Non-Hodgkin Lymphoma in Children

Non-Hodgkin Lymphoma in Children

Non-Hodgkin lymphoma (NHL) in children is a type of cancer that affects the lymphatic system, which is part of the immune system. NHL is a rare disease in children, accounting for approximately 7% of all childhood cancers. The most common types of NHL in children are Burkitt lymphoma, diffuse large B-cell lymphoma and lymphoblastic lymphoma.

Causes and Risk Factors

The exact causes of Non-Hodgkin lymphoma (NHL) in children are not fully understood, but research has identified some factors that may increase the risk of developing the disease. These risk factors include –

1. Genetic mutations – Some inherited genetic mutations increase the risk of NHL in children.
2. Weakened immune system – Children with weakened immune systems, such as those with HIV/AIDS, or those who have received an organ transplant and are taking immunosuppressive drugs, are at higher risk of developing NHL.
3. Infections – Certain viral and bacterial infections, such as Epstein-Barr virus (EBV), human T-cell leukemia virus (HTLV-1), and Helicobacter pylori, have been linked to an increased risk of NHL in children.
4. Environmental factors – Exposure to certain chemicals, such as pesticides and herbicides, may increase the risk of developing NHL in children.
5. Radiation – Exposure to radiation, especially at a young age, is a known risk factor for NHL.

Non-Hodgkin Lymphoma in Children

6. Family history – Children with a family history of NHL or other cancers may have an increased risk of developing the disease.

Most children who develop NHL do not have any known risk factors, and the disease can occur in children without any apparent cause or warning signs.

Symptoms

The symptoms of Non-Hodgkin lymphoma (NHL) in children can vary depending on the type and stage of the cancer, as well as the child’s age and overall health. Some common symptoms of NHL in children may include:

1. Swollen lymph nodes – The most common symptom of NHL in children is swollen lymph nodes, which may be painless or tender to the touch. The lymph nodes may be located in the neck, armpit, or groin.
2. Fever – Children with NHL may experience a persistent fever that does not go away with typical treatments.
3. Night sweats – Children with NHL may experience excessive sweating during the night, even if the room is cool.
4. Weight loss – Children with NHL may experience unexplained weight loss or a loss of appetite.
5. Fatigue – Children with NHL may feel tired or weak, even after getting enough rest.
6. Abdominal pain – Children with NHL may experience abdominal pain or swelling, which may be accompanied by nausea, vomiting, or diarrhea.
7. Skin rash – Some children with NHL may develop a skin rash, which may be itchy or painful.

These symptoms can also be caused by other conditions, so it’s important to consult with a healthcare provider if your child is experiencing any persistent or unusual symptoms.

Diagnosis and Tests

The diagnosis of Non-Hodgkin lymphoma (NHL) in children typically involves a combination of physical exams, imaging tests, and lab tests. The following are some common diagnostic tests used for NHL in children –

1. Physical exam – The doctor will perform a physical exam to check for any signs of lymph node enlargement or other abnormalities.

2. Blood tests – Blood tests can help to identify abnormal blood counts, which can be a sign of NHL.

3. Imaging tests – Imaging tests such as X-rays, CT scans, MRI, and PET scans may be used to look for tumors or other abnormalities in the lymph nodes or other parts of the body.

• Computed tomography (CT) scan – CT scans use X-rays and computer technology to create detailed images of the body. They can show the size and location of tumors, as well as whether they have spread to other parts of the body.
• Magnetic resonance imaging (MRI) – MRI uses powerful magnets and radio waves to create detailed images of the body. They can show the size and location of tumors, as well as whether they have spread to other parts of the body.
• Positron emission tomography (PET) scan – PET scans use a small amount of radioactive material to create images of the body. They can show areas of increased metabolic activity, which can help to identify areas of cancerous tissue.

4. Biopsy – A biopsy is the most definitive test for diagnosing NHL in children. This involves taking a sample of tissue from the affected lymph node or other affected area of the body for examination under a microscope.

5. Lumbar puncture – In some cases, a lumbar puncture may be performed to check for NHL cells in the cerebrospinal fluid that surrounds the brain and spinal cord.

The diagnosis of NHL in children requires a team of healthcare professionals, including pediatric oncologists, pathologists, and radiologists. These specialists work together to determine the most appropriate course of treatment for each child with NHL.

Stages

The staging system commonly used for NHL in children is the St. Jude Children’s Research Hospital/International Society of Paediatric Oncology (SIOP) staging system, which is as follows –

• Stage I – The cancer is localized to one lymph node region or one extranodal site.
• Stage II – Cancer involves more than one lymph node region on the same side of the diaphragm or one lymph node region and one extranodal site on the same side of the diaphragm.
• Stage III – Cancer involves lymph node regions on both sides of the diaphragm.
• Stage IV – The cancer has spread beyond the lymph nodes to other organs or tissues, such as the bone marrow, liver, or lungs.

In addition to the stage, NHL in children is also classified based on its histology, which refers to the specific type of cancer cells involved. Histology can help guide treatment decisions and predict the outlook for the child. The most common types of NHL in children include Burkitt lymphoma, lymphoblastic lymphoma, and large-cell lymphoma.

Treatments

Treatment options for Non-Hodgkin lymphoma (NHL) in children depend on the type and stage of the cancer, as well as the child’s age and overall health. The main treatment options for NHL in children include –

1. Chemotherapy – Chemotherapy is the most common treatment for NHL in children. It uses drugs to kill cancer cells and may be given in cycles over several months.
2. Radiation therapy – Radiation therapy uses high-energy beams to kill cancer cells. It may be used alone or in combination with chemotherapy.
3. Stem cell transplant – In some cases, a stem cell transplant may be recommended. This involves replacing the child’s bone marrow with healthy stem cells from a donor.
4. Immunotherapy – Immunotherapy is a newer type of treatment that uses the body’s own immune system to fight cancer. It may be used in combination with chemotherapy.
5. Surgery – Surgery may be used to remove a tumor if it is localized and has not spread to other parts of the body.

The specific treatment plan for a child with NHL will depend on several factors, including the type and stage of cancer, the child’s age and overall health, and the family’s preferences. The healthcare team will work with the family to develop a personalized treatment plan that is best for the child.

Outlook

The outlook for Non-Hodgkin lymphoma (NHL) in children depends on several factors, including the type and stage of cancer, the child’s age and overall health, and how well the cancer responds to treatment. In general, the outlook for children with NHL has improved significantly over the past few decades due to advances in treatment.

Every child is unique and may respond differently to treatment. The healthcare team will closely monitor the child’s response to treatment and adjust the treatment plan as needed to achieve the best possible outcome. Regular follow-up appointments will also be scheduled to monitor the child’s health and detect any signs of recurrence.