IT’S NOT ‘HEATINESS’: Dr Kevin Tay (right) with patient Chang Wai Man, who initially mistook his symptoms as signs that his body was too ‘heaty’.
NATURAL – killer / T- cell lymphoma is an aggressive cancer that mimics the symptoms of influenza and must be diagnosed early for successful treatment.
Mr Lau Wei Ming went, in a matter of weeks, from being strong enough to have multiple wisdom teeth extracted to being diagnosed with Natural- killer/ T-cell Lymphoma (NKTCL) – an aggressive cancer that can wreak havoc in a matter of months if not treated.
A week after his extractions, his left nostril became runny and a big reddish lump developed on the left side of his neck. “I thought it was just a runny nose,” he said.
He saw a general practitioner (GP) who suspected a saliva infection and prescribed antibiotics.
But that did not work, so he took the advice of another GP and went to hospital for treatment.
RESPONDED WELL TO NEW DRUG: Lau Wei Ming (above) had aggressive lymphoma, which responded well to a new type of chemotherapy.
There, specialists from the Ear, Nose and Throat (ENT) department did thorough checks and took a biopsy of his left nostril.
“A week later, the doctor told me I had cancer. It was Stage 2 NKTCL. I was very shocked. I couldn’t accept it,” said the 35- year-old senior technician, who has two children in primary school.
Mr Lau was referred to the National Cancer Centre Singapore (NCCS), where doctors wanted to ward him immediately, but he refused as he wanted a second opinion.
Another biopsy confi rmed his diagnosis. Explaining the illness, Dr Kevin Tay, Consultant, Department of Medical Oncology, NCCS, said the immune system has many kinds of immune cells which protect and help the body fi ght against viruses and bacteria.
Natural-killers/T-cells are among them. NKT/ T-cellCL happens when Natural-killers in the immune system become cancerous.
The cause is thought to be the Epstein Barr virus, which is common in South-east Asia, making the incidence of the cancer higher in Asians than Caucasians.
In Singapore, the NCCS sees about 10 to 20 cases a year.
Dr Tay said that in the early stages, the cancer occurs in the nose area, leading to symptoms such as a runny nose, nasal blockage and fever – similar to fl u symptoms, except that they do not respond to antibiotics.
“It’s like a persistent fl u that doesn’t go away. It might even get worse, with severe symptoms such as bleeding from the nose and signifi cant weight loss over a period of time.”
In the early stages, the disease can be treated successfully with chemotherapy and radiation.
But in the advanced stages, because of its aggressive nature and rapid progression, it can be lethal. Dr Tay said this lymphoma usually affects those 65 years old and above.
“This is because as we age, our immune system is more likely to fail, predisposing us towards lymphoma.”
However, a small number of younger patients, such as Mr Lau, who have a genetic predisposition, can also be affected and they often get the more aggressive form, which no amount of immunity boosting can prevent.
Retiree Mr Chang Wai Man, 65, was diagnosed with malignant lymphoma in 1980, but regular treatment and check-ups at NCCS and Singapore General Hospital’s ENT department kept him healthy for more than 30 years.
But in July last year, one of his nostrils got blocked with persistent discharge and occasional bleeding.
“I had no pain, fever or cold, but my mouth was very dry and I drank a lot of water.
I thought my body was too ‘heaty’, so I tried taking Chinese medicine,” said Mr Chang, who has three children and one grandchild.
As he had an appointment with an ENT doctor in September, he waited until then to consult the specialist.
After various tests, including a biopsy, he was told he had NKTCL and was referred to NCCS.
Both Mr Chang and Mr Lau underwent chemotherapy and radiotherapy.
According to Dr Tay, patients in the early stages usually go through chemotherapy for two to three months, followed by radiotherapy for two months.
For Mr Lau, though, the treatment included something new.
His doctors suggested a new chemotherapy regimen GIFOX-Velcade. He opted for it and the lump on his neck subsided the next day after his fi rst chemotherapy session. Both patients had strong family support.
Mr Chang’s family encouraged him by reminding him of his successful treatment in 1980.
They told him that, since he managed to pull through before, he could do it again. Mr Lau stayed positive for himself and others.
He related an encounter he had with a fellow patient who felt like giving up. “I talked to him about positive things.
The next day, he thanked me and told me he wouldn’t give up on his treatment.
I was very happy when I saw him recover. His family was overjoyed as well and thanked me for my support.”
Although NKTCL is an aggressive form of lymphoma which can manifest and spread very quickly in weeks or months, the rate of cure is relatively good if the condition is diagnosed early. The fi ve-year survival rate in Singapore for Stage 1 NKTCL is about 70 per cent, said Dr Tay.
He added: “A delay in seeing the doctor can allow the cancer to advance undetected. There are times when the tumour is simply more aggressive. Always be mindful of symptoms that just don’t go away – you should have them investigated.”
Researchers in Singapore have found gene mutations associated with Natural-killer/T- cell Lymphoma (NKTCL), paving the way for a potential new treatment.
The researchers from the National Cancer Centre Singapore (NCCS) and Duke- NUS Graduate Medical School Singapore found mutations in a gene called Janus Kinase 3 (JAK3) in the tumour cells of 35 per cent of the patients they tested. Normal cells do not have this mutation.
The discovery creates the possibility of developing an inhibitor for targeted chemotherapy, said Dr Kevin Tay, Consultant, Department of Medical Oncology, NCCS, who is among the 20 or so people involved in the study.
The inhibitor would target only tumour cells with JAK3 because it recognises that only Naturalkiller tumour cells have this mutation.
Scientists here are now planning clinical trials. It will take a few months to a year to get them running and to recruit patients, said Dr Tay.
The trials will probably run for two years and also include Stage 4 NKTCL patients.
• This story was fi rst published in Singapore Health, Sep/Oct 2012.