What is Hodgkin Lymphoma (HL)?
Hodgkin Lymphoma is a cancer arising within cells of the lymph glands (which includes the Spleen). There are many kinds of lymphoma, but broadly speaking these are divided into Hodgkin Lymphoma (HL) which spreads through the lymphatic system slowly, and Non Hodgkin Lymphomas (NHL) which in children tends to grow more quickly and spread through the blood stream. With modern treatment programs using multiagent chemotherapy, with or without radiation therapy, over 80% of children with HL will be cured. Cure rates vary depending on the risk factors and your doctor will give you a better estimate after taking those all into account.
What are the signs of childhood HL?
These are related to invasion of lymph nodes or lymph tissue but can also be due to substances released by the cancer:
- Painless lumps in the neck, collarbone area, armpits or groin
- Mass inside the chest
- Feeling tired or looking pale
- Weight loss, night sweats or fevers
What causes HL?
Nobody knows for sure, there is nothing in the diet that caused this. It is typically not inherited so other children in the family should not be at risk. It has been linked to viral infections such as “mono” (EBV), but it is not infectious so it cannot be passed to other children or playmates.
How is HL diagnosed?
- A careful physical exam and history may show some or all of the signs above.
- Blood tests such as complete blood count (CBC), blood chemistry and viral testssupport but do not confirm the diagnosis.
- Chest x-ray may show if the lymphoma has formed a mass in the chest.
- CT scan: is a special kind of X-ray that shows more clearly enlargement of lymph nodes, liver, spleen and chest masses in detail.
- Lymph node biopsy is the key test in which an affected lymph node is removed (biopsy) by a surgeon and sent to a pathologist who reviews the lymph tissue under a microscope looking for cancerous cells (Reed-Sternberg cells), and looking at markers on the surface of the cancer cells. This allows an accurate diagnosis and subtype
- PET-CT scan is a special kind of scan that can show where the lymphoma has spread in the body (and later can also show whether it is responding to treatment).
- Bone marrow aspiration and biopsy, removal of liquid bone marrow and a tiny piece of bone by inserting a needle into the hipbone while the child is sedated can check for spread of HL, it may not be needed if a PET-CT scan has already been done.
What is risk grouping in HL?
Risk factors tell us how likely the HL will come back without adequate treatment (relapse) and are used to plan chemotherapy, which includes information at diagnosis:
- Ann Arbor Stage (disease spread, I being localized, and IV being widespread)
- Presence of fever, weight loss, and night sweats (B symptoms), absence labeled as A
- Bulky disease.