Battling lymphoma: Getting the right treatment and support

Parkway Cancer Centre’s Dr Colin Phipps explains this type of blood cancer and the treatment options available

Lymphoma is more common in those aged 50 and above, with fatigue and night sweats being common symptoms. PHOTO: GETTY IMAGES PHOTO: GETTY IMAGES

Not all cancer symptoms carry noticeable red flags. In the case of lymphoma, a type of blood cancer that affects the lymphatic system and weakens the immunity, the signs can sometimes be easily overlooked. 

With global cancer organisations marking World Lymphoma Awareness Day tomorrow, learn more about one of the top 10 cancers in Singapore, according to the Singapore Cancer Registry. Dr Colin Phipps Diong, a senior consultant in Haematology at Parkway Cancer Centre, answers key questions about the disease and the treatment options that continue to make advancements for more positive outcomes. 

Q: What is lymphoma? 

The lymphatic system consists of networks of lymph nodes and vessels that help the body’s immune system to function. When the cells of this lymphatic system become cancerous, it is called lymphoma.

Poor appetite, unexplained weight loss and painless lumps in the neck and groin are some common symptoms of lymphoma. PHOTO: GETTY IMAGES

Lymphoma tends to present mostly in patients aged 50 years and above. It has over 60 sub-types which are broadly categorised into Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL). The former is less common and mostly affects people between 15 and 30 years old, as well as between 65 and 80 years old. 

NHL can be classified into three groups: B-cell, T-cell and NK-cell. B-cell NHL is the most common. 

The survival rate depends on the type of lymphoma. For instance, younger patients with HL have a survival rate of 80 per cent and above, compared to patients with B-cell NHL (60 per cent survival rate) or T-cell NHL (40 per cent survival rate).

Q: What are the signs of lymphoma and when should you see a doctor?  

Prolonged fever, fatigue, unexplained weight loss, poor appetite, heavy night sweats that cause one’s clothes or even bedsheets to be drenched, and painless lumps due to swollen lymph nodes in the neck, underarm or groin areas, are some of the common symptoms.

See a doctor early if you suspect you have symptoms of lymphoma. PHOTO: GETTY IMAGES

Always seek a doctor’s advice if you worry about having developed any of these symptoms. This is especially so if you suffer from certain chronic infections, are immunocompromised, are taking medicines that suppress the immune system, or have previously undergone an organ transplant. 

Q: What are the top three concerns of patients after being diagnosed with lymphoma?

It is common for patients with lymphoma to have advanced stage disease when they first present. It is important to know that advanced stage lymphoma can still be cured. What advanced stage means in terms of prognosis is different in lymphomas compared to other types of cancer.

How and why patients get lymphoma, and whether it is hereditary, are also top of their minds. It is important to quell unnecessary fears and understand that although the cause of lymphoma in most cases is unknown, the right treatment can lead to good outcomes. 

The right treatment can lead to good outcomes, with most patients able to return to their usual activities. PHOTO: GETTY IMAGES

Drastic lifestyle changes after treatment are a concern too. But most patients, regardless of age, recover well enough to be able to return to their usual activities. 

Q: What are the treatment options available?

A doctor will be able to determine the appropriate treatment, in consultation with the patient.

Most lymphoma cases are treated with a combination of chemotherapy and a form of targeted therapy like immunotherapy. This modal of treatment is tolerable to most patients, even the older ones. 

Immunotherapy makes use of the patient’s own immune system or medications made from components of the immune system, to fight the disease. It is rare to depend on immunotherapy as the only form of treatment in lymphoma.

Chemotherapy is usually used in combination with other targeted therapy to treat lymphoma. PHOTO: GETTY IMAGES

Radiotherapy uses high-energy rays to shrink tumours but it is usually also not the main treatment for lymphoma nor considered as the first line of treatment. It is used in cases where more treatment is needed after chemotherapy or in patients who suffer a relapse of the disease. 

Stem cell transplantation helps in the growth of new blood cells after the patient with recurrent lymphoma receives high doses of chemotherapy – with or without radiotherapy – that kill healthy and unhealthy blood cells in the bone marrow. It is also not the first line of treatment of lymphoma.  

A recent treatment option is Chimeric Antigen Receptor (CAR) T-cell Therapy, which is a form of targeted therapy. It modifies immune T-cells taken from the patient to identify and kill specific cancer cells. However, it should only be considered in later lines of treatment after standard treatments have failed.

Q. Besides medical support, what other kinds of support do patients and their caregivers need?

A dietician’s support will be beneficial during the treatment phase because patients may suffer poor appetite and weight loss during chemotherapy. So the patients and their caregivers will want to know how to improve appetite, prepare suitable food, supplement meals, and more. 

Getting a dietician involved will help patients eat healthy, suitable food and combat weight loss during treatment. PHOTO: GETTY IMAGES

Self-care to maintain mental well-being is important too, especially during the initial months of treatment. Being psychologically strong to go through the first or second cycle of treatment will make the rest of the treatment journey easier to manage. 


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