Understanding Lymphoma

Lymphoma is a type of blood cancer that affects the lymphatic system, which plays an important role in the body’s immune defence. The lymphatic system includes lymph nodes, lymph vessels, the spleen, thymus and bone marrow. Collectively, these structures help fight infections and maintain fluid balance in the body.

Lymphomas are among the more frequently diagnosed cancers in Singapore. According to the Singapore Cancer Registry Annual Report 2023, lymphoma was the fourth most common cancer in males and the fifth most common in females, with over 5,000 new cases diagnosed in Singapore between 2019 and 2023.

Lymphoma is also the most common blood cancer in adolescents and young adults (aged 16–45), highlighting its impact across different age groups.

At the National Cancer Centre Singapore (NCCS), lymphoma care involves detailed clinical assessment, imaging, pathology and molecular testing, supported by multidisciplinary treatment planning. This page gives an overview of what lymphoma is, how it is diagnosed and staged, treatment options available, and the support patients can expect throughout their care journey.

What Is Lymphoma

Lymphoma develops when lymphocytes, a type of white blood cell, undergo genetic changes that cause them to grow and multiply in an uncontrolled manner. These abnormal lymphocytes can accumulate in lymph nodes or other parts of the lymphatic system, forming swellings or affecting organ function.

Because lymphocytes circulate throughout the body, lymphoma can occur at multiple sites at the same time. Depending on the lymphoma type, the disease may progress slowly in some individuals or more rapidly in others.

Types of Lymphoma

Lymphoma is broadly divided into two main categories based on how the cancer cells appear under a microscope and how the disease behaves.

Hodgkin Lymphoma

Hodgkin lymphoma is a less common type of lymphoma characterised by the presence of specific abnormal cells called Reed–Sternberg cells. It often affects younger adults and is considered one of the more treatable forms of lymphoma.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma includes a wide group of lymphomas that vary in how quickly they grow and how they are treated. These may be further classified as:

• Indolent (slow-growing) lymphomas, which may not require immediate treatment 
• Aggressive (fast-growing) lymphomas, which usually require prompt therapy

The specific subtype influences treatment decisions and outlook.

Symptoms of Lymphoma

Symptoms of lymphoma can vary depending on where the disease is located and how active it is. Some people experience few symptoms initially.

Possible symptoms include:

• Painless swelling of lymph nodes in the neck, armpit or groin 
• Persistent fatigue 
• Unexplained fever 
• Night sweats 
• Unintentional weight loss 
• Shortness of breath or cough, if lymph nodes affect the chest 
• Abdominal discomfort or fullness

These symptoms can also be caused by infections or other non-cancerous conditions, therefore it is important to consult with a doctor if you experience such persistent or unexplained symptoms .

Causes and Risk Factors for Lymphoma

The exact cause of lymphoma is not fully understood. It develops when genetic changes occur in lymphocytes, affecting how they grow and survive.

Non-modifiable Risk Factors

• Increasing age, depending on lymphoma type 
• Certain inherited immune conditions 
• A weakened immune system due to medical conditions or treatment

Modifiable or Environmental Factors

• Certain viral infections, such as Epstein–Barr virus (EBV), in specific lymphoma types 
• Long-term immune suppression following organ transplantation 
• Exposure to certain chemicals

However it is important to note that many people diagnosed with lymphoma have no identifiable risk factors.

How Lymphoma Is Diagnosed

Diagnosis of lymphoma involves confirming the presence of cancer, identifying the subtype and determining how far the disease has spread.

Biopsy and Pathology

A biopsy is required to confirm lymphoma. This usually involves removing part or all of an affected lymph node. The tissue is then examined under a microscope and tested to determine:

• The lymphoma subtype 
• Whether it is Hodgkin or non-Hodgkin lymphoma 
• Molecular and genetic features that may guide treatment

Imaging Tests

Imaging helps to assess the extent of the disease and may include: 

• CT scans 
• PET scans to evaluate active disease sites 
• MRI scans in selected cases

Blood and Bone Marrow Tests

Blood tests assess overall health and immune function. In some cases, a bone marrow biopsy may be performed to check for the presence of cancer cells .

Staging and Classification

Staging in lymphoma describes how extensively the disease involves the lymphatic system and whether it has affected organs outside the lymph nodes. Because lymphocytes circulate throughout the body, lymphoma can involve multiple areas, and staging focuses on patterns of lymphatic spread rather than tumour size.

Assessing Lymphatic Involvement

Doctors assess:

• The number and location of affected lymph node groups, such as those in the neck, chest, abdomen or groin 
• Whether lymph nodes on one or both sides of the diaphragm (the muscle separating the chest and abdomen) are involved
• Involvement of lymphatic organs, including the spleen, liver or bone marrow

Imaging studies and, in some cases, bone marrow testing help to provide a complete picture of disease extent.

How Lymphoma Stage Is Interpreted

Unlike many solid tumours, a higher stage of lymphoma does not always mean a poorer outcome. Some lymphomas that are widespread may still respond well to treatment, particularly if they are slow-growing or highly sensitive to therapy.

Why Staging Matters

Staging, together with lymphoma subtype and disease behaviour, helps to guide treatment planning and clarify treatment goals. It supports decisions about treatment intensity and whether treatment is given with curative or long-term disease-control intent. Patients are encouraged to discuss with their doctor what their stage means for their specific type of lymphoma.

Treatment for Lymphoma

Treatment for lymphoma is individualised and guided by a multidisciplinary team at NCCS. Because lymphoma includes many different subtypes with varying behaviour, treatment decisions are based on a combination of clinical and biological factors rather than just stage alone.

Key considerations include: 

• Lymphoma type and subtype (for example, Hodgkin or non-Hodgkin lymphoma, and whether the disease is slow-growing or aggressive) 
• Stage and pattern of lymphatic involvement 
• Rate of disease progression and symptom burden 
• Overall health and immune function  
• Patient preferences, where there are suitable treatment options

Some patients require immediate treatment, while others may be safely monitored before therapy is started.

Active Monitoring

For certain slow-growing (indolent) lymphomas, treatment may not be needed at the time of diagnosis. Instead, patients are closely monitored with regular reviews, blood tests and imaging. Treatment is introduced if the lymphoma shows signs of progression or begins to cause symptoms.

Chemotherapy

Chemotherapy is commonly used in the treatment of many lymphoma subtypes, particularly aggressive forms. These medicines target rapidly dividing lymphoma cells and are usually given in cycles over a defined period. Chemotherapy may be used alone or in combination with other treatments, depending on the lymphoma type and stage.

Immunotherapy

Immunotherapy helps the body’s immune system recognise and attack lymphoma cells. It is frequently combined with chemotherapy for certain lymphoma subtypes and has improved outcomes for many patients. The use of immunotherapy depends on the specific characteristics of the lymphoma.

Targeted Therapy

Targeted therapies act on specific proteins or pathways that support lymphoma cell growth. These treatments are used when testing shows that the lymphoma is likely to respond and may be given alone or alongside other therapies. Targeted treatments can be particularly useful for selected lymphoma subtypes.

Radiation Therapy

Radiation Therapy may be used to treat localised lymphoma or to relieve symptoms caused by enlarged lymph nodes pressing on nearby structures. It is sometimes combined with chemotherapy, especially in early-stage disease or when disease is confined to a limited area.

Stem Cell Transplantation

In selected cases, a stem cell transplant may be recommended. This approach is most often considered for lymphoma that has returned after treatment or has not responded fully to initial therapy. Stem cell transplantation allows higher-intensity treatment to be given under carefully controlled conditions.

What Treatment Aims to Achieve

Treatment goals for lymphoma depend on the subtype, stage and disease behaviour and may include: 

• Achieving remission, where no active disease is detectable 
• Controlling disease progression in lymphomas managed as long-term conditions 
• Relieving symptoms related to lymph node enlargement or organ involvement 
• Maintaining quality of life and daily function

Supportive Care and Living With Lymphoma

Supportive care is an essential part of lymphoma management and may begin at diagnosis, alongside active treatment. Because lymphoma affects the immune system and treatments can influence immunity and energy levels, supportive care focuses on maintaining physical resilience, preventing complications and supporting emotional wellbeing.

Support may include:

• Infection prevention and early management, as lymphoma and its treatments can weaken immune defences 
• Monitoring and management of fatigue, which is a common symptom both during and after treatment 
• Nutritional guidance, particularly for patients experiencing appetite changes, weight loss or treatment-related side effects 
• Psychological and emotional support, helping patients and families cope with uncertainty, anxiety and long treatment courses 
• Rehabilitation and social support, including assistance with returning to daily activities, work or studies

Patients are encouraged to discuss any symptoms or concerns promptly with their care team so that supportive care measures can be initiated .

Follow-Up and Monitoring

Regular follow-up is an important part of care after lymphoma treatment.

Follow-up helps assess recovery, monitor immune system function and detect any signs of disease recurrence or late treatment effects. Follow-up care may include: 

• Blood tests, to assess blood counts and immune recovery 
• Imaging studies, such as CT or PET scans, to monitor lymph nodes and organs involved 
• Physical examinations, focusing on lymph node areas and overall wellbeing

The frequency and duration of follow-up depends on the lymphoma subtype, treatment received and individual risk factors. Some patients require long-term monitoring, particularly those with lymphomas which are managed as chronic conditions.

Guidance and Support at NCCS

Being diagnosed with lymphoma can raise many questions and uncertainties. At NCCS, multi-disciplinary care is delivered with close collaboration between specialists, to ensure that medical treatment, follow-up and supportive care are carefully coordinated. Patients are supported with clear explanations, practical guidance and access to appropriate services throughout diagnosis, treatment and recovery.

Open communication is encouraged, and patients are supported in understanding their condition, exploring treatment options and participating in decisions about their care. Information and support are also available for family members and caregivers.

For more information about lymphoma or to discuss your individual care plan, please speak with your NCCS care team or visit www.nccs.com.sg.

Commonly Asked Questions

1. Is lymphoma always a fast-growing cancer?

Some lymphomas grow slowly and may not require immediate treatment, while others grow more quickly and need prompt therapy.

2. Can lymphoma be cured?

Many types of lymphoma are highly treatable, and some can be cured. Treatment outcomes depend on the lymphoma subtype, stage and response to treatment.

3. Why might treatment be delayed for some lymphomas?

For slow-growing lymphomas, active monitoring may be recommended until treatment is necessary. This approach avoids unnecessary side effects while maintaining close observation.

4. Will lymphoma treatment affect my immune system?

Some treatments can temporarily weaken the immune system. Your care team will monitor this closely and provide guidance to reduce infection risk.

5. How long will follow-up continue after treatment?

Follow-up schedules vary. Some patients require long-term monitoring to ensure early detection of recurrence or late effects of treatment.