What is Lymphoma, Lymphoma, Hodgkins, Non-Hodgkins

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What is Lymphoma?

Lymphoma is a type of blood cancer that begins in the cells of the lymphatic system which is responsible for fighting disease and infection. It affects the infection-fighting cells of the immune system known as lymphocytes. There are two types of lymphocytes called B cells and T cells. These cells have the ability to recognise and destroy infectious microorganisms and abnormal cells. Because the immune system is found throughout the body, lymphoma can begin almost anywhere..

Lymphoma occurs when the lymphocytes multiply abnormally and collect at specific parts of the lymphatic system, such as the lymph nodes, bone marrow and spleen. These affected lymphocytes also lose their infection-fighting ability making the body more vulnerable to infection.
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Symptoms of Lymphoma, Lymphoma, Hodgkins, Non-Hodgkins
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There are more than 60 specific types of Lymphomas.  The two most common types of Lymphoma are Hodgkin Lymphoma and Non-Hodgkin Lymphoma..

The main difference between Hodgkin lymphoma and Non-Hodgkin lymphoma is in the specific lymphocyte affected. There is an abnormal cell called a Reed-Sternberg cell which is present in Hodgkin lymphoma, but absent in Non-Hodgkin Lymphoma..

Hodgkin Lymphoma is a form of cancer affecting the lymphatic system. Hodgkin Lymphoma occurs when the cells in the lymphatic system begin to grow abnormally and spread to different organs and tissues.
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What are the signs & symptoms of Hodgkin Lymphoma?

The signs and symptoms of Hodgkin Lymphoma include:

  • Painless swelling of the lymph nodes in the neck, armpit, or groin
  • Itching of the skin all over the body
  • Persistent fatigue
  • Fever
  • Unintentional weight loss
  • Severe night sweats
  • Pain in the lymph nodes after alcohol consumption
  • Coughing and trouble breathing
  • Pain in the chest, abdomen, or bones
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What are the causes of Hodgkin Lymphoma?

Hodgkin Lymphoma may occur when the infection-fighting cells called lymphocytes undergo genetic mutations resulting in the uncontrolled growth and multiplication of these affected cells.
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These abnormal lymphocytes usually grow and accumulate in a particular part of the lymphatic system, such as the neck or groin, and crowd out the healthy cells. Over time, the abnormal lymphocytes can spread to other parts of the body, such as the spleen, bone marrow, liver, and lungs.
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What are the risk factors for Hodgkin Lymphoma?

The factors that can increase the risk of Hodgkin Lymphoma include:

  • Age: People can be diagnosed with Hodgkin Lymphoma at any age although the most common age of diagnosis is between 20 and 40 years old, and those above 55 years old.
  • Gender: Hodgkin Lymphoma is slightly more common in males than in females.
  • Previous exposure to Epstein-Barr virus: This virus is known to alter the DNA of B-lymphocytes. An infection caused by the Epstein-Barr virus may result in a condition called infectious mononucleosis that can increase the risk of Hodgkin Lymphoma.
  • Family history: People with a first-degree relative (parent, sibling or child) who has Lymphoma may have a higher risk of developing it, although it is not clear if it is due to an inherited genetic mutation or lifestyle factors.
  • Weak immune system: People with a weakened immune system because of their medical condition (such as AIDS) or are on medications (such as immunosuppressants) are at increased risk.
  • Environmental factors: Early birth order, having fewer siblings or playmates, and single-family homes are associated with a higher risk of Hodgkin Lymphoma.
  • Genetic syndromes: Patients with Klinefelter’s syndrome and Down syndrome are at increased risk.
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Non-Hodgkin Lymphoma represents a group of cancers originating in the lymphatic and immune systems. It affects the lymph nodes and the blood cells called lymphocytes..


What are the signs & symptoms of Non-Hodgkin Lymphoma?

The signs and symptoms of Non-Hodgkin Lymphoma may include:

  • Painless swelling of the lymph nodes in the neck, armpit or groin
  • Anaemia or reduced red blood cell count (if the bone marrow is affected)
  • Unexplained weight loss
  • Fever
  • Persistent fatigue
  • Night sweats
  • Coughing, difficulty in breathing, and chest pain
  • Loss of appetite
  • Pain, swelling, or sensation of fullness in the abdomen
  • Itching of the skin all over the body.


What are the causes of Non-Hodgkin Lymphoma?

Non-Hodgkin Lymphoma occurs due to the rapid multiplication of lymphocytes. The life cycle of lymphocytes involves the formation of new cells that can replace the old lymphocytes. Non-Hodgkin Lymphoma occurs when the lymphocytes grow indefinitely resulting in an increased number of immature lymphocytes in the blood. This results in the accumulation of a large number of lymphocytes in the lymph nodes, causing them to swell..

Non-Hodgkin Lymphoma usually affects the B-lymphocytes that produce antibodies to fight infections. The subtypes of Non-Hodgkin Lymphoma affecting B cells include follicular Lymphoma, diffuse large B-cell Lymphoma, Burkitt Lymphoma, and mantle cell Lymphoma..

In rare cases, Non-Hodgkin Lymphoma may occur in T lymphocytes that attack and destroy foreign bodies directly. The subtypes of Non-Hodgkin Lymphoma affecting T cells include cutaneous T-cell lymphoma and peripheral T-cell Lymphoma.


What are the risk factors for Non-Hodgkin Lymphoma?

  • Age: The risk of developing this disease increases with age. People above 60 years of age have an increased risk of developing Non-Hodgkin Lymphoma.
  • Weak immune system: People with weakened immune systems due to a medical condition (such as AIDS) or are on medication (such as immunosuppressants) are at increased risk.
  • Environmental factors: People working with herbicides may be at a higher risk of this disease..

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How is Lymphoma diagnosed?

  • Physical examination
    Our doctor will check for swollen lymph nodes in your armpits, neck, and groins for the possible diagnosis of Lymphoma. Enlargement of the spleen or liver can also be a sign of Lymphoma. Biopsies are then usually done to confirm the diagnosis.
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  • Biopsy
    A lymph node biopsy that involves the removal of part or all of a swollen lymph node can help to confirm the diagnosis of Lymphoma. The sample is sent to a laboratory to detect the presence of cancer cells. Analysing the lymph node tissue in a laboratory will help to identify the type of Lymphoma.
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  • Blood and urine tests
    Our doctor may recommend blood and urine tests to rule out infections or other diseases.
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  • Imaging tests
    Imaging tests such as X-ray, CT, MRI, and PET (Positron Emission Tomography) can help in the diagnosis of Lymphoma.
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  • Bone marrow aspiration
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    bone marrow biopsy and aspiration involve inserting a needle into the hipbone to draw a sample of the bone marrow. The sample is then analysed in a laboratory to detect Lymphoma cells.
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Treatment of Lymphoma

Treatment of lymphoma can be given via different modalities of therapy..

First line treatment of lymphoma is usually given in cycles of therapy. Each cycle is typically 3-4 weeks in duration with treatment given over a few days as a combination of different chemotherapy drugs (sometimes with targeted therapy)..

  • Chemotherapy
    Chemotherapy can help to kill cancer cells. These medications can be given orally or by injections. It can be combined with other treatments such as radiation for improved outcomes.
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  • Other Drug Therapy
    Biological therapy that involves the use of medications such as rituximab can be effective for treating Lymphoma. These drugs work by improving the functions of your immune system..

    • Rituximab is a monoclonal antibody that can attach itself to B lymphocytes and make them more visible to your immune system. This allows the immune cells to identify and attack the cancer cells more effectively.
    • Another drug called ibrutinib can be used for the treatment of Non-Hodgkin Lymphoma.
    • Radioimmunotherapy drugs like Ibritumomab tiuxetan are made of monoclonal antibodies carrying radioactive isotopes. These drugs facilitate the attachment of antibodies to cancer cells, thus allowing radiation to be directed precisely at them. These treatments can help to limit the growth and spread of Lymphoma.
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  • Radiation Therapy
    Radiation therapy involves exposure of the affected tissues to high-powered energy beams such as protons and X-rays to destroy the cancer cells. During radiation therapy, you will be asked to lie on a table. A large machine will move around you to direct the beams of energy to the affected lymph nodes to destroy them.
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  • Stem Cell Transplant
    Stem cell transplant involves the removal of healthy stem cells from you or a donor’s bone marrow to be later infused into your bloodstream. The healthy stem cells, once injected into your body, flow to your bones and rebuild the bone marrow, thereby restoring the normal production of lymphocytes. Stem Cell Transplantation for lymphoma is usually reserved for patients with high risk subtypes of lymphoma or patients with relapsed lymphoma

 

  • CAR-T Cell Therapy
    CAR-T cell therapy has been shown to be effective in patients with B-cell Lymphoma who have relapsed or refractory diffuse large B-cell Lymphoma, transformed follicular Lymphoma, as well as primary mediastinal B-cell Lymphoma.
    In Singapore, the current approved form of CAR-T cell therapy is indicated for patients with diffuse large B-cell Lymphoma who have previously failed at least 2 lines of standard treatment.

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FAQs on Lymphoma

There are various factors that may increase one’s risk of developing Lymphoma. These include age, gender, and family history. Those aged between 15 to 40 or those over 55 are at higher risk of developing Lymphoma. Similarly, men are more likely to develop Lymphoma when compared to women.

For many patients diagnosed with Lymphoma, no risk factors can be changed. However, some studies indicate that building and maintaining a strong immune system may help lower your risk of developing Lymphoma. For example, staying within a healthy weight range, keeping active, and following a nutrient-dense diet which has less red meats and processed foods may help reduce the risk of developing Lymphoma.

Some of the most common initial signs of Lymphoma include painless swellings in the neck, armpits, or groin, persistent fatigue, and night sweats. Patients may also report shortness of breath and unexplained weight loss as some of the first signs of Lymphoma.

A blood test alone is usually insufficient to make a diagnosis of Lymphoma.

A diagnosis of Lymphoma is usually confirmed through a combination of a detailed clinical assessment, blood tests, a PET-CT scan as well a biopsy of the affected lymph nodes. In many patients, a bone marrow evaluation will also be performed as part of staging to assess whether there is Lymphoma involvement in the bone marrow.

Lymphoma of the brain or spinal cord, also known as primary central nervous system (CNS) Lymphoma, is a rare form of leukaemia which begins in the lymph tissue of the brain or spinal cord. However, Lymphoma of the brain or the spinal cord is rare, with around only 4 in every 100 brain or spinal cord tumours (4%) being Lymphomas..

Sometimes, particularly in patients with aggressive stage 3 or 4 Lymphoma, the disease can also spread to the Central Nervous System.

Patients diagnosed with Lymphoma should aim to eat a healthy and balanced diet to supplement the body. This should consist of a high-fibre diet made up of fruits and vegetables while avoiding saturated fats found in highly processed foods.

While there is no specific diet for patients diagnosed with Lymphoma, sticking to a nutrient-dense, well-balanced diet can help support your body as you undergo treatment. Try to include complex carbohydrates, lean proteins, healthy fats, and ample fresh fruits and vegetables.

This often depends on the sub-type of Lymphoma. Some low-grade forms of Lymphoma can be very slow progressing and may just need observation with no active therapy..

However, high-grade sub-types of Lymphoma can be very aggressive, and patients can become seriously unwell in a matter of weeks to months without proper treatment

While high-grade Lymphomas tend to progress more rapidly, a good proportion of high-grade Lymphomas can be effectively treated with a low risk of relapse..

Low-grade Lymphomas often respond well to treatments available. However, they are not usually cured and may recur eventually over time.

Low-grade Lymphomas tend to respond well to the available therapies. However, many of these Lymphomas tend to recur over time..

While a significant proportion of high-grade Lymphomas can be successfully treated with chemotherapy, certain forms of high-grade Lymphomas are highly aggressive as determined by their Lymphoma sub-type (from the analysis of the tissue biopsy). Unfortunately, many of these aggressive forms of Lymphoma have a poorer prognosis.

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FAQs on Lymphoma Treatments

At CFCH, we offer the following treatments for lymphoma: 

  • Chemotherapy
  • Radiation therapy 
  • Other drug therapies
  • Stem cell transplant
  • CAR-T cell therapy

If the Lymphoma isn’t growing at an accelerated rate or causing problems, it can be watched closely without treatment over a period. If treatment is required, it depends on the stage of the Lymphoma. When the Lymphoma is only in one lymph node or area (stage I), it may be treated with radiation therapy. The majority of patients with Lymphoma require treatment with a combination of chemotherapy and targeted drug therapy.

During radiation therapy, you will be asked to lie on a table and a large machine will move around you to direct the beams of energy to the affected lymph nodes and destroy them.

Some biological therapy medications used for Lymphoma treatments are rituximab, ibrutinib and ibritumomab tiuxetan.

In order for doctors to determine if your bone marrow transplant is successful, your blood count levels need to return to normal along with your immune system. This can take between 6 to 12 months. Our transplant team will continue to monitor you during this period for any issues that may surface.

CAR-T cell therapy has been shown to be effective in patients with B-cell Lymphoma who have relapsed or refractory diffuse large B-cell Lymphoma, transformed Follicular Lymphoma, as well as primary mediastinal B-cell Lymphoma.

In Singapore, the current approved form of CAR-T is indicated for patients with Diffuse Large B-cell Lymphoma (DLBCL) who have previously failed at least 2 lines of standard treatment.

Common complications related to Lymphoma treatment include:

  • Hair loss
  • Gastrointestinal symptoms such as nausea and vomiting
  • Lethargy
  • Sore mouth
  • Sore skin from radiation
  • Increased risk of infections

Patients treated for Lymphoma are also at increased risk for longer-term complications, including cardiac issues, reduced fertility and an increased risk of secondary cancers..

Our team at CFCH will guide you through the potential complications of your therapy and discuss the best approaches towards managing your symptoms.

Most Lymphoma cases are treated with a combination of chemotherapy agents and sometimes targeted therapy. Patients are often treated in cycles of therapy using the same drug combination every few weeks to gradually eliminate the Lymphoma..

Patients usually receive 6-8 cycles of treatment depending on the disease stage and sub-type. Upfront treatment for Lymphoma can last typically for 4-6 months. Our haematology specialists at CFCH will be able to advise you in detail on your specific treatment pathway.

The cost of Lymphoma treatment in Singapore varies depending on factors such as your type of Lymphoma and the treatment plan recommended for you. For more information on the cost of Lymphoma in Singapore and the insurance claims you may be eligible for, get in touch with us at CFCH.

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Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

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    CFCH Email

    Locations

    Contact

    WhatsApp : +65 6256 8836
    Email : contact@cfch.com.sg
    .

    Consultation Hours

    Monday to Friday : 8.30am – 5.30pm
    Saturday : 8.30am – 12.30pm
    Closed on Sunday & Public Holidays

    Find us on Facebook

    Drop a Line

    If you have any questions about your condition or would like to make an appointment, simply fill up the form and we'll contact you as soon as we can

      © Centre for Clinical Haematology | 2023