He fought stage 3 cancer at 26 and survived to marry and have a child
- A Hodgkin lymphoma survivor overcame advanced-stage cancer that was diagnosed when he was 26
- Even though fertility issues is a common concern among cancer patients his age, he fathered a child
- Hodgkin lymphoma commonly affects youth and young adults
- Regardless of the type of cancer and treatment, there are options for patients to preserve fertility
- Open discussions on fertility should take place before cancer treatment, doctors said
SINGAPORE — Just weeks after Mr Bryaan Lea and his fiancee set their wedding date, he was diagnosed with stage 3 Hodgkin lymphoma, a type of cancer that starts in white blood cells or lymphocytes.
Mr Lea, who was 26 years old at the time and a financial consultant, had been getting skin rashes and experiencing breathing difficulties and voice hoarseness for two to three months. He thought it was just a severe bout of sore throat or flu.
When taking lozenges and pi pa gao (a Chinese traditional herbal remedy) did not help, he saw a doctor.
Scans revealed an 8cm-large mass in his chest. Cancer was also found in his spleen.
Shaken by the diagnosis, he wondered if he would survive advanced cancer.
“At the time, we didn’t even know what Hodgkin lymphoma was,” he said. “There was an eerie silence (in the consultation room) when the doctor broke the news. We didn’t know how to react to it.”
Now 31 years old, Mr Lea has overcome the disease, is happily married and has started his own business, proving that there is hope and life after cancer.
Miraculously, he also managed to father a child, something that can be difficult when a cancer patient undergoes chemotherapy.
He now hopes to raise awareness of Hodgkin lymphoma, which often hits young adults at the prime of their lives who may be starting a family of their own.
The National Cancer Centre Singapore (NCCS) sees around eight to 10 new cases of Hodgkin lymphoma a year. Most of them are under the age of 30.
Besides afflicting youth and young adults in their 20s and 30s, this type of lymphoma is also often seen in older adults around 60 to 70 years old.
IMPACT ON FERTILITY
When cancer hits at a young age, patients such as Mr Lea face unique challenges.
Clinical Assistant Professor Nagavalli Somasundaram, head and consultant from the department of lymphoma and sarcoma at NCCS’ division of medical oncology, said that fertility is often a prime concern for this age group.
Some cancers, in itself, can result in infertility. For example, testicular cancers may cause low sperm counts even before cancer treatment, she said.
Studies have long shown that cancer treatments such as chemotherapy can affect the ability to have children later in life.
Dr Kevin Tay, a senior consultant medical oncologist at OncoCare Cancer Centre (Singapore) who treated Mr Lea, explained: “Chemotherapy works by killing cells that divide rapidly. Normal cells in the body that divide quickly are most affected by chemotherapy.
Examples of rapidly dividing cells include sperm cells in men and oocyte (immature egg cell) in women, which are more susceptible to damage by chemotherapy.
Clinical Asst Prof Nagavalli said that different chemotherapy regimens and doses can have varying impact on fertility, some of which may be permanent.
“For example, alkylating agents and platinum-based chemotherapy are some groups of chemotherapeutic drugs that can cause infertility. These drugs result in destruction of sperms and eggs thereby affecting fertility,” she said.
“Other treatments like radiotherapy administered to the pelvis region can cause direct damage to the testes or ovaries resulting in impairment of fertility. Radiotherapy to certain areas of the brain can also affect production of hormones that control fertility.”
Surgery involving removal of reproductive organs may result in infertility as well, she added.
Dr Tay said that the degree of infertility varies with the type and duration of chemotherapy regimen as well as the patient’s age.
In the case of Hodgkin lymphoma, he said: “The most commonly used regimen, ABVD chemotherapy, causes infertility in less than 10 per cent of patients whereas more intensive regimens such as BEACOPP chemotherapy regimen result in infertility in nearly all of patients treated.”
Clinical Asst Prof Nagavalli said that most medical oncologists in Singapore will discuss fertility preservation options with patients of child-bearing age.
The cancer type, stage and aggressiveness of the cancer, medical urgency to initiate treatment and potential for the treatment to cause infertility will all be taken into account.
Dr Tay said that this is usually done before commencing chemotherapy.
For example, male patients may be referred to do sperm banking while oocyte or embryo cryopreservation (freezing of eggs) are available for female patients.
Clinical Asst Prof Nagavalli said that another option is the use of gonadotropin-releasing hormone (GnRH) analogues, which are medications given to suppress the function of ovaries indirectly.
It is not considered a standard option for fertility preservation, but may be discussed if patients are unsuitable for the standard options of oocyte or embryo cryopreservation, based on their doctor’s discretion, she said.
“At NCCS, we work very closely with our gynaecology colleagues in the reproductive medicine department and refer patients for a consultation at the point of diagnosis,” she added.
“We have found that most patients would prefer to have this discussion and be made aware of the options regardless of outcomes. This discussion is usually held with the medical oncologist managing the patient.”
Her advice for young cancer patients is to have such an open discussion with their oncologist and gynaecologist.
“It would also be a good idea to include your partner in the discussion,” she added.
For Mr Lea, fatherhood seemed like an abstract concept while he was battling cancer.
Although the possibility of infertility due to chemotherapy crossed his mind, he said that he declined storing sperm samples in a sperm bank when his doctor brought up the topic.
“My main priority was to get better,” he said.
Six months after completing his cancer treatment, Mr Lea married his fiancee, Ms Magdalene Liew, in 2017.
A year after their marriage, they unexpectedly conceived a baby girl the old-fashioned way.
“We took everything naturally. I was worried whether the cancer treatment affected our chances of conceiving but when I learnt that my wife conceived, those worries went away,” he said.
“We are so happy to be able to have our own family. I’m very thankful to have my daughter.”
CAUSES AND SYMPTOMS OF HODGKIN LYMPHOMA
Lymphoma is the fifth most common cancer in men and the sixth most common cancer in women in Singapore.
Dr Tay said that Hodgkin lymphoma accounts for around one in 10 of lymphoma cases.
The exact cause of the cancer is not known, though Dr Tay said that there are some factors that increase the risk, such as:
A family history of the cancer
Infection with certain viruses such as the Epstein-Barr virus or human immunodeficiency virus
A history of autoimmune disorders
Having a compromised immune system, for example, post-transplant patients
The most common symptom includes enlarged lymph nodes in the neck, armpit and groin regions. If lymph node in the neck increases in size significantly, it can also cause breathing and swallowing difficulties, Dr Tay said.
Other symptoms include persistent fever, night sweats and significant weight loss — of more than 10 per cent of one’s original weight over six months.
Dr Tay said: “Most benign conditions like a common flu or sore throat usually resolve after a few weeks, or at least, the patient will experience improvement in the symptoms. However, if it were due to cancer, the symptoms usually persist and worsen over time.”
He advised seeking medical attention and not ignore or downplay symptoms if they worsen or do not go away after a few weeks.
“Any cancer that is detected early is treatable and potentially curable,” he said, adding that for Hodgkin lymphoma, the disease is “highly curable” in the early stages.
The five-year survival rate — or the percentage of people alive five years after their diagnosis — is 90 to 95 per cent for stage 1 patients.
“Even stage 4 Hodgkin lymphoma is potentially curable in a good proportion of patients, with a five-year survival rate of 70 to 80 per cent. This is in contrast to other advanced cancers such as pancreas or liver cancers that have a five-year survival rate of only less than 10 per cent,” he said.
‘I WASN’T SURE IF I COULD SURVIVE’
Mr Lea’s treatment plan involved six cycles of ABVD chemotherapy, which took around six months.
Dr Tay said that this is the most commonly used treatment regimen for Hodgkin lymphoma.
It comprises multiple chemotherapy drugs (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) administered intravenously. It is available both in private and restructured hospitals.
Living with the side effects from chemotherapy was challenging and Mr Lea took a year off from work.
He felt nauseous after each chemotherapy session and his taste buds were altered, making him extremely sensitive to certain smells. The lethargy and hair loss were also “demoralising”.
However, the hardest part of his journey was not knowing if he could beat the cancer, despite his doctor’s reassurances that it was possible.
His loved ones were his pillars of strength and support at the time.
His then-fiancee, Ms Liew, took a sabbatical leave from her full-time job to spend time with him. His parents accompanied him during his chemotherapy sessions while his grandmother prepared healthy meals for him.
Now a father to an active two-year-old toddler, Mr Lea, who is in remission, said that his family is his motivation to live more healthily.
“In the past, I did not exercise. Now, I make exercise a part of my lifestyle. I hit the gym at least once a week to build stamina.”
He spent the past year forging strong bonds with his daughter, who loves swimming and going to the playground.
Realising that life is fragile, Mr Lea decided to pursue his passion in photography and videography. He started his own content development company, Momentscreatives, while still juggling work as a financial consultant.
“My cancer journey changed how I look at life. I think it’s important to live every day with happiness and joy instead of having regrets.”
He does not know if a cancer relapse will happen later, but chooses not to dwell on things he cannot control.
Now still on six-monthly follow-ups with Dr Tay, Mr Lea said: “If someone newly diagnosed with cancer came to me, I would urge him or her to have a positive mindset to see the good in every situation. Focus on getting better, it makes it easier to go through the treatment.”
