Know yourself, know your enemy, and you will never be defeated
Increase in New Cases and Mortality Rates
Lymphoma (primarily non-Hodgkin lymphoma) is one of the “top ten cancer killers” in Hong Kong. According to the latest data, there were 1,068 new cases of non-Hodgkin lymphoma in 2022, ranking it as the eighth most common cancer. In the same year, the total number of deaths from lymphoma was 395, placing it tenth among fatal cancers, with the number of deaths among males (221) higher than that among females (174).
The risk of developing lymphoma increases significantly with age. Based on data from 2018–2022, the median age group for diagnosis was 73 years for males and 75 years for females. Like many other cancers, the age-standardized incidence rate of lymphoma in Hong Kong has shown a consistent upward trend over the past few decades. This may be attributed to factors such as an aging population, advancements in diagnostic techniques, environmental factors, and changes in the prevalence of immune system-related diseases. The prognosis (survival rate) of lymphoma varies greatly due to its numerous subtypes, but early diagnosis remains a critical factor in determining outcomes.
Early Symptoms of Lymphoma
The most noticeable symptom of lymphoma is a painless lump in the neck, armpit, or groin (the area between the lower abdomen and thigh). In addition, lymphoma patients may experience heavy night sweats or fever, persistent itching all over the body, constant fatigue, loss of appetite, and weight loss. Since these symptoms can also occur with other conditions, seeking medical attention for further testing is essential to confirm whether lymphoma is present if any of these signs appear.
Investigating the Causes of Cancer
The human body contains an extensive network of lymphatic vessels and lymph nodes. Small lymphocytes circulate through various organs and tissues to fight infections. However, these lymphocytes can undergo malignant transformation, leading to uncontrolled division and growth, or failure to die as they age. When these abnormal lymphocytes gradually replace healthy cells, the immune system’s ability to combat infections weakens. At the same time, lymph nodes may enlarge, forming painless tumours. These painless tumours are called “lymphomas,” also known as lymphatic cancer.
Primary High-Risk Factors
The exact causes of lymphoma are still under extensive medical research. Based on various cases, the following factors may increase the risk of developing lymphoma:
Lymphoma cells typically originate in the neck, but the tumour can gradually spread to any body part, including the liver, spleen, and bone marrow. If cancer cells spread to the bone marrow and begin disrupting blood cell production, patients may experience bruising, anaemia, and frequent bacterial infections.
Comprehensive Examination
If symptoms suspected to be lymphoma appear in the body, prompt examination is necessary. Before the examination, the doctor will palpate the patient’s neck, armpits, chest, or groin to check for signs of swelling. Subsequently, preliminary tests will be conducted, with biopsy being one of the more common methods. There are two ways to obtain a biopsy: the first is called a ” Aspiration biopsy,” where the doctor inserts a needle into the tumor to remove a small piece of tissue; the second is called an “Excisional biopsy,” where the patient undergoes general or local anesthesia, and the entire lump is removed. After obtaining the biopsy sample, the doctor will examine it under a microscope to determine whether lymphoma cells are present.
If the patient is diagnosed with lymphoma, the doctor will conduct further in-depth tests to determine the extent of cancer cell spread in the body.
A blood sample is taken to check the counts of red blood cells, white blood cells, and platelets. Low blood cell counts may indicate lymphoma spreading to the bone marrow. Additionally, since lymphoma tumours can affect liver and kidney function, the doctor can assess whether lymphoma cells have affected these organs based on blood test results.
An X-ray checks whether lymphoma tumours have spread to the lymph nodes in the chest or lungs.
The tonsils and other throat parts are examined to check for swollen lymph nodes.
A gel is applied to the patient’s abdomen, and a small probe resembling a microphone, which produces sound waves, is moved over the area. The echoes collected are converted into images by a computer to reveal any abnormalities in the examined area.
This is another type of X-ray. A few hours before the scan and again in the X-ray room, the patient is asked to drink a liquid contrast agent to ensure precise imaging. A computer then takes and processes multiple images of the chest and abdomen to obtain detailed internal images.
Gallium is a weakly radioactive substance. It is injected into a vein near the swollen lymph nodes, and the scan is performed a few days after the injection.
A thin needle extracts a fluid sample from the patient’s spine, which is then sent to a laboratory to check for lymphoma cells.
In certain exceptional cases, doctors may perform additional tests for the patient:
This test aims to check whether lymphoma has spread to the abdomen or pelvis, though CT scans are gradually replacing it. The doctor first administers local anaesthesia to the patient’s feet and injects a blue dye into the skin to highlight the lymphatic vessels connected to the lymph nodes. Then, a second oil-based dye is injected into the lymphatic vessels at the top of the feet, and the flow of the dye is observed on an X-ray screen. If the lymph nodes contain lymphoma cells, they appear different in shape from normal lymph nodes.
The doctor will ask the patient to lie on their back inside a metal cylinder, where magnetic imaging is used to scan cross-sectional views of the body.
Generally, lymphoma can be divided into two main categories and four stages.
Seek Immediate Medical Consultation
The appropriate treatment approach depends on the type of lymphoma.
Hodgkin Lymphoma:
Radiation therapy is typically used if the cancer cells have not spread, and symptoms such as sweating and weight loss are absent. If the cancer has spread throughout the body or if the above symptoms are present, chemotherapy is recommended. Some patients may receive a combination of both treatments.
Non-Hodgkin Lymphoma:
Treatment may not be necessary for low-grade lymphoma, where cancer cells grow slowly, or patients may only require oral medication at home. For aggressive lymphoma, where cancer cells develop rapidly, intensive chemotherapy is needed. Other treatment options include peripheral blood stem cell transplantation and purine analogue medications.
This treatment involves intravenous injection in the arm or oral administration of special anticancer drugs. These drugs travel through the bloodstream to various parts of the body, particularly the lymphatic system, where they disrupt and destroy the growth of lymphoma cells. If the cancer cells grow slowly, patients may take oral medication at home or require a short hospital stay for intravenous injections. For rapidly growing cancer cells, a combination of multiple drugs is administered intravenously over several consecutive days, followed by a break of a few weeks to allow the body to recover from side effects. This treatment typically involves weekly intravenous injections and may last three to four months, during which patients must undergo regular check-ups.
Some patients may require higher doses of chemotherapy. After local or general anaesthesia, a plastic catheter is inserted into a vein in the chest to control drug delivery and avoid the pain of repeated injections.
While the drugs target cancer cells during chemotherapy, they also temporarily reduce the number of healthy blood cells, making patients more susceptible to infections, fatigue, bruising, and bleeding. Other possible side effects include nausea, mouth sores, hair loss, and weight loss. Certain drugs used to treat non-Hodgkin lymphoma may even cause infertility.
This treatment uses high-energy rays to destroy cancer cells and prevent their division when lymphoma appears in one or two lymph nodes. The doctor marks the patient’s skin to indicate the areas requiring radiation. The patient lies on a simulator to take X-rays of the treatment area. The course typically lasts five days, depending on the type and size of the lymphoma.
If the patient receives radiation therapy to the neck, they may experience mouth pain or altered taste. Other possible side effects include nausea, vomiting, fatigue, and hair loss in the treated area. However, radiation therapy does not leave the patient radioactive, posing no danger to others.
This newer treatment method involves a group of antimetabolic chemical drugs that prevent lymphoma cell formation and repair the patient’s DNA. It can be administered intravenously or subcutaneously.
Similar to chemotherapy, patients may experience fatigue, nausea, and increased susceptibility to infections, including shingles, after treatment with purine analogues.
If the treatments above are ineffective against lymphoma or if the lymphoma recurs after treatment, this therapy may be necessary. High-dose chemotherapy destroys the bone marrow, but transplanting stem cells from the blood or bone marrow can help restore normal blood cell levels. Doctors may use the patient’s stem cells or stem cells from a donor.
Suppose the patient is eligible for stem cell transplantation. In that case, the doctor will administer a special protein growth factor to stimulate rapid stem cell production and release from the bone marrow into the bloodstream. Once the stem cell count reaches a certain level, collection can begin, taking approximately 3 to 4 hours. After sufficient stem cells are accumulated, blood is drawn from a vein in the arm and transferred to a cell separator to isolate the stem cells from other blood components. Once collection is complete, the remaining blood is returned to the body through a vein in the other arm, while the stem cells are frozen. After high-dose chemotherapy, the stem cells are thawed and injected into the bloodstream.
The side effects of this treatment are similar to those of chemotherapy, including fatigue, bleeding, bruising, and nausea, which can be managed with medication.
Follow-Up Treatment
After treatment, patients must undergo regular check-ups, with the frequency decreasing over time. In daily life, patients should maintain a balanced diet, moderate exercise, and get sufficient rest, while also paying attention to personal hygiene. Additionally, patients should minimise visits to crowded public places to avoid further bacterial or viral infections. If any unusual symptoms or new signs appear, they should seek medical attention promptly to check for possible lymphoma recurrence.
*Sources:
Cancer Online Resource Hub
▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.
Our centre operates from Monday to Friday, 09:00 AM to 5:30 PM, and Saturday, 09:00 AM to 1:00 PM. For appointments or to speak with our staff, please call +852 3598 9090.
Should you need to contact us outside business hours, kindly leave a message, and we’ll get back to you as soon as possible.