Hong Kong artiste Kristal Tin Yui-lee has revealed on social media that cancer cells were found in her lymph nodes, more than a year after being diagnosed with early-stage lung cancer, drawing renewed attention to the disease.
A former leading actress at TVB after starting her career at the now defunct ATV, the 48-year-old has shifted her focus in recent years to screenplays and online media. She won the best lead actress award in 2024 for her role as a wife in Big Divorce Day, a theatre production looking at a failing marriage from the perspectives of both spouses.
In a Facebook post on Friday, Tin revealed she had been diagnosed with cancer after Chinese New Year but said she was well supported by her husband, actor Chapman To Man-chak, her oncologist at a Taiwan hospital and a Buddhist master.
The South China Morning Post looks at the complications caused by lymph node cancer.
1. How did cancer strike Kristal Tin?
Tin revealed that she had a persistent low fever at the end of last year and suspected it was a bacterial infection. She said she underwent a lymph node biopsy after Chinese New Year, which confirmed cancer cells in her body.
“When I heard this news, I had to admit it was really hard to accept,” she said.
Tin was diagnosed with lung cancer in late 2024 and revealed in December that year that she had undergone a successful operation in Taiwan.
She said the new diagnosis prompted her to stop “all plans” in Taiwan, where she is currently receiving targeted therapy drugs in hospital that she described as “effective”.
2. How are lymph nodes affected?
The human body has a lymphatic network through which lymphocytes – a type of white blood cell in the immune system – are circulated to organs and tissue to fight infections.
According to the American Cancer Society, cancer can appear in lymph nodes in two ways: either starting in the lymph nodes or spreading to them from somewhere else in the body.
Cancer that starts in the lymph nodes is called lymphoma. When malignant changes occur in the cells, they multiply and gather in the lymph nodes or glands, forming tumours and spreading to the bone marrow, spleen, liver and other organs.
The causes of lymphoma are not fully understood yet, but recent studies have identified some risk factors, such as genetic changes, radiation and immune diseases such as Aids and rheumatoid arthritis.
Symptoms included painless swelling of the lymph nodes, fever, excessive sweating, loss of appetite, weight loss, persistent itchy skin and fatigue. If the lymphoma cells have already spread to the bone marrow and affect blood production, patients may have anaemia, bruising and frequent infections.
The second case occurs when cancer cells detach from a primary tumour and migrate to other parts of the body via the bloodstream or the lymphatic system.
While most of these cells perish as they spread, those that survive may settle in lymph nodes or other tissue to form new tumours. This secondary growth in a new location is medically defined as metastasis.
3. How common is lymphoma?
According to the Hong Kong Cancer Registry, non-Hodgkin’s lymphoma – the more common type of lymphoma in Hong Kong and neighbouring areas in Asia – was the ninth most common cancer in 2023, with 1,245 new cases registered that year.
It accounted for 3.1 per cent of cancer deaths in 2023, ranking eighth. The top three killers were lung, colorectum and liver cancer.
Lymphoma is not easy to diagnose because swelling of the lymph glands is not necessarily related to cancer. The only way to determine if the swelling is benign or malignant is through a lymph gland biopsy, in addition to a thorough history and physical examination.
4. How often does cancer develop again in survivors?
Professor Stephen Chan Lam of the Chinese University of Hong Kong’s department of clinical oncology said there were two scenarios in which a cancer survivor developed cancer again.
The first possibility is a recurrence, which happens when a patient is theoretically cured after surgery or therapies, but some “occult, microscopic tumours that remain invisible under medical scans” resurface after a few years.
The second is metachronous cancer – a second primary cancer that develops after the diagnosis of an initial primary cancer.
Chan said that for lung cancer, the risk of recurrence was relatively high, ranging from 30 per cent to 50 per cent, unless the diagnosis occurred at a very early stage.
As for metachronous cancer, the risk would be higher for younger cancer survivors because of their longer life expectancy. Clinically, there were even patients who developed three cancers one after another.
“We look at two things, the timeline and the pathology, which means they are caused by the same type of cancer cell,” he said.
For example, if the cell type found in the first cancer is adenocarcinoma, but the cell type in the second cancer is lymphoma, the case is not a recurrence regardless of how close the timing is.
A common scenario is that lung cancer patients who smoke could get laryngeal cancer because both organs are affected by cigarettes. The two types of cancer cells could surface at different times.
Some people get cancer again because of genetic factors. For example, those carrying the BRCA gene mutation would have a higher chance of getting breast cancer, ovarian cancer and pancreatic cancer.
American actress and filmmaker Angelina Jolie tested positive for the BRCA1 gene mutation and hence underwent preventive operations of a double mastectomy in 2013 and removal of her ovaries and Fallopian tubes.
5. Can you avoid getting cancer twice?
To prevent a relapse, cancer survivors who were treated at public hospitals would typically receive five years of follow-up surveillance, Chan said.
As for metachronous cancer, it can be picked up with the help of screening tools.
Authorities currently provide cancer screening services for colorectal, cervical, breast cancer, and liver cancer-causing hepatitis B for the high-risk groups.
Meanwhile, all cancer survivors should also manage the risk factors, such as giving up smoking and alcohol, managing their weight and maintaining a good immune system.