Lymphomas in children

Symptoms

Symptoms depend on where in the body the lymphoma is growing.

Abdominal lymphomas (40%): the symptoms are tiredness, vague abdominal pain, nausea, vomiting or digestive disorders.  Sometimes, there is an increase in abdominal volume and the clinical examination then reveals one or more abdominal mass and possibly an enlarged liver and spleen.  Certain forms are very apparent and manifest as acute surgical problems such as intussusception (a condition in which part of the intestine slides into an adjacent part of the intestine blocking the bowel).

Thoracic lymphomas (25%): present as difficulties with breathing and eating, a cough and enlarged lymph nodes around the neck or under the armpits.

ENT lymphomas (15%): they can present with swollen lymph nodes in the neck, parotid gland, large tonsils.  The child may present with nose bleeds, nasal or throat obstruction.

Lymphoma spreads through the lymphatic or blood vessels.

Invasion of the bone marrow may have already occurred at the time of diagnosis. However, if more than 25% of the cells in the bone marrow are malignant, this is considered to be leukemia. This medullary involvement can manifest as bone pain but it is often discovered during a bone marrow aspiration.

Involvement of the meninges or brain is sought from the time of diagnosis.  Signs can be the presence of abnormal lymphocytes in the cerebrospinal fluid (fluid surrounding the brain), the involvement of one or more of the nerves supplying the head or upper body or signs of spinal cord compression.

Diagnosis

The aim of diagnostic investigations is to determine the type of lymphoma cell and how far the disease has spread.

To identify the type of cell, a sample needs to be taken by performing a biopsy, This sample is then examined under a microscope and genetic analyses are also carried out.

We generally perform a PET scan to determine how far the disease has spread. This involves injecting a radioactive product into a peripheral blood vessel. This product attaches to sites of high metabolic activity throughout the body. The images taken in the hours following the injection therefore show any distant sites that the primary tumor has spread to.

Other important examinations are also requested to ensure that the patient is able to tolerate treatment at the doses usually administered:

• Echocardiogram, ECG
• Assessment of kidney function

Treatment

Lymphomas are mainly treated with chemotherapy.

Certain forms of the disease require the additional administration of monoclonal antibodies or radiotherapy.

The treatments follow well-established international protocols and are regularly adapted during treatment to the safety and efficacy documented during midpoint assessments.