Causes of death among people living with metastatic cancer

Tests To Diagnose Non-Hodgkin Lymphoma

You usually have a number of tests to diagnose non-Hodgkin lymphoma (NHL). If you have NHL, these test results help your doctors find out what type and stage of NHL you have. They also help them decide what treatment you need. The tests include: Tests your GP might do Most people with symptoms start by seeing their GP. Your GP might do some tests to help them decide if you need to see a specialist. These tests include: blood tests a physical examination Depending on the results of your examination and blood tests, your GP may also arrange for you to have other tests. For example, an x-ray or ultrasound scan. You usually have these tests at your local hospital.  Blood tests Blood tests can check your general health including: Physical examination Your doctor usually asks you to lie or sit down. They look at and feel your skin and check for any abnormalities or areas that are swollen. Things they look for include signs of bleeding, bruising and infection. They may also listen to your chest and tummy (abdomen) to find out if they sound normal. You can ask for someone else to be in the room with you if you want, to act as a chaperone. A chaperone is a trained healthcare professional such as a nurse. A friend or relative can also stay with you for support. They can be with you during the examination.  Tests your specialist might do Depending on your symptoms and the results of your blood tests, your GP might arrange for you to go to the hospital.  The specialist you see at the hospital is called a haematologist. This is a doctor who specialises in diseases of the blood such as lymphoma. Your specialist usually repeats the blood tests done by your GP. You also have more tests. These might include: Testing your lymph nodes The most common symptom of NHL is one or more swollen lymph nodes. The main test to diagnose NHL is a lymph node biopsy. A doctor removes part or all of the swollen lymph node. They send it to the laboratory for a specialist to look at it under a microscope. How you have a lymph node biopsy This depends on where the swollen lymph node is. You often have a local anaesthetic which means you are awake. But you might have a general anaesthetic if the lymph node is deeper inside your body. This means that you are asleep and do not feel anything.   The doctor might use a CT scan or ultrasound scan to guide them to the exact place to take the biopsy from. So you might hear this test called an ultrasound guided biopsy or a CT guided biopsy. Your doctor might take a sample of tissue from the lymph node using a needle. This is called a needle biopsy or a core biopsy. You usually have this under local anaesthetic in the radiology department. Or your doctor might remove a whole lymph node. This is called an excisional biopsy. You have the biopsy under local or general anaesthetic. It is a small operation that most people have as a day case. Your doctor might also need to take biopsies from other parts of your body. This depends on where the suspected lymphoma is. They might do: Scans You usually have some scans to find out where the lymphoma is in your body. PET-CT scan A PET-CT scan combines a CT scan and a PET scan. PET stands for positron emission tomography. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal. The CT scan takes a series of x-rays from all around your body. The computer puts them together to create a 3 dimensional (3D) picture. PET-CT scans can be useful for some types of NHL. Your doctor will tell you if you need this type of scan. The scan can show: where the lymphoma is in your body (the stage) how well treatment is working PET scans can show if tissues are actively growing, like cancer. Or if the tissue is an old injury or scar. After treatment, they can show if swollen lymph nodes are scar tissue or lymphoma that has not responded to treatment. CT scan A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. You might have a CT scan of your chest, tummy (abdomen) or pelvis. The scan shows up any lymph nodes affected by NHL. MRI scan MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to create pictures of the inside of body.  MRI scans can sometimes show up soft tissue more clearly than CT scans. It might give a clearer idea of where the lymphoma is in your body. Your doctor might arrange an MRI scan to look at certain parts of your body, such as your spine or brain. Ultrasound scan You might have an ultrasound to look for changes in your lymph nodes, liver or spleen.  An ultrasound scan uses high frequency sound waves to create a picture of a part of the inside of your body. The ultrasound scanner has a probe that gives off sound waves. The probe looks a bit like a microphone. The sound waves bounce off the organs inside your body, and the probe picks them up. The probe links to a computer that turns the sound waves into a picture on the screen. Bone marrow test You may have this test to check whether there are lymphoma cells in your bone marrow.  You usually have this test under local anaesthetic. This means that you are awake but the area is numb. During a bone marrow biopsy, your doctor or specialist nurse uses a needle to take a sample of bone marrow. They may use a second needle to take out a piece of more solid bone marrow tissue. They usually take these samples from the back of your hip bone. Lumbar puncture A lumbar puncture is a test to check if lymphoma cells have spread to the fluid circulating around the brain and spinal cord. The fluid is called cerebrospinal fluid (CSF). You might have a lumbar puncture for certain types of lymphoma that have a higher risk of spreading into the CSF. Or if you have symptoms that suggest the lymphoma might be affecting your brain.  You normally have this test in the outpatient department. You have it under local anaesthetic, so you will be awake but the area is numb. Tests to check for infection NHL and its treatment can weaken your immune system.  You'll have blood tests to check if you have had or have specific viruses before you start treatment. Some viruses can be linked to NHL. And there is a risk that some viral infections can flare up during treatment. Infections that your doctor might test for include: human immunodeficiency virus (HIV) hepatitis B virus (HBV) hepatitis C virus (HCV) cytomegalovirus (CMV) Epstein Barr virus (EBV) You might have tests for other types of infections if you have certain types of NHL. For example they will test you for an infection called helicobacter pylori (H. Pylori) if you have a gastric MALT lymphoma. Other tests you may have You may have other tests before starting treatment. These include tests to check your heart. This is because some chemotherapy drugs can affect the muscles of the heart. If you're going to have one of these drugs, you need to have your heart checked before you start treatment.  Electrocardiogram (ECG) You might have a recording of the electrical activity of your heart. This test is called an electrocardiogram (ECG). An ECG tells your doctor a bit more about how well your heart is working. It can help the doctor decide if you need further tests. Echocardiogram or MUGA An echocardiogram (echo) is an ultrasound of the heart. It uses high frequency waves to create a picture of your heart. Doctors can look at the structure of your heart and see how well it is working. You might have a test called a multigated acquistion (MUGA) instead. A MUGA is like an echo except you have a radioactive drug injected into your vein. A special scanner takes pictures to see the pumping action of your heart.  Treatment The tests you have help your doctor find out if you have lymphoma, what type it is, and where it is in your body. This is important because doctors use this information to recommend the best treatment for you. Coping Coping with a diagnosis of NHL can be difficult. There is help and support available for you and your family.

Treatments For Lymphoma Have Advanced Beyond Chemotherapy

Treatment for blood cancers can include chemotherapy alone or chemo in conjunction with cutting edge CAR-T therapies, immunotherapies, targeted therapy, bone marrow transplant and radiation therapy. Photo by Adobe Stock/HealthDay News

For anyone newly diagnosed with blood cancers known as lymphomas, their first question might be: What treatments can help?

Of course, there have been big advances in chemotherapy against the disease, but treatments now go beyond chemo, said Mayo Clinic expert Dr. Stephen Ansell.

"It's about improving outcomes while minimizing side effects -- using treatments that can specifically target the cancer and have less of an impact on the body's healthy, normal cells," Ansell said in a Mayo news release.

"There is a high percentage of patients whose lymphoma is cured," he added. "When people are cured, they may have to deal with long-term complications. Our idea is to have the best outcomes and minimize long-term problems."

According to the American Cancer Society, there are about 80,620 cases of the leading type of lymphoma, Non-Hodgkin lymphoma, diagnosed among Americans each year, and just over 20,000 deaths annually. The disease tends to strike men more often than women.

Nearly 8,600 cases of Hodgkin lymphoma, the second major type, are diagnosed each year, and it kills just over 900 people annually. This type of cancer typically arises in youth or young adulthood -- in fact, it's the leading cancer type diagnosed in people ages 15 to 19, the ACS said.

According to Ansell, lymphomas' typical symptoms include swollen lymph nodes, itchy skin, night sweats, fever, persistent fatigue, unexplained weight loss and shortness of breath.

As far as treatment, that can include chemotherapy alone or chemo in conjunction with treatments such as cutting edge CAR-T therapies, immunotherapies, targeted therapy, bone marrow transplant and radiation therapy.

Ansell described each of these non-chemo options:

Immunotherapy. In these approaches, drugs trigger the body's own immune system to seek and destroy the lymphoma cells. These include what are known as immune-checkpoint therapy drugs that target cancer cells while leaving healthy cells unharmed.

CAR-T therapies. CAR-T stands for "chimeric antigen receptor-T cell" therapy. In this approach, doctors first remove the patient's immune system white cells, which are then tweaked in a lab to produce specific cellular receptors than can "activate T-cells' ability to recognize and kill cancer cells" once they are re-infused into the patient.

Targeted therapies include drugs that are designed to spot and then fight abnormalities within cancer cells, leaving healthy cells unharmed.

Bone marrow transplant. In this strategy, stem cells are infused into the body and help the patient's bone marrow begin again to produce healthy blood cells.

Radiation. This utilizes high-powered energy to zap cancer cells. "For certain types of non-Hodgkin lymphoma, radiation therapy may be the only treatment you need, particularly if your lymphoma is slow-growing and located in just one or two spots," Ansell explained. "More commonly, radiation is used after chemotherapy to kill any lymphoma cells that might remain."

So far, no one has determined how to prevent lymphomas, although living healthy -- a good diet, exercise -- can help lower your odds, Ansell said.

More information

Find out more about lymphoma at the Cleveland Clinic.

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$50m Grant For Research To Find Better Ways Of Treating Lymphoma, Colorectal Cancer In S'pore

SINGAPORE - Singapore's fight against cancer has received another boost, with $50 million in national grant funding awarded to two research teams aiming to better understand, diagnose and find precise treatments for two common cancers – lymphoma and colorectal cancer.

The focus is on treating individuals with the right treatment at the right time, instead of a one-size-fits-all approach, which does not take into account variables that influence a person's cancer development and response to treatment.

One of the teams is studying Asian-centric lymphomas to find cost-effective and innovative treatments, while the other will develop new approaches to screen, detect and treat colorectal cancer. They will receive $25 million each.

This was announced on May 24 at the National Cancer Centre Singapore (NCCS), which is a key player in the two five-year research programmes.

Lymphomas are the fifth most common cancer in Singapore, with more than 5,000 new cases diagnosed between 2017 and 2021. Colorectal cancer is the most common cancer affecting both men and women, with 12,239 new cases diagnosed in that period.

The lymphoma research, which comes under the Symphony 2.0 (Singapore Lymphoma Translational Study 2.0) research programme, is a continuation of a decade's worth of work by the same group.

Lymphoma develops when white blood cells, called lymphocytes, grow out of control. It is not a single disease.

"There are more than 80 types of lymphoma, and because of this, it results in difficulties in making a diagnosis and also treatment. In addition to that... Certain types of lymphomas predominate in the West while certain types of lymphomas predominate in the East," said the lead principal investigator of Symphony 2.0, Professor Lim Soon Thye, who is also the chief executive of NCCS.

For instance, in Asia, 15 per cent to 20 per cent of all lymphomas are classified as Natural Killer/T-cell lymphoma, or NKTCL, compared with 5 per cent to 10 per cent in Western countries. The survival rates for this aggressive lymphoma are poor as it remains less studied, is poorly understood, and has limited treatment options.

Symphony 2.0 will build on its work "to address unmet needs in Asian-centric lymphomas and improve patient outcomes", said the team. Its key projects include establishing a Lymphoma Atlas centralising patient data for research, and determining effective drug combinations for lymphoma patients in clinical trials using artificial intelligence (AI).

For colorectal cancer, which kills around 80 patients a month, the research team hopes to come up with more non-invasive screening tests and find better ways of detecting and treating the cancer.

Dr Goh Hak Su, who in 1989 established the department of colorectal surgery at the Singapore General Hospital, the first of its kind in Singapore and the region, said that cases of colorectal cancer have increased over the years, and too few people go for screening and follow through with it.

Screening methods include a test to detect blood in the stools and colonoscopy, a procedure that uses a long, flexible tube to look inside the colon. Colonoscopy is the most effective method, as pre-cancerous polyps that are found during a screening can be removed. But the procedure has to be done under sedation, and comes with a much higher cost.

Hence, one of the research programme's goals is to come up with new non-invasive blood and stool tests and new AI-enabled endoscopy methods to complement current screening methods, said Associate Professor Iain Tan, a senior consultant at NCCS and the Goh Hak Su Professor in colorectal surgery.

"Can we detect them early enough, not just with colonoscopy alone, but perhaps with stool tests and blood tests?"

Prof Tan, who is the clinical chair and corresponding principal investigator of the Colo-Script research programme, said they chose the name because every single cancer has a beginning, and there is a script for the cancer as it begins and develops.

"As we understand this script, we will be able to have subtype-specific research that will allow us to understand how cancers behave, how to diagnose them and how to treat them," he said.

Colorectal cancer is now treated largely as one disease, though there are two major subtypes. Patients with high-risk polyps are more likely to progress to advanced-stage disease, for which the cure rate is less than 10 per cent, he said.

However, patients may be diagnosed late because they did not undergo screening, or because their type of flat polyps may have been missed during a scope.

The two research programmes involve multiple institutions, including the Agency for Science, Technology and Research, National University Hospital, and Singapore General Hospital.

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