Lymphomas In Children

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Lymphomas In Children
Lymphomas In Children
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Video: Lymphomas in children 2023, February
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Lymphomas in Children

Malignant lymphomas in childhood are cancers that start from immature cells of the specific immune system, the lymphocytes. With a share of around eleven percent, they are the third most common pediatric cancer and the most common in adolescence. The cause of changes in the genome of the affected lymphocytes is unclear.

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  • What types of lymphoma are there in children and adolescents?
  • What are the causes of lymphomas?
  • What are the symptoms?
  • How is the diagnosis made?
  • How is lymphoma treated?
  • Whom can I ask?
  • How are the costs going to be covered?

What types of lymphoma are there in children and adolescents?

Hodgkin's lymphoma and the large group of non-Hodgkin's lymphomas are distinguished on the basis of the affected tissue.

Hodgkin lymphoma

Hodgkin's lymphoma (Hodgkin's disease, Hodgkin's disease, lymph gland cancer, lymphogranulomatosis) accounts for around five percent of malignant diseases in children and adolescents. Infants and young children are rarely affected, and the disease becomes more common with age. Thanks to modern therapies, almost all children and adolescents who develop Hodgkin's lymphoma for the first time can be cured. Hodgkin's disease is caused by a malignant change in the B lymphocytes. The lymph nodes are most frequently affected, but other organs such as the spleen, and less frequently the lungs, liver, bones or bone marrow can also be affected.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) can occur at any age. Children over the age of five are most often affected. NHL is rare before the age of three. One of the main signs is swelling of the lymph nodes (lymphomas). In pediatric oncology, the following distinguishable biological subspecies are of clinical, therapeutic and prognostic importance:

  • Lymphoblastic lymphomas: These correspond to lymphoblastic leukemias in many ways at the cellular level. The arbitrary distinction is made based on the extent of bone marrow involvement: if the bone marrow is more than 25 percent, it is called leukemia. These lymphomas of the T-cell type are more common, affect boys more often than girls, are rather rare in small children and are characterized by rapid, aggressive growth. In addition to palpable, painless swelling of the lymph nodes in the chest, the thymus gland is often affected and enlarged, which can cause breathing difficulties. Surgical or radiation treatment has no prognostic advantages. The drug treatment is similar to that of lymphoblastic leukemia, and the healing prognosis is generally good.
  • Mature B-cell lymphomas of the Burkitt type: Burkitt lymphomas are one of the fastest growing malignancies. Lymphatic tissue of the outer and inner neck or the lower small intestine (Peyer's plaques) are often affected. Often, a lymphoma-related invagination of the lower small intestine into the large intestine can lead to reduced blood flow to the intestine with severe pain and an intestinal obstruction. Over 80 percent of the sick can be cured with chemotherapy.
  • Large cell lymphomas: painless swelling of the lymph nodes or organ infiltration develop at different speeds. In some of these lymphomas, an inflammatory reaction caused by the cancer of the lymph glands can simulate an infection.

Almost all childhood and adolescent NHL spreads rapidly throughout the body, causing serious illness that, if left untreated, is fatal. Thanks to efficient therapies, most of those affected can be cured.

What are the causes of lymphomas?

The cause of changes in the genome of the affected lymphocytes is unclear. According to current knowledge, it is likely that various factors must work together before a lymphoma develops. For most diseases there is no indication of a special prerequisite, but there is an increased risk with congenital or acquired immune deficiency or with congenital defects in the gene repair system, examples of this include:

  • congenital diseases of the immune system (e.g. Wiskott-Aldrich syndrome, Louis Bar syndrome),
  • acquired immune deficiencies (e.g. through HIV infection),
  • Infection with viruses (e.g. Epstein-Barr virus),
  • immunosuppressive therapy over a long period of time (e.g. as part of an organ transplant),

Theoretical external causes are:

  • radioactive beams,
  • chemical substances,
  • Medication.

What are the symptoms?

Signs of illness can vary greatly from person to person. Common complaints include:

  • Fever (over 38 ° C);
  • Tiredness, general exhaustion, listlessness, feeling sick;
  • heavy night sweats;
  • unexplained weight loss;
  • Loss of appetite;
  • Itching all over the body;
  • painless, palpable lymph node swelling;
  • Chronic cough, breathing difficulties (if, for example, breast lymph nodes, airways or pleura are affected;
  • Abdominal pain, back pain, feeling of pressure or diarrhea (if lymph nodes or other organs in the abdomen are affected, e.g. spleen and liver);
  • Pale skin due to a lack of red blood cells (anemia) (if the bone marrow is affected);
  • Bone or joint pain (if the bones are affected).
  • Headache, visual disturbances, vomiting on an empty stomach, cranial nerve paralysis (if the central nervous system is involved);
  • Increased susceptibility to infections (due to the reduction in functional white blood cells);

How is the diagnosis made?

If there is evidence of lymphoma in the medical history or during a physical examination, a blood test is carried out. If the suspicion is confirmed, further examinations are carried out in a hospital specializing in cancer and blood diseases in children and adolescents, for example:

  • Lymph node biopsy,
  • Bone marrow and lumbar puncture: in NHL,
  • Ultrasound examination,
  • Magnetic resonance imaging,
  • Computed tomography,
  • Positron emission tomography,
  • Skeletal scintigraphy.

How is lymphoma treated?

The focus is on chemotherapy. In some of the patients, this is followed by radiation therapy in the affected regions. In rare cases, e.g. if the disease does not respond to the usual treatment or if the disease relapses (relapse), high-dose chemotherapy can be considered. Since this also destroys the blood-forming system in the bone marrow, stem cells for blood formation must then be transplanted.

In the early stages of a so-called lymphocyte-predominant Hodgkin lymphoma (LPHL), a single affected lymph node can often be completely surgically removed. About two thirds of these patients get well without chemotherapy and radiation therapy. However, they must continue to be examined regularly and treated appropriately if the disease recurs.

forecast

Almost all children and adolescents can be cured long-term if they develop Hodgkin's lymphoma for the first time. In non-Hodgkin lymphomas, cure rates of 80 to 90 percent can be expected, depending on the subtype and stage of spread. The disease relapses (relapse) in around ten to 15 percent. In these cases, the chances of recovery from Hodgkin lymphoma are generally better than that of non-Hodgkin lymphoma. Even with some large-cell lymphomas, the chances of recovery are comparatively good after a relapse.

Whom can I ask?

The first point of contact is a doctor specializing in paediatrics.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Medical aids & aids
  • Health Professions AZ
  • and via the online guide to reimbursement of social insurance costs. 

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