Q+A: The lymphoma that killed New Zealand cricket great Martin Crowe
While lymphoma is one of the more common types of cancer, it was a very rare sub-type of the disease which killed Martin Crowe.
The former New Zealand cricket captain died on Thursday, aged 53.
Crowe first learned he was suffering from lymphoma in late 2012, but looked to have held it at bay after a rigorous course of chemotherapy. However, back pains in 2014 led to tests which revealed the cancer had returned.
At the time, he said: "You never beat lymphoma, but I was hopeful that after the first episode I might be clear for a few years; I felt very well."
WHAT TYPE OF CANCER DID MARTIN CROWE SUFFER FROM?
Crowe was diagnosed with a type of non-Hodgkin lymphoma, follicular lymphoma, and later diagnosed with double-hit lymphoma.
Last year, he said: "It's an ugly beast. It transformed from follicular to double-hit. Sheer random luck really."
Without commenting on Crowe's personal situation, Cancer Society of New Zealand's medical director Dr Chris Jackson says about 5 per cent of cases of low-grade lymphoma transform and become highly aggressive.
"That does become much more difficult to treat when it transforms.
"The basis of that is cancer by its nature is a genetically unstable condition and if it acquires an additional change in mutation that can be what leads to it transforming from a low-grade condition to a highly aggressive and rapidly growing condition."
HOW COMMON IS LYMPHOMA?
Every year, more than 800 people in New Zealand are diagnosed with lymphoma, making it the sixth most common type of cancer. Non-Hodgkin lymphoma represents more than 85 per cent of all cases and around 300 people die from it every year.
WHAT IS THE LYMPHATIC SYSTEM AND WHAT ARE LYMPH NODES?
To understand Crowe's cancer we first need to understand the lymphatic system, which is part of our immune system which protects our bodies against disease and infection.
The lymphatic system is made up of a vast network of vessels similar to blood vessels. These vessels contain lymph – a colourless fluid that carries special white blood cells, lymphocytes.
Clusters of bean-shaped organs known as lymph nodes, or glands, are found at various points throughout the lymphatic system and are filled with lymphocytes. They filter the lymph as it passes through, getting rid of bacteria, viruses, and other harmful substances.
SO, WHAT IS LYMPHOMA?
Lymphoma is the general term for cancers that develop in the lymphatic system. Non-Hodgkin lymphoma is a cancer of the lymphocyte. Over time, these malignant lymphocytes (called lymphoma cells) crowd out the healthy cells meaning the patient's immune system can no longer function properly.
Follicular lymphoma is a relatively common type of lymphoma, representing around 25 per cent of cases. It gets its name from the way in which the lymphocytes are arranged in clusters or circular structures called follicles within the lymph node. It's usually slow-growing, over months or years. Double-hit lymphoma occurs when patients have two genetic abnormalities within their cancer. This rare blood disease has a grim prognosis: only 5 per cent of patients live to 12 months. They typically don't do well with present standard treatments.
HOW MANY DIFFERENT TYPES OF LYMPHOMA ARE THERE?
The World Health Organisation recognises more than 40 different sub-types of lymphoma, with most being grouped together and called non-Hodgkin lymphoma (or B- and T-cell lymphomas).
Jackson says non-Hodgkin lymphoma can either be indolent or aggressive: "Indolent is usually slow-growing and the aggressive is much more rapidly growing."
LYMPHOMA OR LEUKAEMIA?
Crowe had lymphoma. When lymphoma cells are found within the blood and bone marrow, the cancer presents as leukaemia. When the affected cells are mainly found in the lymphatic system, the cancer almost always presents as lymphoma. In some cases, the disease can present as both and is therefore classified as both.
WHO IS AT RISK OF NON-HODGKIN LYMPHOMA?
Non-hodgkin lymphoma is seen in all age groups – the head boy of Christchurch Boys' High School, Jake Bailey, also suffered from a type of non-Hodgkin's lymphoma – but is more common in people older than 50.
WHAT ARE THE SYMPTOMS?
Lymphoma is often tricky to diagnose because its symptoms can be confused with those of a common virus. Symptoms may include:
- Swollen lymph nodes
- Regular and frequent fevers
- Excessive sweating especially at night
- Weight loss
- Generalised itching
WHAT'S THE TREATMENT?
Jackson says, broadly speaking, lymphoma in many people can be highly treatable.
"If people have rapidly enlarging lymph glands or unexplained weight loss they should see their doctor for further investigation."
After being diagnosed with follicular lymphoma in October 2012, Crowe underwent intensive chemotherapy treatment for the cancer. He was given the all-clear in June 2013.
After being diagnosed with double-hit lymphoma in September 2014, he initially said he was set to have further treatment. He later decided to forego chemotherapy, owing to its brutal side-effects. He took natural remedies to boost his immune system, including a product based on sea cucumber given to him by friend and former All Black, Grant Fox.
WHAT ARE THE CAUSES?
The causes of lymphoma are poorly understood, however Jackson says the rates of lymphoma in New Zealand appear to be increasing over time.
The risk is increased slightly in patients with chronic infections, autoimmune diseases such as coeliac disease, or rheumatoid diseases such as rheumatoid arthritis. There are no known substances which cause lymphoma.
When Crowe was originally diagnosed he traced his problems back to his playing days, particularly in touring the subcontinent. He believed his immune system had been weakened by picking up salmonella poisoning and glandular fever.
Sources: Leukaemia & Blood Cancer New Zealand, International Lymphoma Coalition, Cancer Society New Zealand