Lymphoma is a type of blood cancer that originates from lymphocytes. Lymphocytes are a type of white blood cells which circulate in the lymphatic system and fight infections. Lymphoma has become more common in Hong Kong and there are nearly than 1000 new cases each year.
What is Lymphoma?
Lymphoma occurs when lymphocytes develop a malignant genetic mutation i.e. they change and grow uncontrollably, affecting the normal functioning of the immune system. Lymphoma cells also have the ability to enter the bloodstream, so that the cancer cells would travel to a new site to form a tumor.
There are two main types: non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). These two types can be further divided into many subtypes.
- Non-Hodgkin lymphoma is more common than Hodgkin lymphoma. The ratio is around 9:1 in Hong Kong.
- Non-Hodgkin lymphoma is more prevalent in the elderly, while Hodgkin lymphoma is more commonly seen in people aged 15 – 30 years and above 50 years.
- Non-Hodgkin lymphoma is more fatal. It is also one of the ten most common cancers.
Signs and Symptoms of Lymphoma
General symptoms are :
- Painless swelling of lymph nodes in your neck, armpits or groin
- Persistent fatigue
- Night Sweats
- Shortness of breath
- Unexplained weight loss
Specific symptoms include:
- Non-Hodgkin lymphoma: abdominal pain or swelling, chest pain, coughing or trouble breathing.
2. Hodgkin lymphoma: severe itching, increased sensitivity to the effects of alcohol or pain in your lymph nodes after drinking alcohol.
What are Lymph Nodes?
Lymph nodes are one of the components of our lymphatic system. The lymphatic system is part of our immune system. The role of lymph nodes is to filter out fluid and substances such as wastes and bacteria. Immune cells (lymphocytes) can also be found in lymph nodes to fight infection.
Causes of Lymphoma
The exact causes remain unknown. However, several factors can increase risks. They include:
- Age: Most diagnoses of lymphoma are in people aged above 55.
- Gender: Males are more likely to get lymphoma compared to female (in Hong Kong in 2016, the male to female ratio was 1.5:1).
- Having a weak immune system: Lymphoma is more common in people who have an immune system disease or people who take drugs that can suppress their immune system such as corticosteroids.
- Having certain infections: Infections such as those caused by Epstein-Barr virus, Human Immunodeficiency virus and Helicobacter pylori infections increase the chance of having lymphoma.
- Family history: People who inherit genetic changes in their immune system have a higher chance of getting lymphoma.
Diagnosis of Lymphoma
Doctors would usually diagnose it by:
- Physical Exam: Doctors would check for swollen lymph nodes in your body.
- Blood tests: A blood sample would be taken and doctors would use it to count the number of cells for further diagnosis.
- Taking a sample of a lymph node: A part of the lymph node might be removed for laboratory testing.
- Taking a sample of bone marrow: Bone marrow aspiration, a procedure to remove a small sample of bone marrow, might be performed to look for cancer cells.
- Imaging tests: Imaging tests such as MRI, CT or PET scan might be used to look for signs of lymphoma in other areas of the body.
Stages of Lymphoma
There are four stages of lymphoma:
- Stage 1: In this stage, it is present in only one group of lymph nodes.
- Stage 2: In this stage, there is lymphoma in two or more groups of lymph nodes, on the same side of the diaphragm.
- Stage 3: In this stage, there are lymphoma on both sides of the diaphragm.
- Stage 4: In this stage, it has already spread to at least one body organ outside the lymphatic system (e.g. lungs, liver).
How to treat Lymphoma?
Generally speaking, it is a highly treatable type of blood cancer. With the right treatments, 80-90% of early stages of Hodgkin lymphoma can be cured (dropping to 60-70% for late stages). For non-Hodgkin lymphoma, around 70% of patients with early stages can be cured (30-50% for late stages). For patients who do not respond to chemotherapy, stem cell transplants may save lives of up to 50% of them.
There are several treatment options, although the choice of treatment depends greatly on the type of lymphoma.
The most common treatments are:
- Chemotherapy: Using drugs to destroy fast growing cancer cells.
- Drug therapy: Some drugs can be used in combination with chemotherapy, for example rituximab which is an immunotherapy drug used to enhance immune response.
- Radiation therapy: Radiation therapy uses high energy radiation such as x-ray to kill the cancer cells. It is usually used as an adjunctive therapy.
If these treatments do not show any effect, a stem cell transplant might be necessary.
What is the cost of Lymphoma Treatment in Hong Kong?
Cost of Lymphoma Treatment in Hong Kong’s Public Sector:
For eligible persons with a HKID card, the cost for inpatient service is $75 admission fee and $120 per day. Extra medications or other injections needed are not included. For day procedure and treatment at Clinical Oncology Clinics, the cost is $96 per attendance.
For non-eligible persons without a HKID card, the cost for inpatient general hospital is $5,100 per day. For day procedure and treatment at Clinical Oncology Clinics, the cost is $895 per attendance.
Beware of waiting times which can be very long in the public sector.
For details, call the Hospital Authority at 2300 6555.
Cost of Lymphoma Treatment in Hong Kong’s Private Sector:
The cost of in the private sector would be determined according to the condition of the patient. Consultation in private sector ranges from $800 to $2500 and chemotherapy costs range from $150,000 to $500,000. Fees for radiation therapy can reach up to $50,000 – 100,000 but it depends highly on the number of doses assigned by your doctor.
* All amounts are in HKD and were last updated in July 2019. No responsibility is accepted for any inaccuracies, errors, or omissions. It is always best to call ahead to make sure the information is still up-to-date.
Does insurance usually cover the cost of treatment in Hong Kong?
According to AD MediLink, surgery is usually reimbursed under hospital/surgical benefits whereas chemotherapy/radiation therapies are usually reimbursed under cancer cover. Generally, high-end medical plans will reimburse cancer treatments in full without any sub-limit whereas local plans will have sub-limits. If you have questions, contact an expert at [email protected].
Useful Resources in Hong Kong
This article was medically reviewed by Dr. Herman Liu on July 11, 2019. Dr. Herman Liu was a graduate from the University of Hong Kong in 1992. He has been practising haematology and haematological oncology for 20 years. He was a consultant in haematology before he left the public service sector in 2016. His clinic in Central provides a series of haematological consultation, diagnosis and treatment.