Pediatric Hodgkin Lymphoma
The human immune system is a complex network that contains various systems, all of which play a vital role in protecting the body. One of those systems is the lymphatic system which comprises lymph nodes, lymphatic organs and lymphatic vessels.
The lymphatic system produces a type of white blood cell known as a lymphocyte, which can, on rare occasions, grow and multiply uncontrollably. This is how a tumor forms and leads to the cancer of the lymphatic system known as Hodgkin’s lymphoma.
Hodgkin’s lymphoma is a type of cancer that affects the lymphatic system and usually develops in the lymph nodes. It can affect patients of all ages, including children, and Hodgkin’s lymphoma accounts for approximately 3% of all childhood cancers.
Childhood Hodgkin’s lymphoma leads to enlarged lymph nodes, high fever, fatigue and weakness, unexplained weight loss and night sweats.
To get a better understanding of Hodgkin’s lymphoma in children, you need to understand all of its causes and symptoms, how it’s treated and all other relevant information.
Pediatric Hodgkin’s Lymphoma Causes
Medical professionals aren’t sure what causes pediatric Hodgkin’s lymphoma, but it is known that it develops due to a change in the genes of lymphocytes. However, even though it’s not known what exactly causes this cancer, there are certain risk factors that are associated with it.
These risk factors include having HIV, Epstein-Barr virus (EBV) infection, infectious mononucleosis, a family history of Hodgkin’s lymphoma or an already weak immune system. Of course, having a risk factor doesn’t mean the child will develop HL, just that there is a greater chance.
Pediatric Hodgkin’s Lymphoma Symptoms
Pediatric Hodgkin’s lymphoma can have various signs and symptoms from one patient to another, mostly depending on where exactly the tumor is located. For example, if a child’s Hodgkin’s lymphoma is located in their chest, they will display symptoms such as shortness of breath, coughing and chest pain.
In some cases, it can be completely asymptomatic, but that’s a very rare occurrence. Overall, the general symptoms of pediatric Hodgkin’s lymphoma include:
- Lymph node swelling in the neck, abdomen, chest, groin or underarm
- High fever and night sweats
- Loss of appetite
- Sore throat, often followed by trouble swallowing
- Breathing problems and shortness of breath
- Weakness and fatigue
- Unexplained weight loss
- Itchy skin
It’s important to remember that these symptoms don’t necessarily indicate a child has Hodgkin’s lymphoma and the only way to know for sure is to get a proper diagnosis.
Pediatric Hodgkin’s Lymphoma Diagnosis
If you suspect your child might have Hodgkin’s lymphoma and if they’re displaying the above mentioned symptoms, it’s essential to take them to a doctor. A trained and qualified medical professional will go through all the necessary steps to see what the underlying issue is.
These are all the steps a doctor would need to take when looking to diagnose Hodgkin’s lymphoma:
- Physical exam and medical history: An initial assessment of the child’s symptoms and a review of their medical history will help the doctor see if HL is a possibility.
- Lymph node biopsy: Since Hodgkin’s lymphoma typically first develops in the lymph nodes, the doctor will order a lymph node biopsy. This procedure involves the removal of a small amount of tissue from the lymph nodes to be examined under a microscope in order to look for any indication of a tumor. A biopsy can show with certainty if the issue is HL.
- Blood tests: To determine how serious the disease is and how far it has advanced, the doctor will perform a few blood tests that will check the patient’s white blood cell count and the level of inflammation in their body. These tests include a complete blood count (CBC) and an erythrocyte sedimentation rate (ESR) test.
- Imaging tests: After the doctor has diagnosed the child with lymphoma through the biopsy and blood tests, they will use imaging tests to check whether the disease has spread throughout the body and where exactly the affected lymph nodes are located. These imaging tests typically include a CT scan, an MRI, a PET scan, and an X-ray.
- Bone marrow aspiration and biopsy: One of the areas where Hodgkin’s lymphoma can potentially spread is the bone marrow, and doctors typically check if this has happened with every patient. During this procedure, a small amount of bone marrow liquid is extracted as well as a thin piece of bone marrow, and those samples are tested in a laboratory by a pathologist. This will allow the doctor to see whether the bone marrow contains any cancerous cells.
Pediatric Hodgkin’s Lymphoma Stages
After a tumor has been diagnosed, it’s important to determine its stage. In the case of HL, the staging shows how big the tumor is, if and where it’s spread from its original location.
Pediatric Hodgkin’s lymphoma has four stages:
- Stage 1 Hodgkin’s Lymphoma: In the first and mildest stage, the lymphoma is only located in one region or organ, meaning the cancer is contained in a single lymph node. Most of the time it’s directly below or above the patient’s diaphragm.
- Stage 2 Hodgkin’s Lymphoma: In stage 2, the cancer is also usually located above and below the diaphragm, but in this case, it affects two or more lymph node regions within the same area. In some cases, it can also spread to a nearby organ.
- Stage 3 Hodgkin’s Lymphoma: If a patient enters stage 3 Hodgkin’s lymphoma, the affected lymph nodes are more widespread throughout the body. This means that the tumor can be found in the diaphragm but also adjacent tissues and/or organs.
- Stage 4 Hodgkin’s Lymphoma: This is the most advanced stage of Hodgkin’s lymphoma and if a patient is in stage 4, that means that the cancer has spread to distant organs and tissues, far from the lymphatic system. Some of the areas it spreads to include the liver, lungs and bone marrow.
Pediatric Hodgkin’s Lymphoma Treatment
Getting a Hodgkin’s lymphoma diagnosis can be scary, but the most important thing is to start with treatment right away. Your child’s doctor may suggest a couple of different treatment options. While each case is unique and will require a different approach, it will consist of one or a combination of the following treatments.
One of the most common and effective ways to treat almost any type of cancer is with chemotherapy, which is a process during which specialized drugs are used to destroy the cancerous cells within the patient’s body.
Chemotherapy can be given in pill or IV form, and it’s given in multiple cycles. Depending on the severity and staging of the disease, chemotherapy could be the only treatment that’s given or it may be combined with other treatment options.
Radiotherapy uses high-energy rays to destroy cancer cells. While it can be used as a standalone treatment, in most cases it’s used after chemotherapy.
Radiotherapy can be used for all stages of Hodgkin’s lymphoma but it’s typically given to patients whose lymphoma is more advanced because it can help alleviate the symptoms and destroy residual cancer cells. However, doctors typically avoid radiotherapy for very young children because it can stunt their growth.
Targeted therapy is a treatment option that involves the use of specialized drugs to target only cancerous cells. While all other treatment options have an effect on both healthy and cancerous cells, targeted therapy doesn’t damage healthy cells.
The goal of targeted therapy is to stop the cancerous cells from growing and spreading even more than they already have. Most of the time this treatment option is only used for stage 4 Hodgkin’s lymphoma after other treatment options have been attempted.
Bone Marrow Transplant
If the tumor spreads to the patient’s bone marrow or if it’s too advanced for other treatment options, the doctor will have to perform a bone marrow transplant, which is usually done in combination with high-dose chemotherapy.
This treatment option involves injecting healthy stem cells into the patient’s body in order to repair it since damaged bone marrow can’t produce enough red and white blood cells and platelets.
After a bone marrow transplant, the patient’s body will be more equipped to fight off the cancer.
Pediatric Hodgkin’s Lymphoma Complications
Just like all other diseases, pediatric Hodgkin’s lymphoma comes with its own set of complications. These complications vary based on the stage of the disease.
The most common ones include lung problems, heart disease, a higher risk of developing an infection, infertility and a higher chance of developing another type of cancer.
Pediatric Hodgkin’s Lymphoma Prognosis
Whenever a doctor diagnoses any sort of disease, they will also give a prognosis for the patient. This prognosis is an estimate of how the cancer will affect the patient and also how they expect them to respond to treatment.
The prognosis depends on:
- The stage of the lymphoma: The lower the stage, the better the prognosis.
- Whether or not the patient is symptomatic: Asymptomatic patients typically have a better prognosis.
- The size of the tumor: Larger (bulkier) tumors often come with a worse prognosis.
- How well the patient is responding to treatment: If the patient responds to treatment very quickly, their prognosis is better.
- Whether the patient has anemia: Those with anemia typically have a worse prognosis.
- The location of the tumor: If the lymphoma is only located in the lymph nodes, the prognosis is better than if it has spread to other parts of the body.
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Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and are dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.
Request a consultation
Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.
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