Children with lymphoma
Lymphomas are the third most common form of cancer among children. There are annually about 15 new cases of paediatric lymphoma in Finland; 2–5 are annually treated in Tyks.
Almost half of the paediatric lymphomas are Hodgkin's lymphomas, while slightly more than half are non-Hodgkin lymphomas. The non-Hodgkin lymphomas (NHL) of children are almost always aggressive diseases, and children rarely have the type of NHL seen in adults, where disease progression is slow.
Hodgkin's lymphomas (HL), on the other hand, are similar in appearance and behaviour in children as in adults.
Paediatric lymphomas may emerge in any organ containing lymphatic tissue: lymph nodes, tonsils, liver, spleen, thymus, skeleton, gut and elsewhere.
Of course, the location of the tumour determines largely the symptoms. If the tumour is situated, for example, in the mediastinum (the area between the lungs), the symptoms may be cough, hoarseness, feeling of chest pressure and dyspnea. General symptoms may include fever, loss of appetite, weight loss, night sweats, fatigue or itch.
The symptoms of NHL depend on the location of the tumour. Malignant cells may appear in the peritoneal cavity or other organs. If malignant cells are found in the bone marrow and blood, the symptoms may well mimic leukaemia. If a NHL is situated in the upper part of the mediastinum, the patient may experience cough and breathing difficulties or swelling of the face and neck.
The symptoms a NHL in the abdominal area (usually Burkitt's lymphoma) are usually abdominal pain, vomiting, nausea or distended abdomen. The disease may also cause haemorrhage in the gastrointestinal canal or obstruction of the gut. Lymphomas in the head and neck area usually cause lymph node enlargement, which may be marked, or tumours in the throat.
The treatment of lymphomas rests on combination chemotherapy, i.e., simultaneous or consecutive administration of cytostatic drugs. In some cases, radiotherapy may also be needed.
Patients with lymphoma experience disease-associated pain only rarely and this is also true at the time of diagnosis. Understandably, pain may still occur, depending on the size and location of the tumour or tumours.
Pain assessment and treatment are done continuously at the hospitals providing cancer treatment to children and young people, and procedure-associated pain is prevented by all available means. Pain is managed with medicines, and with creams and adhesives containing a topical anaesthetic.
The duration of lymphoma treatment varies by type of disease from just one month up to no less than two years. HL is also treated with radiotherapy if the effect of chemotherapy is suboptimal.
International protocols are followed for treating these lymphomas.
The prognosis of Hodgkin's lymphoma is good: up to 90% of the children with HL are permanently cured. Most children (70–90%) are cured even if the disease is wide spread at the outset. Also relapsed HL is often curable.
Regarding the prognosis of NHL it is most important to specify what type of lymphoma is being treated and how advanced is it. Generally, the prognosis is good. The prognosis is best for patients with Burkitt's lymphoma, 90% of whom are cured with our current treatment. The prognosis of patients with other forms of NHL is slightly poorer.