Lymph Node Cancer

Cancers that present in the lymph nodes could have started in the lymph nodes or could have been spread from other parts of the body.

Metastasis

Cancer cells can break away from the primary site and travel through the bloodstream to reach distant organs. Similarly, the cancer cells may also gain access to the lymphatic system to circulate and reach other organs. As they travel through the lymphatic system, they may deposit in the lymph nodes. Most cancer cells are killed or destroyed before they reach other parts of the body, but if one or two cancer cells are able to evade the body’s immune system, they can settle in a new area and begin to grow and replicate.

Metastasis mostly affects lymph nodes that are near the tumour itself.

Lymphomas – primary cancers of the lymph nodes

Lymphomas begin when the white blood cells (lymphocytes) develop genetic mutations. The mutations cause the cell to multiply in an uncontrolled rate. Mutations also allow the abnormal cells to escape death, causing the proliferation and collection of diseased white blood cells in the lymph nodes and other organs, forming tumours.

Besides the lymph nodes and vessels, the lymphatic system includes other organs such as the thymus, spleen and bone marrow. Lymphomas can also affect these organs, and also other organs throughout the body.

Lymphomas are the third most common cancer among young adults and children in Singapore. Early detection and diagnosis is important to increase the chances of cure.

The most common types of lymphomas are:

• Hodgkin’s Lymphoma
  • More common in young adults aged between 15 to 30 years
  • Includes classical Hodgkin’s Lymphoma (more common) as well as nodular lymphocyte-predominant Hodgkin’s lymphoma
• Non-Hodgkin’s Lymphoma
  • More common in older people and more common than Hodgkin’s Lymphoma
  • Includes diffuse large B-cell lymphoma and follicular lymphoma

Lymphomas are also associated with reduced immunity, due to increasing age or other causes. Such causes include reduced immunity from birth, immunosuppressant drugs or infection by HIV. Treatment and prognosis depends on the type of lymphoma a patient has.

Symptoms that patients may experience depends on whether the cancer of the lymph node is due to metastasis or if it is a primary lymph node cancer.

A common symptom of cancers in the lymph nodes include swollen lymph nodes. This presents as painless lumps that persist over time, and may increase in size. The rate of growth also depends on the type of lymphoma. The type of symptoms that present also depend on the rate of growth; slow-growing lymphomas tend to cause fewer symptoms while fast-growing tumours are more aggressive, causing more severe symptoms. However, other conditions besides cancer could also cause enlarged lymph nodes.

Common symptoms include:

• Swollen lymph nodes in the neck, underarm or groin
• Persistent fever and chills
• Fatigue and weakness
• Night sweats
• Loss of weight and appetite
• Shortness of breath
• Chest pain, or pain in the abdomen or bones for unknown reasons
• Enlarged liver or spleen

• Age – different lymphomas associated with different age groups
• Male – have a slightly higher chance of developing lymphoma in comparison to females
• Impaired immune system – due to immunosuppressive drugs, infections such as HIV or congenital conditions
• Development of certain infections – such as Epstein-Barr virus and Helicobacter pylori infe

Your doctor may perform a physical examination to look for swollen lymph nodes, especially in the neck, underarms and groin. If there are few cancer cells in the node, the doctor will have to use special tests to find them. If there are a lot of cancer cells in the node, a large mass may be seen easily.

A blood test would help to check the white blood cell count. It would also help to identify any abnormalities in the levels of enzymes in the blood. For example, raised amounts of an enzyme called lactate dehydrogenase is a marker for lymphoma.

The lymph node may be removed for testing. This is known as a biopsy, where a small amount of tissue is extracted in order to test for cancer cells. This will also help your doctor to identify the subtype of lymphoma which will affect the treatment plan.

If your doctor suspects that the lymphoma may have affected the bone marrow, a bone marrow aspiration and biopsy using a needle may be recommended to confirm this.

X-rays, computerised tomography (CT) or magnetic resonance imaging scans (MRI) also help to identify enlarged lymph nodes that are difficult to find with physical examination alone, especially if the symptoms are persistent.

Treatment is dependent on the type of cancer in the lymph nodes, the spread and stage of the disease, and also on the overall health of the patient.

Some lymphomas are slow growing. If this is the case, your doctor may advise you to wait and monitor the condition through periodic tests.

Treatment is multidisciplinary, personalised and precise and there are a variety of treatment options available. These may include the following, and possibly in combination:

• Surgery
• Radiation therapy
• Chemotherapy
• Bone marrow transplant
• Immunotherapy

Treatment for lymph node metastases is based on the original organ type where the cancer came from. Lymphomas are usually treated with chemotherapy or radiotherapy, and often in combination.

Once the diagnosis is made the consultation with an oncologist is essential in order to understand which treatment options are the most suitable.