Y Magazine

Early detection

Oman is making significant strides in lymphoma detection, says Dr Fauzia Wasim, a haematologist at Sultan Qaboos University Hospital, however, early detection is always the best way to leading a normal healthy life. 



Globally, the number of people living with cancer has increased. The number of cancer patients in Oman has also steadily risen over the past decade. The latest report from the National Oncology Centre and the Ministry of Health (MOH), called Cancer Incidence in Oman 2012, has revealed that 1,314 cancer cases were registered in 2012. The most common cancers are breast, leukaemia, lymphomas, stomach, thyroid, prostate, colorectal, skin and liver, in order of prevalence.

Lymphoma is a cancer of the blood cells called lymphocytes. Lymphocytes have an important function in the body as part of the immune system, and serve to fight certain types of infections. However, sometimes, the lymphocytes may be transformed into cancer cells. There are two main types of lymphoma; Hodgkin Lymphoma (HL) and non-Hodgkin Lymphoma (NHL). NHL is more common. In the 15-34 age group, non-Hodgkin lymphoma accounted for the most frequent type of cancer in men (18 per cent). According to the World Health Organization, (Cancer Country Profiles, 2014) lymphoma contributed to 10-12 per cent of deaths related to cancer. Even if lymphoma were widespread, its cure could be achieved in a significant number of people.

Accurate diagnosis of the sub-type of lymphoma is essential for appropriate and specific treatment. Enlargement of the lymph glands – especially in the neck, armpit and the groin, without an obvious reason – and persisting for more than two to four weeks, should prompt the person to seek medical advice. Additionally, some people may develop fever, loss of weight and drenching sweats. It is important to keep in mind that not all swollen glands turn out to be lymphoma.

The exact cause of most forms of lymphoma remains unknown. At this time, there are no widely recommended screening tests for this cancer. The best way to find this cancer early is to be mindful of  the signs and symptoms of this disease. Careful, regular medical check-ups are important for people with known risk factors such as viruses, including human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), human T-lymphotropic virus (HTLV) and the bacterium Helicobacter pylori, organ transplants receiving medicines used to suppress the immune system, autoimmune disease, or prior cancer treatment. Not everyone with risk factors get lymphoma.

The gold standard for diagnosis of lymphoma is a biopsy of the enlarged lymph node, or suspected organ. Once the diagnosis is established, certain other scans are undertaken to establish the extent of the disease in the body. These tests are called staging investigations, and these include blood tests, CT scan, occasionally MRI scan, and now more commonly, a PET scan, which is readily available at Sultan Qaboos University Hospital. PET/CT is a big step forward in Oman and has been assigned a central imaging role in Hodgkin lymphoma. This technology has been demonstrated to be more sensitive and specific than either gallium scintigraphy or computerised tomography (CT).

More cases are coming to light and the probable reasons include better diagnostic facilities, increased awareness and better treatment facilities.The relatively recent integration of PET/CT into routine oncologic imaging has further improved baseline staging and facilitated functional evaluation of disease behaviour, metabolic response to therapy, earlier detection of disease recurrence, assessment of transformation, and, more recently, as a surrogate marker in new drug development. The most effective use of PET/CT requires multidisciplinary collaboration between a radiologist, a haematologist, clinical and a radiation oncologist. Recent attempts to standardise PET in clinical trials and the incorporation of this technology into adopted response criteria will hopefully lead to an improved outcome for patients with lymphoma.