Lymphoma in children
Lymphoma is the third most common type of cancer in children; it is a cancer of a part of the lymphatic system. Organs and tissues in the lymphatic system include the lymph nodes, thymus, spleen, adenoids, tonsils, bone marrow, and the lymphatic vessels or channels that connect them; the lymphatic system is part of the immune system, helping the body to fight off infection. Other types of cancer can metastasize to the lymphatic system, but lymphoma actually originates somewhere in the lymphatic system. Lymphomas are separated into two categories: Hodgkin’s disease and non-Hodgkin lymphoma. The categorization depends on the appearance of the cancerous cells.
Hodgkin Disease
Hodgkin’s disease is characterized by the presence of malignant cancer cells, specifically called Reed-Sternberg cells in one or more of the lymphatic organs. With Hodgkin’s lymphoma, the cells in the lymphatic system begin to abnormally reproduce, making the body less able to fight off infection and eventually the lymph nodes will swell. Hodgkin’s happens most commonly in adults, but it does affect a large number of older children that do have lymphoma.
Symptoms
Symptoms of Hodgkin’s lymphoma may include painless swelling of the lymph nodes in the neck, underarm, groin, and chest; difficulty breathing due to enlarged lymph nodes in the chest; fever, night sweats; tiring easily; decreased appetite accompanied by weight loss; itching skin; and frequent viral infections.
Diagnosis
A complete medical history and physical exam are necessary for a diagnosis of any kind. Possible tests and additional exams run to diagnose lymphoma are blood and urine tests; x-rays of the chest; lymph node biopsy; CT of the chest, abdomen, and pelvis; lymphangiogram; and bone marrow biopsy.
Treatment
The treatment for Hodgkin’s disease depends on the child’s age, overall health, medical history, the stage of the disease, the child’s tolerance for certain medications and treatments, expectations for the course of the disease, and the family’s preference. Possible treatments include chemotherapy, radiation therapy, surgery, bone marrow transplant, supportive care, and continuous follow-up care. Discuss the possible side effects of any of these treatments with your healthcare provider.
Prognosis
The majority of children (about 9 out of 10) are cured of Hodgkin’s lymphoma, but the prognosis largely depends on the individual child’s response to treatment and how far the lymphoma had progressed before treatment was started.
Non-Hodgkin Lymphoma
As in Hodgkin’s lymphoma, non-Hodgkin’s lymphoma is a cancer occurring when cells somewhere in the lymphatic system begin to produce abnormally, causing tumors to grow. There are three different types of non-Hodgkin’s lymphoma.
Lymphoblastic non-Hodgkin lymphoma – involves the T-cells (cells involved in immunity) and is usually presented by a mass in the chest, swollen lymph nodes, with or without bone marrow and central nervous system involvement.
Burkitt’s lymphoma – the cancerous cells are undifferentiated (immature) and diffuse (spread out over a large area); it is characterized by a large tumor in the abdomen and may or may not have central nervous system involvement.
Large cell or diffuse histiocytic non-Hodgkin lymphoma – involves the T-cells and B-cells (both are involved in immunity; there is lymphatic system involvement and usually involvement of a non-lymph structure, like the jaw, brain, skin, or bones.
Symptoms
This type of cancer can evolve rather quickly, in a matter of weeks. Possible symptoms include abdominal mass, complaints of abdominal pain, fever, constipation, and decreased appetite. Sometimes there are symptoms of a mass in the chest, causing respiratory problems, breathing difficulties, coughing, and wheezing. Other symptoms are painless swelling of the lymph nodes in the neck, chest, abdomen, underarm, or groin; sore throat; bone and joint pain; night sweats; tiring easily; weight loss and decreased appetite; itching skin; and recurring infections.
Diagnosis
The diagnosis is the same as it is for Hodgkin’s lymphoma.
Treatment
The treatment option depends on the same things as for Hodgkin’s lymphoma. Treatment options are chemotherapy, radiation therapy, surgery, close monitoring of blood work, bone marrow transplant, bone marrow examinations, spinal taps, antibiotics to treat or prevent infections, supportive care, and long-term follow-up care.
Prognosis
The prognosis depends on the stage of the disease and the child’s response to treatment.
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