A special type of white blood cell, called lymphocyte, is important for your body's resistance to disease. These cells get exposed to various substances within the body in an attempt to build the immunity. They collect and filter the substances at the Lymph nodes. Lymph nodes are found anywhere in the body, particularly in the neck, armpits, groin, above the heart, around the big blood vessels inside the abdomen. Lymphocytes may also group together in the tonsils, spleen and thymus. Lymphoma is a type of cancer that develops in the lymphocytes in any of these areas.
Lymphoma is the 5th most common male cancer and the 6th most common cancer for females in Singapore, according to the Singapore Cancer Registry 2014-2018. There were about 833 cases reported yearly between the year 2014-2018. It is one of the most common cancer seen in children and young adults, and affects more men than women. Most adult patients develop lymphoma after the age of 50.
Lymphomas are broadly divided into Hodgkin's disease and non-Hodgkin's lymphoma, based on the looks under the microscope. There are many types of non-Hodgkin's lymphoma. The size and shape of the cancer cells and arrangement of the cancer cells in the lymph node determine the type of non-Hodgkin's lymphoma. Non-Hodgkin's lymphomas are further divided into aggressive (high grade) or slow-growing (low-grade) groups. Hodgkin's lymphoma develops for a specific abnormal lineage of B-cells. It is diagnosed when these specific cancer cells are present.
Lymphoma commonly appears as a painless lump that persists or increases in size. A doctor should be seen if there is any painless swelling in the neck, armpits or groin with or without persistent fever, drenching sweats or unexplainable weight loss.
There is no specific cause for lymphoma, but it has been closely associated with abnormally decreased immune systems that may be present from birth or associated with viruses such as the AIDS virus.
Benign conditions can also cause swelling, so a diagnosis of lymphoma is made only after a biopsy (removal of a piece of tissue) is done and the tissue is examined by a pathologist (a doctor who examines tissue under a microscope).
Once lymphoma is confirmed, further tests, such as scans, biopsy of bone marrow and blood tests may be needed to see how widespread the lymphoma is. Tests of heart function may also be required to see how fit a person is for treatment.
Treatment of lymphoma may require chemotherapy. Chemotherapy drugs are either injected into the hand veins or swallowed as pills. Each course of treatment is given at regulated intervals to kill cancer cells and allow the body to recover.
Radiation therapy is a localised treatment using high-energy rays to kill lymphoma cells wherever the rays are directed. The area covered may just be the lymph nodes or organ involved by lymphoma or, in some cases, to a wider area encompassing the lymph nodes in the neck, chest and under both armpits. It may be given alone or combined with chemotherapy. (Biological therapy uses products that boost the body's own immune system to fight cancer. It may be used alone or combined with chemotherapy.
Chimeric antigen receptor (CAR) T-cell therapy is an innovative approach which involves re-programming T-cells so that they recognise and kill cancer cells.
Many new developments in the field of biological therapy are emerging. Antibodies to one type of lymphoma have been developed and may be used when conventional treatment is no longer effective. The combined treatment of high dose chemotherapy is being studied for certain patients. Here chemotherapy is given at much higher doses than standard chemotherapy treatment to kill any remaining lymphoma cells. But the high dosage also kills healthy bone marrow that produces white blood cells (infection-fighting cells), red blood cells (cells that carry oxygen), and platelets (cells that prevent bleeding). To help the patient tolerates high dose chemotherapy, stem cells or bone marrow from the patient or donor is collected beforehand. After a patient receives the chemotherapy, the stem cells or bone marrow is returned to the patient through a drip in a hand vein.
The stage of the lymphoma when diagnosed and whether it is slow growing or aggressive will determine the type of treatment given.
Clinical examinations, x-rays and pathology reports, age and overall health status of the patient all help the medical team decide what the progress of an individual case of Lymphoma may be. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with Lymphoma is good.
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