Introduction 
A special type of white blood cell, called lymphocyte, is important for your body's resistance to disease. Where they form a group of cells it is called a lymph node. Lymph nodes are found anywhere in the body, particularly in the neck, armpits, groin, above the heart, and 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.
How common is Lymphoma?
Lymphoma is the eighth most common male cancer in Singapore according to the Singapore Cancer Registry. However in children and young adults, it is the third most common cancer seen. It affects more men than women. Most adult patients develop lymphoma after the age of 50.
Causes and Risks
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.
Symptoms
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, armpit or groin
• persistent fever
• drenching sweats, or
• unexplainable weight loss.
Diagnosis
Benign conditions can also cause swelling, so a diagnosis of lymphoma is made only after a biopsy (removal of a piece of tissue) of a swelling is done and the tissue examined by a pathologist (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.
Clinical examinations, x-rays and pathology reports 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.
Types of Lymphoma
Lymphomas are broadly divided into Hodgkin's lymphoma and non-Hodgkin's lymphoma, based on the presence or absence of certain types of cells in the cancer. There are many types of non-Hodgkin's lymphomas. 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 is diagnosed when specific cancer cells are present.
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. The drugs circulate throughout the body and so will reach cancer cells even when they are widespread.
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. Many new developments in the field of biological therapy are emerging.
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 produce white blood cells (infection-fighting cells), red blood cells (cells that carry oxygen) and platelets (cells that prevent bleeding). To help the patient tolerate the high dose chemotherapy, stem cells or bone marrow from the patient or donor are 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.
Frequently Asked Questions
Is lymphoma contagious?
There is no evidence that lymphoma can spread to another person by close contact as it is not a virus or bacteria. It is a collection of cells in the body that has become cancerous.
Why do some lymphomas need to be treated straight away while other lymphomas do not need treatment?
The fast-growing, high grade or aggressive lymphomas can increase in size and spread sometimes over days or weeks, and cause the patient to become very sick. These lymphomas need to be treated within a short period of time to get the disease under control. The slower growing lymphomas may take months or years to grow and may sometimes even disappear without any treatment. They may cause disturbing symptoms to the patient eventually and this is when treatment is started.