What is lymphoma? This is an oncological disease of lymphoid tissue. A distinctive feature of this disease is the increase in lymphoid nodes, the destruction of various internal organs, in which there is a significant accumulation of lymphocytes with tumor cells. White blood cell (lymphocyte) is the main element of the body’s immune system. In ICD-10, lymphoma is listed under the code C 85.
Causes
The exact causes of lymphomas in children are currently not fully understood. The appearance of the disease is predisposed to pathologies in lymphocytes. Cells can affect not only the lymph nodes, but also other internal organs. But doctors identify some causes of Hodgkin's lymphoma in children, the prognosis of which is not very favorable:
- hepatitis infection;
- HIV infection;
- malignant changes in B-lymphocytes;
- autoimmune diseases (lupus erythematosus, rheumatoid arthritis);
- radioactive radiation not only on the child, but also on the woman during pregnancy;
- the use of immunosuppressive therapy;
- decreased immunity;
- the presence of leukemia in parents or other relatives;
- infectious disease and herpes virus infection;
- the effect of carcinogens;
- chemotherapeutic treatment, radiation therapy;
- genetic and ethnic predisposition (Klinefelter and Down syndrome);
- lymphoid depletion;
- the persistence of certain viruses - Epstein-Barr, Louis-Bar, Wiskott-Aldrich, T-lymphocytic.
If chemotherapeutic treatment was used to eliminate other tumors in children, there is an increased risk of developing lymphoma, since drugs of this type are very toxic and can damage the genetic apparatus of both cancer cells and healthy cells.
How is lymphoma manifested?
According to oncologists, up to 3 years of age, lymphoma occurs extremely rarely, but with age, the risk of its development increases. Therefore, if the family has or had previously had malignant oncopathologies, it is necessary to carefully monitor the health of the child, regularly undergo examinations that will not let the moment of the onset of the disease begin to be missed. Most often, in childhood, Hodgkin’s lymphoma develops, which has favorable prognoses than non-Hodgkin’s lymphoma. In general, today the influence of causes on the occurrence of lymphomas is being actively studied.
Symptoms
Early detection of symptoms of lymphoma in children significantly increases the chances of a favorable prognosis and the effectiveness of the therapy. As a rule, symptoms are detected during medical examination for other diseases, but a very important role is given to parents, who must carefully monitor changes in the physical condition and behavior of children.
The main symptom of lymphoma in children is an increase in one or several lymph nodes at once. The increase in size is most often observed on lymph nodes located in the neck, in the clavicular and occipital parts, in the armpits, in the inguinal region, as well as in the hidden lymph nodes (in the pelvis, abdomen, and spine). It should be noted that the increase in lymph nodes is painless and does not cause the child any unpleasant sensations, so the task of parents is not to miss these physiological changes on the baby’s body.
In the case when enlarged lymph nodes begin to press on the organs located next to them, concomitant symptoms occur:
- shortness of breath or coughing may indicate an enlarged lymph node in the trachea or lungs;
- abdominal pain, digestive upset may be the result of an increase in hidden lymph nodes in the abdomen;
- when lymph cells enter the liver or spleen, these organs become enlarged.
The presence of lymphoma in a child is also accompanied by some common symptoms that are characteristic of a number of diseases. These symptoms must be taken into account when drawing up a general history. These include:
- The child quickly gets tired - at the initial stage appears after active actions, but the further the disease develops, the more passive the child becomes? and activity time is reduced.
- Increased drowsiness, apathy.
- The child sweats heavily at night, in combination with weight loss and fever.
- Severe skin itching for no apparent reason.
You can’t say for sure how long lymphoma develops in children. In some, symptoms appear after three weeks, in others after four months.
Kinds
Nowadays, there are many types of lymphomas, but not so long ago they were divided into Hodgkin's disease and non-Hodgkin's lymphoma, however, such a contrast of this disease does not fully reflect the essence of lymphoma and does not allow to determine the most effective treatment tactics and its prognosis.
Non-Hodgkin lymphomas were divided into neoplasms that have a high and low degree of malignancy. Several types of lymphomas were identified in each group, taking into account the morphological characteristics of tumor cells. This classification was accepted, but at the moment this system is outdated, since non-Hodgkin lymphoma has about 16 subtypes.
Hodgkin's lymphoma
What is Hodgkin's lymphoma? In fact, this type of lymphoma is not lymphoma per se, since the neoplasm consists of monocytic and macrophage cells, and not of lymphocytes. So, the disease is considered separately from non-Hodgkin lymphomas, but it is still a malignant formation that occurs in the tissue of the lymph nodes.
Non-Hodgkin lymphoma
This is an extensive concept, therefore, to confirm the diagnosis, it is necessary to clarify the cause of its formation, as well as the level of malignancy. Lymphoid tissue has lymphocytes of two groups: B-lymphocytes and T-lymphocytes. The latter are needed for cell immunity, which contribute to the inactivation of foreign particles. For the formation of specific proteins that bind to a fungus, virus and bacteria, neutralize them, there are B-lymphocytes. These cells are grouped in follicles, in which the periphery is predominantly T-cell, and the center is B-lymphocytic. If the conditions are appropriate, inadequate proliferation of cells in a particular area may occur, which determines the type of neoplasm.
Mature cell lymphomas
These are relatively benign lymphomas that arise from mature lymphocytes, differing in an almost asymptomatic course. The only and most reliable symptom of lymphoma is called excessive enlargement of the lymph nodes. Some of the mature cell lymphomas for a certain time pass into the lymphosarcoma.
Burkitt's Lymphoma
This type of lymphoma has a high level of malignancy, it spreads to the blood, internal organs and bone marrow, beyond the borders of the lymphatic system. The disease begins gradually and suddenly, which is affected by the localization of the tumor.
Large-cell diffuse limform
This type of lymphoma is highly aggressive. The primary focus in most cases is located extradontally or in the lymph nodes. Separately, it is worth noting the primary B-large cell lymphoma of the mediastinum, which occurs in the thymus, gradually growing into the mediastinum.
Diagnostics
When conducting procedures for the diagnosis of lymphoma in children, an external medical examination of the patient who is being treated is initially carefully carried out. After that, to confirm the diagnosis, the child must pass the following necessary tests:
- blood;
- do an ultrasound or x-ray.
In addition, in order to confirm the presence of lymphoma, it is mandatory to carry out several interconnected important studies, thanks to which it will be possible to accurately determine which variant of the disease is present and at what stage it is now. Doctors, using a tissue analysis of the patient, use the biopsy method. To conduct it precisely by this method, a diseased lymph node is taken and carefully examined by a specialist under a microscope.
In order to determine the stage of an existing disease, in addition to the methods listed above, one can use magnetic resonance imaging, two-photon emission tomography, perform computed tomography or make scintigraphy of the skeleton. To get as much information as possible about a tumor in the bone marrow and determine how many affected cells there are, at the most critical stages of the disease, they go on to trepanobiopsy.
Before starting the necessary treatment therapy, it is tedious to examine the child’s heart by making a cardiogram or replacing it with an ultrasound scan of the heart, and for greater effectiveness, both procedures can be performed simultaneously. In addition, it may be necessary to diagnose for abnormalities in the metabolism.
All these diagnostic methods may not be used in each case. What kind of study or a set of studies to assign to the patient can only be determined by the attending physician.
Treatment
If the child has a physically confirmed lymphoma, he must be urgently put in the oncology department of the hospital, and the hematology department may also be suitable.
In most cases, chemical therapy is used for treatment. In this case, the baby is treated with a cytostatic agent, focused on the suspension of cell separation or their complete elimination (cells where the tumor is detected). Using only one method will not be enough to eliminate all affected cells, as a result of this, doctors have developed a combination of cytostatics, otherwise they are also called polychemical therapy. This method is considered the best because of its maximum effectiveness.
After chemical treatment procedures, in some cases, radiation is also used - radiation therapy. If chemical and radial therapy do not give the desired results or the disease recurs, they switch to high-dose chemotherapy. A bad factor in this type of therapy is its poor effect on bone marrow blood. As a result of this, it is important to do a stem cell transplant - they often resort to an autologous bone marrow transplant.
Treatment of Hodgkin's disease with lymphocyte dominance
At the initial stages of the disease, one infected lymph node is removed (if there are no other affected ones), if after that no complications arise. Somewhere more than half of patients in these cases are cured without resorting to radial and chemical therapy. They must undergo a systematic examination to constantly monitor their condition. This process is called a wait-and-see study strategy. If there are signs of lymphoma, this strategy ends.
Chemotherapy area
In traditional Hodgkin's disease, several chemotherapeutic blocks are made. The number of cycles, their duration and tension are initially based on what stage of the disease the child has and depend on which therapeutic group is used to treat the patient. Any block of therapy lasts no more than two months. The following substances are included in any treatment course:
- Prednisolone
- Vincristine;
- "Etoposide";
- "Doxorubicin."
In the intervals between therapy, a two-week interval is necessary. On average, the course of treatment for lymphoma lasts at least two and no more than six months, in cases where no repetition of the disease has been detected.
Radiation therapy
Currently, proctologists recommend that for half of the patients do radiation therapy of the disease after the chemical. After observing how the patient's body responds to chemotherapy, the question arises of the possibility of radiation therapy.
In the event that two blocks of chemical therapy for PET were performed, improvements appeared, then the need for this therapy disappears (this applies to any form of the disease). A positive reaction to this method of treatment means a reduction in lymphoma by half, and, based on this, there are no active tumor cells in its residues.
Most often, radiation therapy is used after two weeks after the completion of chemical therapy. On average, a radiation dose equal to twenty gree is issued. With a reduction in the volume of lymphoma after the first two blocks of chemical therapy is carried out by approximately 75%, the radiation dose increases to thirty grays.
In order not to destroy healthy cells located next to the tumor, the required volume is issued not at one time, but in several procedures. Treat the affected area in small portions. The duration of radial therapy on average lasts two or three weeks. Weekends are given to the body for rest and recovery from the procedure.
Hodgkin Puncture
Treatment of lymphoma in children in state clinics in Moscow is possible, but will not bring such a result as abroad. In Germany, for children with lymphoma, only programs called the treatment optimization study are used for treatment. They are generally accepted hospital studies, setting themselves the task of treating patients with progressive programs and at the same time increasing the effect obtained from therapy.
Chances of recovery
Thanks to modern and accurate diagnostic methods and standard punctures of active therapy, the chances of recovery and complete cure of the tumor are very high. Before proceeding to treatment, all patients are divided into different therapeutic groups, each of which has its own treatment methods. According to ongoing studies, the disease often gives a repeat, but in subsequent cases it can be safely cured.