Non-hodgkin's%20lymphoma Signs and Symptoms

Signs and Symptoms

Introduction

The most common hematologic cancer
B-cell non-Hodgkin's lymphoma (NHL) are 80-85% more common than T-cell/natural killer (NK) cell NHLs (15-20%)
Advances in molecular genetics allowed better understanding of the pathophysiology and further identification of the different subtypes of NHL
NHL subtypes are based on the malignant cell's morphology; genetic features, immunohistological characteristics and stage of maturation

Definition

A heterogenous group of lymphoproliferative malignancies formed by either B-cells or T-cell/NK cells

Etiology

Causes of Non-Hodgkin's Lymphoma (NHL)

Genetic aberrations and lesions
- p53 tumor suppressor gene deletions/alterations [eg Burkitt lymphoma (BL), follicular lymphoma (FL), mantle cell lymphoma (MCL)]
- Chromosomal deletions (eg chromosome 6q, chromosome 13q14)
- Chromosomal translocations (eg FL - t[14;18][q32;q21], MCL - t[11;14][q13;q32])

Oncogenic viruses (eg Epstein-Barr virus, Human T-cell lymphotropic virus I, Human Herpes virus-8)

Signs and Symptoms

Clinical Evaluation

Assess patient’s performance status based on the clinical presentation
Systemic B-cell symptoms
- Present in aggressive types of NHLs
- Fever
- Night sweats
- Weight loss

Indolent types of NHL
- Splenomegaly
- Hepatomegaly
- Lymphadenopathy
- Cytopenia

Nonspecific signs and symptoms
- Skin rash
- Generalized fatigue
- Fever of unknown origin
- Pleural effusion
- Pruritus
- Malaise
- Ascites

Lymphoma with gastrointestinal tract involvement
- Anorexia
- Weight loss
- Bloatedness
- Pallor
- Nausea/vomiting
- Abdominal pain
- Early satiety
- Intestinal bleeding

Lymphoma with central nervous system involvement
- Headache
- Blurred vision
- Paralysis
- Dizziness
- Seizures
- Focal neurologic symptoms

Adult T-cell leukemia/lymphoma
- Lymphadenopathy
- Fatigue
- Anorexia
- Splenomegaly
- CNS involvement
- Pulmonary complications
- Skin eruptions
- Abdominal pain
- Hepatomegaly
- Bone marrow involvement

Burkitt lymphoma
- Bone marrow (70%) involvement
- Leptomeningeal CNS involvement (40%)

Extranodal NK/T-cell lymphomas (ENKL), nasal type
- Nasal obstruction
- Nasal bleeding secondary to mass lesion
- Elevated lactate dehydrogenase (LDH) levels

Risk Factors

Acquired immunosuppression (previous organ/bone marrow/stem cell transplant, HIV, AIDS)
Congenital immunodeficiency syndromes
Old age
Positive family history of NHL
Positive medical history of Hodgkin lymphoma
Chemical exposures [pesticides, wood dust, epoxy glue, organic solvents, medication (eg Methotrexate, TNF-α inhibitors)]
Radiation exposure

The changing treatment landscape for premenopausal women with advanced breast cancer: Focus on ribociclib

Dr. Wong Seng Weng, Dr. Lee Guek Eng, 19 Mar 2021

In Singapore, advanced breast cancer (aBC) is the leading cause of cancer death in women 30–49 years of age. For premenopausal women diagnosed with hormone receptor (HR)-positive, HER2-negative BC, cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors provide new hope. Currently, ribociclib is the only CDK4/6 inhibitor studied in the first-line setting for premenopausal women with HR+/HER2- aBC, in the phase III MONALEESA-7 trial. Two experts, Dr Wong Seng Weng, Medical Director & Consultant Medical Oncologist at The Cancer Centre, Paragon Medical & Mount Elizabeth Novena Specialist Centre, and Dr Lee Guek Eng, Senior Consultant & Specialist in Medical Oncology at Icon Cancer Centre and Program Director of the Young Women Cancer Program, weigh in with their views on managing premenopausal women with aBC.

ALL treatment: Current settings, future goals

Roshini Claire Anthony, 08 Jan 2021

Significant advancements in the treatment of acute lymphocytic leukaemia (ALL) in children have improved their outcomes. However, ALL treatment and eradication remain a major challenge in adults. In a recent webinar, two specialists from the US discussed current ALL treatment strategies and goals of future regimens.

Highlights from ESMO Asia 2017: Moving to a dual blockade strategy early in hormone receptor-positive breast cancer

22 Jan 2018

In a symposium chaired by Dr Yoon-Sim Yap of the National Cancer Centre Singapore, renowned regional and international experts in the field of breast cancer, Dr Yen-Shen Lu from Taiwan and Professor Nadia Harbeck from Germany, joined her in providing insights on the current treatment landscape of hormone receptor-positive (HR+) advanced breast cancer. In their respective sessions, they each highlighted new therapeutic options including the optimal use of dual blockade therapy for oestrogenreceptor-positive (ER+) advanced breast cancer for patients in Asia.