h_lymphomas.png

Lymphomas

Lymphomas are malignancies of the lymphatic system. This is the second most common childhood cancer we see in Pakistan There are two main groups of lymphomas: non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (also known as Hodgkin’s disease, as it was first described by Thomas Hodgkin in 1832).

Both non-Hodgkin’s lymphoma and Hodgkin’s disease begin in the lymph nodes. The key difference between them is in the presence of abnormal cancerous cells called Reed-Sternberg cells in Hodgkin’s disease. These are not present in NHL. A further difference is that Hodgkin’s disease tends to spread to adjacent lymph nodes and is less likely than NHL to metastasise to other organs outside the lymphatic system.

Non-Hodgkin’s Lymphoma

In children, NHL can present wherever lymphoid tissue is present. There are two main types of non-Hodgkin’s lymphoma:

  • B-cell NHL usually affects the lymph nodes in the neck, head, throat and abdomen.
  • T-cell NHL usually affects the lymph nodes in the neck and presents in the mediastinum (chest).

Signs and Symptoms

The symptoms of NHL are usually dependent on the site of the tumour. A common presenting feature is enlarged lymph nodes at the site of disease. The placement of the enlarged nodes determines how the child presents. Other, vaguer, symptoms include:

  • Fever
  • Sweating (particularly night sweats)
  • Fatigue
  • Weight loss
  • Itchy or reddened skin

Headache and vomiting are common in children however, if the two occur together for more than weeks, the child should be taken to the specialist.

Diagnosis

CT and MRI scans are used to identify the exact location of the possible tumour and a biopsy may be taken to confirm the type.

Treatment

Chemotherapy is the main method of treatment and is sometimes used alongside radiotherapy.

Prognosis

Overall, 75% of children will be cured in Pakistan.

Hodgkin’s Lymphoma

Signs and Symptoms

This usually presents with a painless lymphadenopathy (swelling of the lymph nodes), most frequently in the neck (and on one side only). The lymph nodes are much larger and firmer than the normal enlarged glands associated with childhood. Other, vaguer, symptoms include:

  • Fever
  • Sweating (particularly night sweats)
  • Weight loss
  • Itchy or reddened skin

Headache and vomiting are common in children however, if the two occur together for more than weeks, the child should be taken to the specialist.

Diagnosis

Biopsy, sometimes involving total resection of the lymph gland, remains the key method for accurate diagnosis. X-rays and CT and MRI scans, bone marrow examination are used in the initial testing stages for non-Hodgkin’s lymphoma.

Treatment

Dependent on the stage of the disease, a combination of chemotherapy and radiotherapy is used as treatment.

Prognosis

Overall, 90% of children will be cured although this decreases to 70% if they present with widespread disease.