Lymphoma

Lymphoma is a type of cancer that attacks cells in the body’s immune system. Learn more about the different types of lymphoma, lymphoma symptoms and possible causes.

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What is Lymphoma? 

Lymphoma refers to a group of cancers of the lymphatic system. It is the third most common cancer among young adults and children in Singapore. Among the various cancers, lymphoma is most likely to be cured if it is diagnosed early and treated in time. 

Lymphocytes are a type of white blood cell that fight infections and are an important part of our immune system. Lymphomas begin when some lymphocytes start dividing abnormally before they mature and are unable to fight infection. These abnormal lymphocytes start collecting in the lymph nodes and grow into tumours.

The exact causes of lymphoma are not clear. Lymphomas are closely associated with an increasing age and an abnormally reduced immunity either from birth, or as a result of immunosuppressant drugs and infections with viruses such as HIV  and the Epstein-Barr virus. Men are more likely to be affected than women.

Major Types of Lymphoma

There are two principal types of lymphoma — Hodgkin and non-Hodgkin lymphoma.

Hodgkin lymphoma (HL, also known as Hodgkin’s disease) is more common in young adults aged between 15 and 30 years and adults over the age of 50. There are two main types of HL: classical and nodular lymphocyte-predominant HL. Between the two, classical HL is more commonly diagnosed.

Non-Hodgkin lymphoma (NHL) is common in older people and generally more common than HL. There are many subtypes of NHL, of which the most common subtypes are diffuse large B-cell lymphoma and follicular lymphoma.

The different types of lymphoma determine the symptoms and ultimately, the treatment prescribed.

Lymphoma Symptoms

Lymphomas usually start in lymph nodes as painless lumps that persist or increase in size. They may also be seen in the stomach, intestines, bone marrow and blood. NHL can grow at varying rates. Slow-growing lymphomas tend to cause fewer symptoms, while fast-growing ones are generally aggressive and may cause severe symptoms.

Symptoms differ with the type of lymphoma. Common lymphoma symptoms include:
Swollen lymph nodes in the neck, armpit or groin
Enlarged spleen or liver
Persistent fever or chills
Persistent fatigue and weakness
Excessive night sweats
Unexplained loss of weight and appetite
Pain in the chest, abdomen or bones for no known reason
Coughing, trouble breathing or chest pain

Lymphoma Diagnosis

Some tests typically done to diagnose lymphomas include:
Physical examination to look for swollen lymph nodes in the neck, the underarms and the groin
Blood tests to check for white blood cell count and raised levels of certain enzymes such as lactate dehydrogenase
Biopsy of the swelling to look for lymphoma cells and identify the subtype of lymphoma
Bone marrow aspiration and biopsy using a needle to see if the marrow is affected by the lymphoma
Imaging studies such as X-rays, computed tomography or magnetic resonance imaging scans to look for enlarged lymph nodes if there is no identifiable mass on examination in the presence of persistent symptoms

Lymphoma Treatment

The treatment for lymphoma is based on the site and stage of lymphoma, its progress, patient age and the patient’s general health. Treatment options include:

Chemotherapy

This involves the use of drugs to kill lymphoma cells. Chemotherapy is given in cycles orally, through a vein, or delivered into the fluids around the spinal cord. Depending on the type of lymphoma, a single drug or a combination of drugs may be used.

Radiation Therapy 

This involves the use of X-rays or other high-energy rays to kill cancer cells and stop their growth when the disease is confined to a limited area. Radiotherapy may be given alone or in combination with chemotherapy.

Biological Therapy  

This involves the use of substances that boost the immune system's ability to fight cancer.

Stem Cell Transplant 

In this technique, special cells in our body called stem cells, which circulate in the bloodstream, are collected from one's own body or from a donor. New healthy blood cells develop from the transplanted stem cells. A stem cell transplant may be needed if lymphoma recurs after treatment.

Chemotherapy and radiotherapy may often damage healthy cells and tissues, resulting in side effects. Side effects may vary by patient and with each treatment session.

Living with Lymphoma

Lymphoma and its treatment may be stressful for patients and their loved ones. To maintain a strong support system:
Talk to your family and friends to help you cope with cancer
Stay active and take time for self-care
Eat well, relax and get enough rest to help combat stress 

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