Treating thyroid lymphoma

Q I was recently diagnosed with thyroid lymphoma resulting from Hashimoto's thyroiditis.

Is there a genetic risk of passing it on to my daughter?

What are the possible side effects of the treatment?

I am still working and my daughter is still young. I want to stay active.

A Lymphoma is a cancer that begins in white blood cells called lymphocytes, which are part of the body's immune system.

Lymphocytes are found mostly in lymphoid organs such as the lymph nodes, bone marrow, tonsils and spleen.

Lymphoma tends to arise in these areas, but it can also occur, though less commonly, in other organs such as the thyroid gland.

It is the fifth-most-common cancer in men and sixth-most-common cancer in women, according to the Singapore Cancer Registry 2010-14.

However, thyroid lymphomas are not common and account for only 1 to 2 per cent of all lymphomas.

While the exact cause of lymphoma is not known, there are certain known risk factors.

Patients with Hashimoto's thyroiditis, a type of autoimmune disease, have a much higher risk of developing thyroid lymphoma - at least 60 times higher - than for those without Hashimoto's thyroiditis.

Lymphoma is not contagious, and it is mostly not passed down from generation to generation.

The most common symptom of thyroid lymphoma is a rapidly enlarging thyroid mass. If the thyroid mass is large enough, it could even cause compressive symptoms such as hoarseness of voice or difficulties in swallowing and breathing.

The two most common types of thyroid lymphoma are diffuse large B-cell lymphoma (DLBCL) and extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT).

DLBCL of the thyroid is an aggressive lymphoma but, with appropriate treatment, it is highly curable. MALT lymphoma of the thyroid is a slow-growing type of lymphoma and offers a good prognosis.

The type of thyroid lymphoma can be determined by means of a needle biopsy.

However, this might not always be possible, hence a small number of patients would require thyroid surgery in order to ascertain the diagnosis.

Chemotherapy would be the treatment of choice for patients with DLBCL, while local therapy such as surgery or radiotherapy alone would be the preferred modality of treatment for patients with MALT lymphoma.

For patients requiring chemotherapy, most regimens these days are carried out in an outpatient setting.

The drugs are infused into the body through a vein over the course of a few hours.

You would need to return to the clinic every three weeks for treatment over six months.

There are now many more medications available to better manage and control the side effects of chemotherapy than in the past.

The main side effects from drugs used to treat thyroid lymphoma include nausea, vomiting, fatigue, hair loss or thinning, a sore mouth or mouth ulcers, taste changes, loss of appetite, changes in bowel habits and a drop in blood cell count.

Most of the side effects will gradually resolve over a few months upon completion of the treatment.

In general, younger patients tend to tolerate chemotherapy better, and some are able to continue working on a part-time basis or with flexible work hours.

While you are on chemotherapy, your immune system will be compromised.

It is important to adopt good hygiene practices such as frequent hand-washing, staying away from overcrowded places and avoiding raw food.

Ensure that meals are properly cooked and freshly prepared. It is also beneficial to maintain a healthy and well-balanced lifestyle. Eat healthily, reduce consumption of sugary foods and drinks, and cut out processed foods from the diet.

Dr Kevin Tay

Consultant and medical oncologist at Mt Alvernia Hospital

This article was first published on February 23, 2016.
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