Did you know, lymphoma is the fifth and sixth most common cancer for males and females respectively in Singapore, with about 800 new cases in total diagnosed per year!

Lymphoma is a cancer arising from cells of the lymphatic system, which is part of the body's germ-fighting network. The lymphatic system includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow.

Lymphoma comprises more than 100 subtypes of two closely related cancers: non-Hodgkin's lymphoma (NHL) and Hodgkin lymphoma.

Hodgkin lymphoma typically affects young adults and adolescents. It is now a poster child of modern-day oncology as a large majority of patients and even those with advanced stages of the disease will be cured with conventional chemotherapy.

Non-Hodgkin's lymphoma on the other hand, is far more common and by itself, constitutes numerous other subtypes. These subtypes are based largely on whether the lymphoma cancer cell originates from the B or T-lymphocyte. Non-Hodgkin's lymphoma ranges from indolent (slow growing) to highly aggressive (fast growing).

With the advent of new drug and targeted therapy, the prognosis and cure rates of B-cell lymphomas has improved tremendously. While indolent B-cell lymphomas are still considered incurable, the survivals are now significantly prolonged such that they are more akin to chronic diseases rather than terminal cancers. On the other hand, due to the rarity of T-cell lymphomas and paucity of clinical trials investigating effective drug combinations in the diseases, the prognosis of many patients with T-cell lymphoma still remains poor.

Common signs and symptoms of lymphoma include enlarged lymph nodes, lethargy, fever, night sweats, poor appetite, weight loss, pain, profound fatigue, itching, and abnormal routine blood tests.

The doctor or physician may feel enlarged lymph nodes during a routine clinical examination, or a computed tomography (CT) or positron emission tomography (PET) scan may show enlarged liver, spleen, or lymph nodes.

The most accurate way to diagnose lymphoma is by obtaining a biopsy of the enlarged or abnormal tissue. A biopsy involves surgically removing a small tissue sample and looking at the specimen under a microscope by the pathologist. Lymphoma can also present in bone marrow, and in some instances, the diagnosis is made by bone marrow biopsy.

Historically, the mainstay of treatment for lymphoma has been with conventional chemotherapy. However, chemotherapy is non-selective in its effect and can cause other bystander healthy cells to be affected and this accounts for the notorious side effects of traditional chemotherapy like hair loss, nausea, diarrhoea, bleeding and infections. As there is a limit to how much chemotherapy the body can receive, autologous stem cell transplantation was developed to allow the body to receive a way higher dose of chemotherapy without permanently damaging the bone marrow. This procedure has remained a standard treatment for patients with relapsed aggressive lymphomas.

Treatment has since evolved a great deal over the past several years and is tailored to the specific subtype of lymphoma. Some lymphomas require immediate treatment (aggressive) while others can be watched and treatment administered only at the time of disease progression (indolent).

 

Precision cancer medicine on the other hand, uses targeted drugs and immunotherapy engineered to directly attack lymphoma cells with specific abnormalities with the goal of leaving normal cells largely unharmed.

 

Here are just some of the therapies that exemplify the advances being made:

 

With the above-mentioned innovations and many more other treatment options on the horizon in the fight against lymphoma, the prognosis of patients will continue to get better and conventional chemotherapeutic agents will eventually become obsolete as they get replaced by precision medicine.

 

This article was contributed by Dr Darryl Lim Ching Wen, AIA Preferred Provider. To request an appointment with Dr Lim, please click here.