Lymphoma, a highly curable cancer
By Grace Segran
JAKARTA (JP): Lymphoma ranks eighth among the most frequent types of cancer in males in Singapore. The number, unfortunately, is increasing and we do not know why.
According to Dr. Ang Peng Tiam, a consultant medical oncologist who specializes in treating lymphoma at Mount Elizabeth Hospital in Singapore, the incidence of lymphoma is increasing at a rate of 3.5 percent per year. It has the second highest rate of increase in incidence among both men and women.
The good news is that while it is a serious condition, it is highly treatable.
What is lymphoma?
Lymphoma is a broad term encompassing a variety of cancers of the lymphatic system. The lymphatic system helps filter out bacteria and is important in fighting disease.
In lymphoma, some of the cells in the lymphatic system multiply uncontrollably. The different varieties of lymphoma are differentiated by the type of cell that multiplies and how the cancer presents itself.
Types of lymphoma
The two main groups of lymphoma are Hodgkin's disease and non- Hodgkin's lymphomas, into which all the other lymphomas are grouped.
According to Dr. Ang, non-Hodgkin's lymphoma is far more common in this part of the world. For some unknown reason, Hodgkin's disease is not so common and accounts for less than one in ten patients with lymphoma.
Hodgkin's disease is the better known form of lymphoma. It is characterized by the presence of Reed-Sternberg cells.
Hodgkin's disease can occur in children and adults and is most common in two age groups -- early adulthood (ages 15 to 40, usually between 25 and 30) and late adulthood (after the age of 55).
The non-Hodgkin's lymphomas encompass over 29 types of lymphoma. The distinctions are based on the type of cancer cells.
"Of the non-Hodgkin's lymphomas," says Dr. Ang, "Diffuse large cell lymphoma is the most common subtype."
Childhood Lymphoma
Cancer strikes one of every 330 children born in the U.S. before the age of 19. Lymphoma makes up 10 percent of those childhood cancers with 55 percent diagnosed as non-Hodgkin's lymphoma and 45 percent diagnosed as Hodgkin's disease.
Profile of lymphoma patients
Interestingly, many rich and famous people have lymphoma, e.g. Jackie Onassis, King Hussein of Jordan, Paul Tsongas, Lee Hsien Loong and Ong Teng Cheong, the former president of Singapore.
However, there are no known risk factors -- so anyone is at risk.
Lymphoma is sometimes associated with Human Immunodeficiency Virus (HIV) infection, but this association is not as common here because of the lower prevalence of AIDS.
Diagnosis
The doctor will make a diagnosis based on many factors, including tests on the patient and an examination of the cancerous cells for telltale characteristics.
Patients usually find a lump in the neck, armpit or groin area. In more advanced stages, it can cause fever, drenching sweats at night and weight loss. Dr. Ang notes that interestingly, some lymphoma patients have pain when they drink alcohol. Another unexplained symptom is itchiness.
"The diagnosis of lymphoma is made through a biopsy," says Dr. Ang. "However, most of the time, a presumptive diagnosis is made from the clinical picture of the swelling of lymph nodes."
Treatment trends
Chemotherapy is the treatment of choice for lymphoma. ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine), for example, is a program used for treating Hodgkin's Disease, while the standard treatment for non-Hodgkin's lymphoma is CHOP (Cyclophosphamide, Adriamycin, Vincristine, also called Oncovin, and Prednisolone).
In patients with a very localized lymphoma, radiation therapy alone may be adequate.
For patients with advanced disease, the addition of high-dose chemotherapy with stem cell rescue improves the cure rate. Stem cells are early blood cells found in the blood and bone marrow. These cells are transplanted as they have the potential for multiplying and growing new blood cells.
Prognosis
Lymphoma is considered a very curable disease because at all stages there are cures for it, says Dr. Ang.
He said: "If I were a young man, I'd prefer aggressive lymphoma because it is curable with chemotherapy. However, If I'm over the age of 65, it may be better to have a low-grade disease because no treatment or some simple oral treatment is adequate, and there's a reasonable chance of living for seven to 10 years."
Recent advances in this medical field have helped to further improve the cure rates. "We now have a new option -- the addition of the monoclonal antibody Mabthera which can improve the cure rate when combined with chemotherapy," says Dr. Ang. "Generally speaking, lymphoma is a highly curable disease."