Do you want your child to know about Non-Hodgkin's Lymphoma? Let's talk about it!

Even if our little ones get a little cold, they feel very scared, don't they? Sometimes, even if you think it's a normal illness, it can be something a little more serious. That's right, a type of cancer that occurs in children, but can be cured if treated properly, is called Non-Hodgkin's Lymphoma . Don't be scared when you hear this name, because it's very important to be well-informed about it. Shall we talk about this in a little more detail ?

Wait a minute, what is this Non-Hodgkin's Lymphoma?

Simply put, non-Hodgkin lymphoma is a type of cancer that starts in the lymphatic system in children. Your body has something called the lymphatic system . It's like our body's defense system. It helps protect us from diseases and germs . This system has parts like lymph nodes and lymph vessels. These are spread throughout the body.

This disease usually affects children between the ages of 5 and 19. But sometimes newborns can also be affected. The good news is that doctors have effective treatments for this, and many children can be cured. However, some children may develop late effects years after treatment. That's why researchers are constantly trying to find more effective treatments that have fewer late effects.

How does this condition affect my child?

This disease, called Non-Hodgkin's Lymphoma, can develop in lymphoid tissue anywhere in a child's body. It can even affect the central nervous system . This lymphoid tissue is also part of the immune system.

This cancer starts in special types of cells in the lymphatic system. These are B-lymphocytes (B-cells), T-lymphocytes (T-cells), or Natural Killer (NK) cells. These cells protect us from various bacterial and viral infections .

There are three main types of non-Hodgkin's lymphoma in children. Each type can affect children differently.

1. Mature B-cell lymphomas

These are types of lymphoma that arise from B-cells. They account for more than half of all non-Hodgkin lymphomas in children. The good news is that more than 90% of children with this type of lymphoma make a full recovery after treatment. There are several main types:

• Burkitt lymphoma/leukemia: These are different forms of the same disease. The treatments are very similar. It usually starts in the lymph nodes in the abdomen or chest. But sometimes it can affect the bone marrow, long bones in the limbs, or the central nervous system. In Burkitt leukemia, there are a large number of abnormal cells in the child's blood, which come from cells in the bone marrow. Both Burkitt lymphoma and leukemia grow very quickly.
• Diffuse large B-cell lymphoma: This is more common in young children between the ages of 12-19 than in younger children.
• Primary mediastinal B-cell lymphoma: This starts in B-cells in the mediastinum, an area behind a child's breastbone. It can also spread to lymph nodes. This is also most common in young children.

2. Lymphoblastic lymphoma

This type accounts for about a third of all non-Hodgkin lymphomas in children. It is also more common in younger children than in older children. Lymphoblastic lymphoma can affect either B-cells or T-cells.

It usually starts in the lymph nodes in the child's mediastinum (the area behind the chest bone) or neck. But it can also affect the lymph nodes in the abdomen, bone marrow, or other organs. More than 80% of children who are treated for this type survive.

3. Anaplastic large cell lymphoma (ALCL)

This accounts for about 15% of all non-Hodgkin lymphomas in children. It affects T-cells and usually begins in the lymph nodes. It can also affect the skin and bones. Approximately 70% of children with ALCL survive.

How common is this disease among children?

Each year, between 800 and 1,000 children are diagnosed with non-Hodgkin's lymphoma. It is slightly more common in white boys. The risk of developing this disease varies with a child's age, and the risk may increase slightly as the child grows.

What are the symptoms of non-Hodgkin lymphoma?

The symptoms of this disease can sometimes be similar to those of other, less serious illnesses. That's why you should be concerned. If your child has swollen lymph nodes, persistent breathing difficulties, a chronic cough, or a fever , you should definitely see a doctor.

Other symptoms may include:

• Frequent fever for no reason.
• Cough.
• Night sweats.
• Weight loss for no reason.
• Swelling of the head, neck, upper body, or arms.
• Difficulty swallowing (dysphagia).

Remember, just having one or two of these symptoms does not mean that your child has this disease. However, if these symptoms persist or worsen, you should definitely seek medical advice.

What causes this disease in children?

In fact, the exact cause of non-Hodgkin's lymphoma in children has not yet been found. However, doctors have identified several risk factors. Even if these risk factors are present, it does not mean that a child will definitely develop this disease. But it is good to be aware of these.

If your child has any of these health problems, ask your doctor about this condition:

• If your child has been treated for another type of cancer.
• If your child has been infected with mononucleosis (Mononucleosis – Epstein-Barr virus) or HIV (Human Immunodeficiency Virus).
• If your child has a weakened immune system (for example, if they have had an organ or bone marrow transplant).
• If the child is taking medications that suppress the immune system.
• If the child has certain hereditary diseases that affect the immune system.

Inherited immune system diseases

Hereditary diseases such as these may increase the risk of developing non-Hodgkin's lymphoma:

• Ataxia-telangiectasia: This is a neurological disease that affects the central nervous system, immune system, and other systems of the body in children.
• Chediak-Higashi syndrome: This affects the immune system and nervous system in children.
• Common variable immunodeficiency: Children with this condition have low levels of antibodies (proteins that fight infection) in their blood.
• Nijmegen breakage syndrome: Children with this condition have immunodeficiency and low levels of immune system proteins and T-cells.
• Severe combined immunodeficiency disorder (SCID): This affects children's T-cells and B-cells, weakening the immune system and putting them at a higher risk of developing certain cancers, including non-Hodgkin lymphoma.
• Wiskott-Aldrich syndrome: This affects children's blood cells and immune system cells. Children with this condition have low levels of platelets. Platelets are cells that help blood clot. When they are low, they can cause easy bruising and bleeding. This syndrome also affects the T-cells and B-cells of the immune system.
• X-linked lymphoproliferative syndrome: This affects the immune system in children. Children with this syndrome may have an unusually severe response to Epstein-Barr virus infection.

How do doctors diagnose non-Hodgkin lymphoma in children?

Diagnosing this disease is a bit of a detailed process. Usually, a series of blood tests, various imaging tests, and biopsies are done. The doctor will carefully examine the child to see if there are any abnormalities, such as lumps or swollen glands. They will also look at the health information of the family, that is, close relatives and distant relatives, and whether there is a history of cancer.

Blood tests

• Complete blood count (CBC): This measures the number of different types of cells in your child's blood. The results can help determine if your child has signs of lymphoma in their bone marrow or if treatment has affected their bone marrow.
• Blood chemistry studies: Blood samples are taken to measure the levels of certain substances released into the blood from the child's organs or tissues. Abnormally high or low levels of a substance can be a sign of disease.
• Liver function tests: This is also a blood test. It measures the amount of certain substances released by the liver into the blood. If there are more than normal amounts, it could be a sign of cancer.

In addition, doctors also use blood tests to check for viruses that may be linked to non-Hodgkin's lymphoma in children.

Imaging tests

• CT scan (Computed tomography – CT scan): This can take detailed pictures of areas inside your child's body. This test is done to look for swollen lymph nodes or other signs of lymphoma.
• MRI scan (Magnetic resonance imaging – MRI): This uses a magnet, radio waves, and a computer to make a series of detailed pictures of the inside of the body. It is used to check for signs of lymphoma in the child's brain or spinal cord.
• PET scan (Positron emission tomography – PET scan): This is used to see if a child has lymphoma or how treatment has affected the lymphoma. During a PET scan, a small amount of radioactive glucose, or sugar, is injected into the child’s body. Cancer cells are more active than normal cells, so they use a lot of glucose. This scan can show where the cancer cells are.
• Ultrasound: This uses high-energy sound waves. These waves bounce off tissues or organs inside the body and create echoes. These echoes are used to create a picture called a sonogram. This is used to look for lymph nodes that are close to the surface of the baby's body, or in the abdomen, liver, or spleen.

Biopsies

Doctors perform biopsies to take samples of lymph nodes, cancerous lumps, and bone marrow and examine them under a microscope or in other lab tests. A biopsy is the only way to definitively diagnose the disease. More importantly, the biopsy results can help determine the exact type of lymphoma. This can then help determine the best treatment for that type.

There are several types of biopsies. Doctors choose the type of biopsy that will cause the least side effects to the child and will remove enough cells and tissue for testing. During these tests, the child is given sedatives, numbing medication, or local or general anesthesia to make sure they don't feel any discomfort.

• Surgical biopsy: An entire lymph node, a lump of tissue, or a small piece of a larger cancerous lump can be surgically removed.
• Needle biopsies: Either core biopsies or fine-needle biopsies are performed to remove tissue or parts of the lymph node.

Other types of biopsies

If your child has non-Hodgkin's lymphoma, further tests may be done to collect tissue to see if the lymphoma has spread. As with other biopsies, these are done under sedation and/or anesthesia to make sure your child doesn't feel any discomfort.

• Lumbar puncture (spinal tap): This is done to see if the cancer has spread to the child's brain and spinal cord.
• Bone marrow aspiration and bone marrow biopsy: These tests are done to see if the lymphoma has spread to your child's bone marrow. To do this, a doctor inserts a hollow needle into your child's hipbone and takes a small sample of bone marrow and bone.
• Thoracentesis: If the lymphoma has spread to the lining of your child's chest or the membrane that covers the lungs, fluid may collect. The fluid is removed using a hollow needle and checked for cancer cells.
• Paracentesis: This involves removing fluid from the baby's abdomen.
• Mediastinoscopy: This is a surgical procedure performed under general anesthesia. It is done to look for abnormalities in the organs, tissues, and lymph nodes between your child's lungs. It is done with a device called a mediastinoscope. It is a thin, tube-like instrument that has a light and lens to see through, and a tool to take tissue or lymph samples. It is inserted through a small incision in the upper part of your child's breastbone.

Do doctors divide pediatric non-Hodgkin lymphoma into stages?

Yes, there are stages to classify Non-Hodgkin's lymphoma. These cancer staging systems are used to create treatment plans.

Non-Hodgkin lymphoma stages

• Stage I: The cancer is in only one area, either above or below the child's diaphragm (the large muscle that separates the chest and stomach).
• Stage II: Cancer is in one area and nearby lymph nodes, or in two or more lymph nodes, or in other areas on the same side of the diaphragm.
• Stage III: The cancer is in one of the following four stages:
• There is cancer in the tissues or lymph nodes on both sides of the diaphragm.
• The child has breast cancer.
• The child has stomach cancer, and it can't be removed with surgery.
• Stage IV: The cancer is in the child's bone marrow, spinal cord, and/or brain.

How is non-Hodgkin lymphoma in children treated?

Doctors continue to search for new treatments, especially ways to cure lymphoma without causing serious late effects. Late effects are serious health conditions that can develop years after treatment ends and a child's non-Hodgkin's lymphoma is gone.

There are six main types of treatment:

• Chemotherapy: This is the main treatment for children with non-Hodgkin lymphoma. Doctors may use just one drug or a combination of several drugs.
• Surgery: In some cases, cancerous lumps are surgically removed at the same time as the biopsy. Even then, the child may need additional treatments, such as chemotherapy or immunotherapy.
• Targeted therapy: This affects specific cancer genes, proteins, or small particles inside lymphoma cells that help them escape the effects of chemotherapy.
• Immunotherapy: This treatment works by stimulating the child's immune system, or by using artificial components of the immune system, to destroy lymphoma cells.
• Radiation therapy: In some cases, radiation therapy is used to destroy any remaining cancer cells.
• Stem cell transplantation: Stem cells taken from the blood or bone marrow are used to replace unhealthy cells with healthy cells.

What are the late effects of cancer treatment?

Late effects of cancer treatment are health conditions that can develop months or years after treatment ends. Some late effects can be life-threatening. As more and more children are living longer after treatment for non-Hodgkin's lymphoma, doctors are trying to identify and treat these late effects as early as possible.

Some of the most common late effects seen in children with non-Hodgkin lymphoma are:

• Secondary cancers: As the name suggests, these are new cancers that develop in children after treatment for non-Hodgkin lymphoma. Common ones include acute myeloid leukemia, myelodysplastic syndrome, breast cancer, and thyroid cancer.
• Heart conditions: Some children who receive chemotherapy may develop heart conditions such as congestive heart failure, heart weakness (cardiomyopathy), hardening or narrowing of the arteries (coronary artery disease), abnormal heartbeat (arrhythmia), or damage to the protective covering of the heart (pericarditis).
• Pneumonitis (inflammation of the lungs): Some chemotherapy drugs can affect the lungs in children.
• Liver problems: Children taking some chemotherapy drugs may develop an enlarged liver or cirrhosis of the liver.

What about clinical trials for pediatric non-Hodgkin lymphoma?

Your child's doctor may recommend that you participate in a clinical trial for treatment of non-Hodgkin's lymphoma. In a clinical trial, some people receive the standard of care, while others receive treatments that are being evaluated.

Standard treatments are drugs and other treatments that have already been approved and have been proven to work. Trial treatments, as the name suggests, are treatments that are being tested to see if they work better than standard treatments, or if they work the same way but have fewer side effects.

Clinical trials may involve new drugs, new doses of existing drugs, or new combinations of existing treatments. Often, doctors at pediatric cancer centers oversee these clinical trials. Ask your doctor if a clinical trial might be a treatment option for your child.

Can non-Hodgkin lymphoma in children be cured?

Yes, doctors can cure many children with non-Hodgkin's lymphoma with the treatments they have. That's really comforting, isn't it?

What is the survival rate for pediatric non-Hodgkin lymphoma?

The survival rate for children with non-Hodgkin's lymphoma varies depending on the type of lymphoma. On average, between 70% and 90% of children with the disease survive more than five years after diagnosis.

What happens after my child finishes treatment for non-Hodgkin lymphoma?

When cancer treatment is over, you and your child will probably feel a great sense of relief and happiness. Celebrate that joy, but remember, your child will still have to maintain contact with the doctor for several more years.

During the first few years after treatment, your doctor will likely recommend regular follow-up examinations and tests. This will help monitor your child's overall health, check for any recurrences of the cancer, and monitor for signs of aftereffects. Your child will need blood tests and scans.

How can I/my child manage the after-effects of cancer treatment?

Children can experience aftereffects of cancer treatment months or even years after treatment ends. Knowing this can make you and your child feel anxious about the future. But know that your child's doctor will monitor your child's health after treatment, so any problems can be identified and treated quickly.

Ask your doctor about the possible aftereffects your child may experience and what the early signs are. Encourage your child to be alert for signs of these aftereffects as they become younger and begin to take care of their own health.

Can I reduce my child's chance of developing non-Hodgkin lymphoma?

Children with weakened immune systems may be more likely to develop non-Hodgkin's lymphoma. For example, if your child has had a bone marrow or organ transplant, they may be at risk for this disease. Also, if your child has certain hereditary diseases that affect the immune system, the risk may be increased.

Your child's doctor knows your child's health history. If you have concerns about this, ask your doctor if your child has any conditions that put them at risk for developing this disease. Then, you can look out for specific things that could be early signs of non-Hodgkin lymphoma.

My child has non-Hodgkin lymphoma. How can I help him?

Cancer is hard for everyone, but it is especially hard for children. Young children may not be old enough to understand why it is so hard for them. They may be afraid of tests and treatments. It is natural for young children who are learning about their illness to feel angry and scared about their situation. If you and your child are struggling to cope with the effects of cancer, ask your doctor about child life services. These services are provided by specialists who help children and families cope with the challenges of cancer.

One moment you have a healthy child, and you think they have a normal illness. The next moment, you have a child with cancer. It's not easy to find out that your child has non-Hodgkin lymphoma. Even though doctors cure many children with this condition, your child still has to face intensive medical treatments that interfere with their daily life. Even after treatment, your child may develop aftereffects, serious health conditions that require additional treatment. It's all hard to cope with. You may feel like your world has been turned upside down, and you may wonder if it will ever be right again.

But remember, your child's doctor understands what you and your child are going through. Ask them for help, which can include information about your child's condition, resources for you and your family, and they're happy to do whatever they can.

Finally, take-home message

• Non-Hodgkin's Lymphoma in children is a cancer that occurs in the lymphatic system.
• This can often be successfully treated, especially if detected early.
• Be aware of symptoms (such as swollen lymph nodes, persistent cough, fever, weight loss). If these persist, see a doctor.
• There are several treatment options (such as chemotherapy, surgery, and radiation therapy). The doctor will choose the treatment that is best for your child.
• After-effects may occur after treatment, so it is important to continue to have medical check-ups.
• You are not alone. Doctors, nurses, and counselors are there to help you and your baby. Don't be afraid to ask them for help.

I hope this information has helped you gain some understanding of this disease. Remember, with a positive attitude and proper medical treatment, you can overcome this challenge.

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