Tuesday, 30 July 2019

Lymphoma cancer

Lymphoma cancer

Lymphoma cancer


Childhood Hodgkin Lymphoma

What is childhood Hodgkin lymphoma?

Childhood Hodgkin lymphoma is a type of cancer that develops in the lymph system, which is part of the body’s immune system. The lymph system includes the following: 
• Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.
• Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
• Lymph Nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along with the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin. 
• Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest
behind the breastbone.

Other parts of the lymph system include the spleen, tonsils, and bone marrow. Because lymph tissue is found throughout the body, Hodgkin lymphoma can start in almost any part of the body and spread to almost any tissue or organ in the body. Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. Hodgkin lymphoma often occurs in teens (age 15 to 19). The treatment for children and teens may be different than treatment for adults.

Anatomy of the lymph system.
Figure: Anatomy of the lymph system.

Why do people develop childhood Hodgkin lymphoma?

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Risk factors for childhood Hodgkin lymphoma include the following: 
• Being infected with the Epstein-Barr virus
• Being infected with the human immunodeficiency virus (HIV)
• Having certain inherited diseases of the immune system
• Having a personal history of mononucleosis (“mono”)
Being exposed to common infections before the age of five may decrease the risk of Hodgkin lymphoma in children because of the effect it has on the immune system.

What are the symptoms of childhood Hodgkin lymphoma?

These and other symptoms may be caused by childhood Hodgkin lymphoma or by other conditions. Check with a doctor for any of the following problems:
• Painless, swollen lymph nodes in the neck, chest, underarm, or groin
• Fever for no known reason
• Weight loss for no known reason
• Night sweats
• Fatigue
• Anorexia
• Itchy skin
• Pain in the lymph nodes after drinking alcohol
Fever, weight loss, and night sweats are called B symptoms.

How is childhood Hodgkin lymphoma diagnosed?

If you have symptoms such as swollen lymph nodes or other signs that suggest Hodgkin lymphoma, your doctor may perform a physical exam, ask about your medical and family history, order blood tests or have chest x-rays or other imaging procedures done. However, a biopsy is the definitive way to diagnose childhood Hodgkin lymphoma. This is the removal of all or part of a lymph node. It is removed during one of the following procedures:
• Thoracoscopy: This is an exam of the inside of the chest, using a thoracoscope. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing.
• Mediastinoscopy: In this procedure, a scope is used to examine the organs in the area between the lungs and nearby lymph nodes.
• Laparoscopy: This procedure uses a laparoscope, inserted through the abdominal wall, to examine the inside of the abdomen.

Excisional biopsy is the removal of an entire lymph node. An incisional biopsy is the removal of part of a lymph node. Core biopsy is the removal of tissue from a lymph node using a wide needle. Fine-needle aspiration biopsy is the removal of tissue from a lymph node using a fine needle. A pathologist views the tissue under a microscope to look for cancer cells, especially Reed- Sternberg cells. Reed-Sternberg cells are large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma. Immunophenotyping may be done on the tissue that was removed: This is a test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out what type of malignant (cancerous) lymphocytes are causing the lymphoma.

What affects the chances of recovery and treatment options?

The prognosis (chance of recovery) and treatment options depend on the stage of cancer, the size of the tumor, the type of the Hodgkin’s lymphoma, and whether there are B symptoms at diagnosis. Other factors include certain features of the cancer cells, whether there are too many white blood cells or too few red blood cells at diagnosis, how well the tumor responds to initial treatment with chemotherapy, and whether the cancer is newly diagnosed or has recurred (come back).

What is staging?

After childhood Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body. The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. Treatment is based on the stage and other factors that affect prognosis. The following tests and procedures may be used in the staging process:
• CT Scan: A computer linked to an x-ray machine makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, and pelvis. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.

• Positron Emission Tomography (PET) Scan: A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

• Magnetic Resonance Imaging (MRI): A magnet, radio waves, and a computer are used to make a series of detailed pictures of areas inside the body.
• Bone Marrow Aspiration And Biopsy: The doctor inserts a hollow needle into the hipbone or breastbone to remove bone marrow, blood, and a small piece of bone by. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.
The following stages are used for childhood Hodgkin lymphoma:
• Stage I: Cancer is found in one of the following places in the lymph system:
• One or more lymph nodes in one lymph node group
• Waldeyer’s ring
• Thymus
• Spleen
• Stage IE: Cancer is found outside the lymph system in one organ or area.
• Stage II: Cancer is found in two or more lymph node groups either above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
• Stage IIE: Cancer is found in one or more lymph node groups either above or below the diaphragm and outside the lymph nodes in a nearby organ or area.
• Stage III: Cancer is found in lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
• Stage IIIE: Cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area.
• Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm, and in the spleen.
• Stage IIIE, S: Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.
• Stage IV: The cancer is found in one of the following combinations:
• Outside the lymph nodes throughout one or more organs, and maybe in lymph nodes near those organs.
• Outside the lymph nodes in one organ and has spread to areas far away from that organ.
• In the lung, liver, bone marrow, or cerebrospinal fluid (CSF). Cancer has not spread to the lung, liver, bone marrow, or CSF from nearby areas.
• Recurrent: Disease has recurred (come back) after it has been treated.

What treatments are used for childhood Hodgkin lymphoma?

The treatment of Hodgkin lymphoma in teens and young adults may be different than the treatment for children. Some teens and young adults are treated with an adult regimen. Five types of standard treatment are used:
Chemotherapy: Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.

The way the chemotherapy is given depends on the risk group. For example, children with low-risk Hodgkin lymphoma receive fewer cycles of treatment, fewer anticancer drugs, and lower doses of anticancer drugs than children with high-risk lymphoma.

Radiation Therapy: Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near cancer.

Radiation therapy may be given, based on the child’s risk group and chemotherapy regimen. External radiation therapy is used for childhood Hodgkin lymphoma. The radiation is given only to the lymph nodes or other areas with cancer.

Targeted Therapy: Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. One type of targeted therapy being used in the treatment of childhood Hodgkin lymphoma is monoclonal antibody therapy. Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Surgery: Surgery may be done to remove as much of the tumor as possible in some cases of childhood Hodgkin lymphoma.

High-Dose Chemotherapy With Stem Cell Transplant: This treatment is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These re-infused stem cells grow into (and restore) the body’s blood cells.

New types of treatment are being tested in clinical trials. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Childhood Non-Hodgkin Lymphoma

What is childhood non-Hodgkin lymphoma?

Childhood non-Hodgkin lymphoma is a disease in which malignant (cancer) cells form in the lymph system. Because lymph tissue is found throughout the body, childhood non-Hodgkin lymphoma can begin in almost any part of the body. Cancer can spread to the liver and many other organs and tissues. The specific type of lymphoma is determined by how the cells look under a microscope. The four major types of childhood non-Hodgkin lymphoma are:
• B-cell non-Hodgkin lymphoma (Burkitt and Burkitt-like lymphoma) and Burkitt leukemia
• Diffuse large B-cell lymphoma
• Lymphoblastic lymphoma
• Anaplastic large cell lymphoma
There are other types of lymphoma that occur in children. These include the following:
• Lymphoproliferative disease associated with a weakened immune system
• Rare non-Hodgkin lymphomas that are more common in adults than in children

What are the symptoms of childhood non-Hodgkin lymphoma?

Possible signs of childhood non-Hodgkin lymphoma include breathing problems and swollen lymph nodes. Other conditions may cause the same symptoms. Check with a doctor for trouble breathing, wheezing, coughing, or high-pitched breathing sounds. Swelling of the head, neck, upper body, or arms are also possible signs, as is trouble swallowing. Other signs include painless swelling of the lymph nodes in the neck, underarm, stomach, or groin, and in boys, painless lump or swelling in a testicle. Fever or weight loss for no known reason and night sweats are also possible signs.

What are the stages of childhood non-Hodgkin lymphoma?

The following stages are used for childhood non-Hodgkin lymphoma:
• Stage I: Cancer is found in one group of lymph nodes or one area outside the lymph nodes, but no cancer is found in the abdomen or mediastinum (the area between the lungs).
• Stage II: Cancer is found in one area outside the lymph nodes and in nearby lymph node; or in two or more areas above or below the diaphragm; or cancer started in the stomach, appendix, or intestines and can be removed by surgery.
• Stage III: Cancer is found in at least one area above and below the diaphragm, or cancer started in the chest, or cancer started in the abdomen and spread throughout the abdomen, or in the area around the spine.
• Stage IV: Cancer is found in the bone marrow, brain, or cerebrospinal fluid (CSF). Cancer may also be found in other parts of the body.
• Recurrent: Disease has recurred (come back) after it has been treated. Childhood nonHodgkin lymphoma may come back in the lymph system or in other parts of the body.

What affects the chances of recovery and treatment options?

The prognosis (chance of recovery) and treatment options for childhood non-Hodgkin lymphoma depend on the following:
• Age of patient
• Type of lymphoma
• Stage of the cancer
• Number of places outside of the lymph nodes to which cancer has spread
• Whether the lymphoma has spread to the bone marrow or central nervous system (brain and spinal cord)
• Whether there are certain changes in the chromosomes
• The type of initial treatment
• Whether the lymphoma responds to initial treatment
• Patient’s general health

What types of treatment are used for non-Hodgkin lymphoma?

Four types of standard treatment are used for childhood non-Hodgkin lymphoma: chemotherapy, radiation therapy (in certain patients), high-dose chemotherapy with stem cell transplant, and targeted therapy. These treatments are described earlier in this chapter. New types of treatment are being tested in clinical trials. Patients may want to think about taking part in a clinical trial. Some cancer treatments cause side effects months or years after treatment has ended. Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:
• Physical problems
• Changes in mood, feelings, thinking, learning, or memory
• Second cancers (new types of cancer)
Some late effects may be treated or controlled. It is important to talk with your doctors
about the effects, cancer treatment can have.

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