Lymphoma Explained

Lymphoma Explained in Plain English

Lymphoma is a type of cancer that starts in the cells of the lymphatic system, specifically in a kind of white blood cell known as a lymphocyte. Doctors classify it as a blood cancer, making it one of the three most common cancers in children. To understand how lymphoma can affect your child, it is important first to understand what the lymphatic system is and what it does.

The Lymphatic System

The lymphatic system has several vital roles in the body. It helps keep fluid levels balanced so that cells will not rupture, removes waste and harmful substances from tissues, and plays a critical role in the immune system by moving white blood cells to areas that need them. The lymphatic system consists of:

• Lymph: This is a fluid that the cells release, but the blood vessels do not take it back. It contains such things as proteins, bacteria, and cell debris.
• Lymph nodes: You can find these little bean- or oval-shaped structures in the abdomen, underarms, groin, pelvis, neck, and chest. These nodes are where white blood cells actively clean and monitor the lymph fluid for problems while awaiting orders to move to problem areas (such as a break in your skin from scratching).
• Lymph vessels: These are tubes that move fluid and white blood cells throughout the body, similar to how blood vessels work.
• Lymph cells:  These cells can be found in many tissues and organs throughout the body, like the small intestine, spleen, tonsils, adenoids, thymus, and bone marrow.

The lymphatic system will channel extra fluid and waste to the kidneys, where it is filtered and leaves the body. It is important for the body to keep the system balanced in a process called homeostasis. Anytime something imbalances that system is when your child feel unwell as their body fights to bring it back into balance.

Symptoms

The symptoms of lymphoma can differ based on where it is within the body, and they can also vary from one child to the next who has the same type. Because these symptoms can look like more ordinary things, such as common infections, it can be hard to diagnose. It is essential to tell the doctor if there is a family history of lymphoma or other cancers.

Some general signs to watch for include:

• A prolonged fever (103 degrees or higher) that doesn’t go away or returns
• Unexplained weight loss not caused by diet or exercise
• Heavy night sweats that drench both clothing and bedding
• Painless swelling of lymph nodes in the abdomen, neck, groin, or armpits that does not go away after several weeks.
• Ongoing fatigue even with plenty of sleep.
• Dry and itchy skin
• Pain in the chest, abdomen, or bones

Specific signs may also develop based on where the cancer is, such as:

• Chest – trouble catching their breath, wheezing, a cough that may not go away
• Abdomen – pain, bloating, constipation, or diarrhea
• Brain – dizziness, headaches, seizures
• Bone Marrow – feeling very tired, easy bruising or bleeding, shortness of breath, catching infections more often.

Types of Lymphoma

How the doctor determines what tests to run to diagnose lymphoma varies based on your child’s symptoms. There are two main types of lymphoma: Hodgkin’s lymphoma (also known as Hodgkin’s disease) and non-Hodgkin lymphoma. The key difference between them is how the cancer cells look under a microscope. Hodgkin’s lymphoma has specific cells called Reed-Sternberg cells, while non-Hodgkin lymphoma does not. There are also subtypes of these cancers, based on which cells are affected and other factors. Your doctor will explain the type after testing and discuss the best treatment options with you.

Treatments

Treatment for lymphoma varies depending on the type of lymphoma and where it is in the body. The two most common treatments are chemotherapy and radiation therapy, however they are not the only options that can be used.

Watchful waiting sounds like doing nothing at all, instead it is watching for changes in symptoms over time and reporting these to the doctor as they improve or become worse, depending on the situation. For example, the doctor may request that you watch the swollen lymph nodes or have concerns about your child’s weight, and document any changes over a period of time. This is one way in which the doctor rules out more common issues that have the same symptoms your child is experiencing.

Chemotherapy uses medication to target cancer cells by disrupting their ability to grow and divide. Since cancer cells grow faster than normal cells, these drugs focus on them. Common side effects include hair loss, sore mouth or throat, and feeling unwell. Chemotherapy is usually given in “cycles,” allowing time for recovery in between.

Radiation Therapy involves using targeted X-ray beams to focus on specific areas of the body. It can be used alone or often together with chemotherapy, usually after a few cycles of treatment.

Surgery removes as much of the affected area (such as a tumor, or affected lymph nodes) as possible to prevent further spread, after which chemotherapy or radiation may follow to kill any remaining cancer cells in the body.

Targeted drug therapy uses specific drugs that block certain actions that cancer cells use to create more cancer cells.

The doctor will discuss the treatments that will best help your child, including any risks and side effects to watch for. It’s crucial to remember that even if two children have the same type of lymphoma, their experiences could be quite different. The doctor will personalize the treatment to your child’s needs.

Outlook for the Future

For non-Hodgkin’s lymphoma (which can be more aggressive in children than adults and can require intensive treatment), when caught early (stage I or II), the 5-year outlook is typically over 90% with later stages usually having an 80% to 90% outlook. In comparison, Hodgkin’s lymphoma, in its early stages, has a similar outlook of over 90%; however, in later stages, the outlook can drop as low as 70%.

Although lymphoma can spread throughout the body and the doctors detect it at a later stage of progression, most cases are treatable even at advanced stages, and many children have positive outcomes. Each case is unique, depending on the type of lymphoma, its stage at diagnosis, and the child’s response to treatment. The good news is that the outlook with lymphoma is generally positive, giving hope for the future.

Resources:

https://www.cancer.gov/types/lymphoma

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/lymphatic-system

https://www.mayoclinic.org/diseases-conditions/lymphoma/symptoms-causes/syc-20352638

https://my.clevelandclinic.org/health/diseases/22225-lymphoma

https://lymphoma-action.org.uk/types-lymphoma-lymphoma-children-and-young-people/lymphoma-childrenA

https://www.mskcc.org/pediatrics/cancer-care/types/pediatric-lymphomas

https://www.cancer.org/cancer/types/childhood-non-hodgkin-lymphoma/detection-diagnosis-staging/survival-rates.html

https://www.healthline.com/health/lymphoma/lymphoma-in-children#how-rare-is-it

https://www.cancer.gov/types/lymphoma/patient/child-nhl-treatment-pdq