymphoma and its treatments can cause some complications and diseases, including:

    Infections

    Lymphoma can weaken your immune system. With a weak immune system, you are at a higher risk of having infections. To prevent serious complications, talk to your doctor if you experience symptoms of an infection such as fever, headache, muscle pains, diarrhoea, fatigue, and painful blistering rashes.

    Heart diseases

    Treatments of lymphoma such as chemotherapy and radiation therapy can lead to heart complications. Doxorubicin, the drug used in chemotherapy, can cause the heart muscle to weaken. Radiation therapy can also damage the heart. These treatments increase your risk of developing congestive heart failure, heart attack, and stroke.

    Respiratory problems

    Lymphoma treatments can increase your risk of developing respiratory complications. For instance, radiotherapy and a chemotherapy drug called bleomycin can lead to scarring of the lungs.

    Infertility

    Treatments such as chemotherapy and radiotherapy can cause temporary and permanent infertility. If you still plan to have a baby in the future, ask your doctor about your options. For men, the option can include storing samples of sperm. Women, on the other hand, can opt to store eggs before undergoing lymphoma treatments.

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    • Mya Hae Tha Dawn

      Specialty:
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      Clinic:
      Parkway Cancer Centre
      Location:
      38 Irrawaddy Road #05-43/50 to 55
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
      Contact No:
      6684 5522
    • Diong Colin Phipps

      Specialty:
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      Clinic:
      Parkway Cancer Centre (MEH L10)
      Location:
      3 Mount Elizabeth #10-11/12
      Mount Elizabeth Medical Centre
      Singapore 228510
      Contact No:
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      Clinic:
      Parkway Cancer Centre
      Location:
      38 Irrawaddy Road #05-43/50 To 55
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
      Contact No:
      6684 5522
    • Lee Yuh Shan

      Specialty:
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      Clinic:
      Parkway Cancer Centre
      Location:
      38 Irrawaddy Road #05-43/50 To 55
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
      Contact No:
      6684 5522
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      Clinic:
      Centre For Clinical Haematology
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      38 Irrawaddy Road #09-47/48/57
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
      Contact No:
      62568836
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      Specialty:
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      Clinic:
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      38 Irrawaddy Road #08-21/29/30
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
      Contact No:
      6259 5538; 6592 8615
      Clinic:
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      Mount Elizabeth Medical Centre
      Singapore 228510
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    • Ng Chin Hin

      Specialty:
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      Clinic:
      Centre For Clinical Haematology
      Location:
      38 Irrawaddy Road #09-47/48/57
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
      Contact No:
      62568836
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      Specialty:
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      Clinic:
      Med & Haematology Clinic
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      3 Mount Elizabeth #14-18
      Mount Elizabeth Medical Centre
      Singapore 228510
      Contact No:
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    • Ng Ronald Paul

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      Clinic:
      Icon Haematology Centre Mount Elizabeth
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      3 Mount Elizabeth #17-03/04
      Mount Elizabeth Medical Centre
      Singapore 228510
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      67378000
    • Tan Chen Lung Daryl

      Specialty:
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      Clinic:
      Dr Daryl Tan Clinic for Lymphoma, Myeloma and Blood Disorders
      Location:
      38 Irrawaddy Road #06-47
      Mount Elizabeth Novena Specialist Centre
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      Contact No:
      6262 6058
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      Specialty:
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      Clinic:
      Haematology & Stem Cell Transplant
      Location:
      3 Mount Elizabeth, Level 7 Mount Elizabeth Hospital
      Singapore 228510
      Contact No:
      6731 2030

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