Contents
1. Lymphoma - a curable cancer, a perspective in the 21st century
   
2.

Evaluation of a lump

Bone-marrow aspiration
and biopsy
   
3.

Blood stem cell transplantation for
lymphoma

Hodgkin's disease -
have we achieved the optimum treatment strategy for early-stage disease
   
4. Radiological imaging of lymphoma
   
5.

Classification and tools
in the diagnosis of lymphomas
   
6.

Cytogenetics and its role
in lymphona
   
  NCC Tumour Board
Files
   
  Quiz
   
  NCC Round Up
   
 

Staff Directory
   
  Pharmacy Tips
   
  Lymphoma - An Overview
   
  Contact
   
   
 

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Lymphoma - a curable cancer, a perspective in the 21st century
 
 

In recent years there has been an unprecedented increase in the incidence of non-Hodgkin's lymphoma in Singapore, mirroring that in Western societies. In 1997, it was the 8th commonest tumour in males, but with about 150 new cases every year the incidence is fast rising. No certain aetiological link is known, although speculation abounds regarding environmental and infectious factors. However, much progress has been made in the classification and treatment of lymphomas.

Lymphomas are one of the few cancers that can be cured, in that after treatment the median survival of a patient could be similar to that of anyone of the same age. This optimistic outlook has been made possible by the success of combination chemotherapy and more recently by the addition of "smart-bomb" immunotherapy and radio-immuno-conjugates. Genetic signatures and immune targets have been best studied in this cancer and have enabled the development of antibody therapy, such as Rituximab (an antibody to CD-20 for treatment of B-cell lymphoma), and genetic tools for precise diagnosis.

Unlike most cancers, for which surgery is the mainstay for removal and cure of early-stage tumours, in lymphomas non-surgical treatment is the cornerstone while surgery has a role in the diagnosis and management of selected complications such as bleeding or obstruction of viscera. Yet, overall the treatment approach is truly multidisciplinary, with radiation playing an important part.

This tumour offers a glimmer of hope in cancer medicine, with cure rates as high as 60% even for advanced-stage disease. This high curability requires proper identification and management of the cancer. Hence it is very important that all physicians understand the management of this entity. Nevertheless, proper understanding is somehow restricted, one difficulty being that there are over 20 histological types of cancers of this one organ system (lymphatic system). In this issue of Cancer Update we hope to present a simple overview to aid understanding of this important and curable malignant tumour. We also hope to educate readers about the common procedures that a patient with lymphoma has to go through. Our aim is that all physicians will become more comfortable in diagnosing and managing or referring future lymphoma patients.

Dr Sandeep K Rajan
Editor