Lymphoma (Hodgkin, non-Hodgkin & Burkitt)

The term ‘lymphoma’ refers to cancers that develop in the body’s lymphatic tissues. Lymphatic tissues include:

  • lymph nodes (also known as lymph glands)
  • thymus
  • spleen
  • tonsils
  • adenoids
  • bone marrow
  • and the channels (known as lymphatics or lymph vessels) that connect them.

 

Although many types of cancers eventually spread to parts of the lymphatic system, lymphomas are distinct because they originate there.
 

Lymphomas are divided into three broad categories, depending on the appearance of their cancerous (malignant) cells:

  • Hodgkin’s lymphoma (HL)
  • non-Hodgkin’s lymphoma (NHL)
  • and Burkitt’s lymphoma (BL).

These are of the most common types of cancers in children. (Herbst, 2017).

Statistics

  • An estimate of somewhat 150 children below the age of 19 years old are diagnosed with lymphoma each year in South Africa.

According to the National Cancer Registry (2012, 2014) the following number of Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, and Burkitt’s lymphoma cases were histologically diagnosed in South Africa during 2012, 2014, respectively:

Incidence of Childhood Hodgkin’s Lymphoma (2012)

Group: 0 to 19 years

Girls – Actual number of cases: 26

Boys – Actual number of cases: 46

Incidence of Childhood Non-Hodgkin’s Lymphoma (2014) 

Group: 0 to 19 years

Girls – Actual number of cases: 22

Boys – Actual number of cases: 42

Incidence of Childhood Burkitt’s Lymphoma (2014)

Group: 0 to 19 years

Girls – Actual number of cases: 4

Boys – Actual number of cases: 16

Signs & Symptoms

Warning signs for lymphoma are similar in children and adolescents as well as in adults.

Symptoms include:

  • One or more enlarged lymph nodes in the neck, underarm, or groin, which are usually painless
  • Chills
  • Swelling of the lymph nodes, which may or may not be painless
  • Abdominal swelling (lymphomas in the chest or abdomen can grow to a very large size before symptoms appear)
  • Unexplained fever
  • Night sweats
  • Loss of appetite
  • Unexplained weight loss
  • Lack of energy
  • Coughing
  • Difficulty breathing
  • Itchiness

If a child has a lymph node that becomes enlarged without explanation or remains enlarged for a prolonged period, a paediatrician should be consulted.  He/she may prescribe a course of antibiotics to treat a possible infection before performing a more extensive evaluation.

(Herbst, Fact Sheet on Childhood Hodgkin’s Lymphoma, 2017)

Diagnosis

Hodgkin’s Lymphoma

The following tests and procedures may be used:

  • Physical examination and history – an examination of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual.
  • CT scan (CAT scan) – a procedure that generates a sequence of detailed pictures of areas inside the body, such as the neck, chest, abdomen, or pelvis, taken from different angles. The pictures are made by a computer linked to an X-ray machine
  • Pet scan (positron emission tomography scan) – a procedure to identify malignant tumour cells in the body. A small amount of radioactive glucose is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant tumour cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • Chest X-ray – an X-ray of the organs and bones inside the chest.
  • Complete Blood Count (CBC) – a procedure where a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of haemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the blood sample made up of red blood cells.
  • Blood chemistry studies – a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Sedimentation Rate – this procedure sees a sample of blood being drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
  • Lymph node biopsy – the removal of all or part of a lymph node. The lymph node may be removed during a thoracoscopy, mediastinoscopy, or laparoscopy. One of the following types of biopsies may be conducted:
    • Excisional biopsy – the removal of an entire lymph node.
    • Incisional biopsy – the removal of part of a lymph node.
    • Core biopsy – the removal of tissue from a lymph node using a wide needle.
    • Fine-needle aspiration (FNA) biopsy – the removal of tissue from a lymph node using a thin needle.

(Herbst, Fact Sheet on Childhood Hodgkin’s Lymphoma, 2017)

Non-Hodgkin’s lymphoma

An accurate diagnosis is required, and the only way to do this is to remove some, or all, of an abnormal lymph node (or tumour) for viewing under a microscope and other lab tests. This is called a biopsy.

Types of biopsies:

  • Excisional or incisional biopsy these are the most common types of biopsy done if lymphoma is suspected. During these procedures, a surgeon cuts through the skin to remove either an entire lymph node (excisional biopsy) or a small part of a large tumour (incisional biopsy).
  • Fine needle aspiration (FNA) or core needle biopsy
    • In an FNA biopsy, the doctor uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of tissue from an enlarged lymph node or a tumour mass.
    • For a core needle biopsy, the doctor uses a larger needle to remove a slightly larger piece of tissue.

(Herbst, Fact Sheet on Childhood non-Hodgkin’s Lymphoma, 2019)

Burkitt’s lymphoma

  • A diagnosis of Burkitt’s lymphoma begins with a medical history and physical examination.
  • A biopsy of tumours confirms the diagnosis.
  • The bone marrow and central nervous system are often involved.
  • Bone marrow and spinal fluid are usually examined to see how far the cancer has spread.
  • Burkitt’s lymphoma is staged according to lymph node and organ involvement.
  • The involvement of bone marrow or the central nervous system means you have stage 4.
  • A CT scan and MRI can help pinpoint which organs and lymph nodes are involved.

(Herbst, Fact Sheet on Childhood Burkitt’s Lymphoma, 2019)

Risk Factors

The causes of lymphoma remain unknown; however, the following may increase the risk of childhood or adolescent lymphomas:

  • Family history (though no hereditary pattern has been firmly established)
  • Autoimmune disease or a history thereof
  • Receipt of an organ transplant
  • Exposure to chemicals such as pesticides, fertilizers or solvents
  • Infection with viruses such as Epstein-Barr, human T-lymphotropic virus type 1, HIV, hepatitis C, or certain bacteria such as Helicobacter pylori

The cause of lymphoma is not known, but there is a genetic component. Incidence rates are higher for those who have a family member diagnosed with lymphoma, especially a sibling. While environmental and lifestyle factors are known to play a role in the development of cancer among adults, these factors have less of an impact on the development of childhood cancer.

Treatment

Treatment of childhood lymphoma is mainly determined by staging. Staging is a way to categorise or classify patients according to how extensive the disease is at the time of diagnosis.

  • Chemotherapy (the use of highly potent medical drugs to kill cancer cells) is the primary form of treatment for all types of lymphoma.
    • In certain cases, radiation therapy (the use of high-energy rays to shrink tumours and keep cancer cells from growing), may also be used.
    • Short-term and long-term side effects – Intensive lymphoma chemotherapy affects the bone marrow, causing anaemia and bleeding problems, and increasing the risk for serious infections. Chemotherapy and radiation treatments have many other side effects — some short-term (including hair loss, changes in skin colour, increased infection risk, and nausea and vomiting) and some long-term (including heart and kidney damage, reproductive problems, thyroid problems, or the development of another cancer later in life).
  • Bone marrow transplants and stem-cell transplants
    • Although most kids do recover from lymphoma, some with severe disease will have a relapse.
    • During a bone marrow/stem cell transplant, intensive chemotherapy with or without radiation therapy is given to kill residual cancerous cells. Then, healthy bone marrow/stem cells are introduced into the body in the hopes that it will begin producing white blood cells that will help the child fight infections.
  • New Treatments
    • Promising new treatments being developed for childhood lymphomas include numerous different types of immunotherapy, specifically the use of antibodies to deliver chemotherapy medicines or radioactive chemicals directly to lymphoma cells.
    • This direct targeting of lymphoma cells may avoid the toxic side effects that occur when today’s chemotherapy and radiation treatments damage normal, noncancerous body tissues.

(Herbst, Fact Sheet on Childhood Hodgkin’s Lymphoma, 2017).

References

  1. Herbst, P. M. (2017, May). Fact Sheet on Childhood Hodgkin’s Lymphoma.
    Retrieved from CANSA: https://www.cansa.org.za/files/2017/05/Fact-Sheet-Childhood-Hodgkins-Lymphoma-NCR-2012-NA-web-May-2017.pdf
  2. Herbst, P. M. (2019, June). Fact Sheet on Childhood Burkitt’s Lymphoma.
    Retrieved from CANSA: https://cansa.org.za/files/2019/07/Fact-Sheet-Childhood-Burkitts-Lymphoma-NCR-2014-web-July-2019.pdf
  1. Herbst, P. M. (2019, September). Fact Sheet on Childhood non-Hodgkin’s Lymphoma.
    Retrieved from CANSA: https://cansa.org.za/files/2019/09/Fact-Sheet-on-Childhood-non-Hodgkins-Lymphoma-NCR-2014-web-Sept-2019.pdf