What is lymphoma? This is an oncological disease of the lymphoid tissue. A distinctive feature of this disease is the increase in lymphoid nodes, the destruction of various internal organs, in which there is a significant accumulation of lymphocytes with tumor cells. The white blood cell (lymphocyte) is the main element of the body's immune system. In the ICD-10, lymphoma is listed under code C 85.
Reasons
The exact causes of lymphomas in children are not yet fully understood. Pathologies in lymphocytes predispose to the appearance of the disease. Cells can affect not only the lymph nodes, but also other internal organs. But doctors identify some causes of Hodgkin's lymphoma in children, the prognosis for which is not very favorable:
- hepatitis infection;
- HIV infection;
- malignant changes in B-lymphocytes;
- autoimmune diseases (lupus erythematosus, rheumatoid arthritis);
- radioactive radiation not only on the child, but also on the woman during pregnancy;
- use of immunosuppressive therapy;
- decreaseimmunity;
- presence of leukemia in parents or other relatives;
- affected by infectious diseases and the herpes virus;
- effect of carcinogens;
- chemotherapeutic treatment, radiotherapy;
- genetic and ethnic predisposition (Klinefelter and Down syndrome);
- lymphoid depletion;
- persistence of some viruses - Epstein-Barr, Louis Bar, Wiskott-Aldrich, T-lymphocytic.
If chemotherapy treatment has been used to eliminate other tumors in children, there is an increased risk of developing lymphoma, since these types of drugs are very toxic and can damage the genetic apparatus of both cancer cells and he althy ones.
How does lymphoma manifest?
According to oncologists, lymphoma occurs extremely rarely before the age of 3, but the risk of its development increases with age. Therefore, if there are or were previously malignant oncopathologies in the family, it is necessary to carefully monitor the he alth of the child, regularly undergo examinations that will not let you miss the onset of the development of the disease. Most often in childhood, Hodgkin's lymphoma develops, which has a favorable prognosis than non-Hodgkin's lymphoma. In general, today the influence of causes on the occurrence of lymphomas is being actively studied.
Symptoms
Early detection of symptoms of lymphoma in children significantly increases the chances of a favorable prognosis and the effectiveness of therapy. Typically, symptomsare detected during medical examinations for other diseases, but a very important role is assigned to parents, who must carefully monitor changes in the physical condition and behavior of children.
The main symptom of lymphoma in children is an increase in one or more lymph nodes. An increase in size is most often observed in the lymph nodes located in the neck, in the clavicular and occipital parts, in the armpits, in the inguinal region, as well as in hidden lymph nodes (in the pelvis, abdomen, spine). It should be noted that the increase in lymph nodes is painless and does not cause discomfort to the child, so the task of parents is not to miss these physiological changes on the baby's body.
When enlarged lymph nodes begin to put pressure on the organs located next to them, accompanying symptoms occur:
- shortness of breath or cough may indicate an enlarged lymph node in the trachea or lungs;
- abdominal pain, indigestion may be due to an increase in latent lymph nodes in the abdomen;
- when lymph cells enter the liver or spleen, these organs become enlarged.
The presence of lymphoma in a child is also accompanied by some common symptoms that are characteristic of a number of diseases. These symptoms must be taken into account when compiling a general history. These include:
- The child quickly gets tired - at the initial stage it appears after active actions, but the furtherthe disease develops, the more passive the child becomes? and activity time is reduced.
- Increased sleepiness, apathy.
- Child sweats a lot at night, in combination with weight loss and fever.
- Severe itchy skin for no apparent reason.
It is impossible to say exactly how long it takes for children to develop lymphoma. Some show symptoms after three weeks, others after four months.
Views
In our time, there are many varieties of lymphomas, but not so long ago they were divided into Hodgkin's disease and non-Hodgkin's lymphoma, however, such a contrast of this disease does not fully reflect the essence of lymphoma and does not allow determining the most effective tactics of therapy and its prognosis.
Non-Hodgkin's lymphomas were divided into neoplasms that have a high and low degree of malignancy. In each group, several types of lymphomas were identified, taking into account the morphological characteristics of tumor cells. This classification was accepted, but at the moment this system is outdated, since non-Hodgkin's lymphoma has about 16 subtypes.
Hodgkin's Lymphoma
What is Hodgkin's lymphoma? In fact, this type of lymphoma is not lymphoma as such, since the neoplasm consists of monocytic and macrophage cells, and not lymphocytes. So, the disease is considered separately from non-Hodgkin's lymphomas, but it is still a malignant formation that occurs in the tissue of the lymph nodes.
Non-Hodgkin's lymphoma
This is a broad concept, so to confirmdiagnosis, it is necessary to clarify the cause of its formation, as well as the level of malignancy. Lymphoid tissue has two groups of lymphocytes: B-lymphocytes and T-lymphocytes. The latter are needed for the immunity of cells that contribute to the inactivation of foreign particles. For the formation of specific proteins that bind to the fungus, virus and bacteria, neutralize them, there are B-lymphocytes. These cells are grouped in follicles, in which the periphery is predominantly T-cell, and the center is B-lymphocyte. If conditions are appropriate, inadequate spread of cells in a particular zone may occur, which determines the type of neoplasm.
Mature cell lymphomas
These are relatively benign lymphomas that arise from mature lymphocytes, characterized by almost asymptomatic course. The only and most true symptom of lymphoma is called excessive enlargement of the lymph nodes. Some mature cell lymphomas develop into lymphosarcoma over time.
Burkitt's lymphoma
This type of lymphoma has a high level of malignancy, it spreads to the blood, internal organs and bone marrow, beyond the borders of the lymphatic system. The disease begins gradually and suddenly, which is affected by the localization of the tumor.
Large cell diffuse lymphoma
This type of lymphoma is highly aggressive. The primary focus in most cases is located extradontally or in the lymph nodes. Separately, it is worth noting the primary large B-cell lymphoma of the mediastinum, which occurs in the thymus,gradually growing into the mediastinum.
Diagnosis
When carrying out procedures for diagnosing lymphoma in children, a medical external examination of the applied patient is initially carefully carried out. After that, to confirm the diagnosis, the child must pass the following necessary tests:
- blood;
- do an ultrasound or x-ray.
In addition, to confirm the presence of lymphoma, it is imperative to conduct several interconnected important studies, thanks to which it will be possible to accurately determine which variant of the disease is present and at what stage it is now. Doctors, when analyzing patient tissues, use a biopsy method. To conduct it using this method, a diseased lymph node is taken and carefully examined by a specialist under a microscope.
To determine the stage of an existing disease, in addition to the methods listed above, you can use magnetic resonance imaging, two-photon emission tomography, computed tomography, or scintigraphy of the skeleton. To get as much information as possible about the tumor on the bone marrow and determine how many affected cells there are, at the most critical stages of the disease, they proceed to trepanobiopsy.
Before starting the necessary medical therapy, it is tedious to examine the child’s heart by making a cardiogram or replacing it with an ultrasound of the heart, as well as for moreefficiency, both procedures can be carried out simultaneously. In addition, it may be necessary to conduct a diagnosis for the presence of abnormalities in the body's metabolism.
All of the above diagnostic methods may not be applicable in every case. Which study or set of studies to assign to the patient, only the attending physician can determine.
Treatment
If a child has a medically confirmed lymphoma, they should be admitted to the oncology department of the hospital urgently, and the hematology department may also be suitable.
Most cases are treated with chemotherapy. In this case, the baby is treated with a cytostatic, focused on stopping cell division or completely eliminating them (cells where a tumor is found). Using only one method will not be enough to eliminate all affected cells, as a result, doctors have developed a combination of cytostatics, otherwise they are also called polychemical therapy. This method is considered the best due to its maximum efficiency.
After chemical therapy procedures, in some cases, radiation is also used - radiation therapy. If chemical and radial therapy do not give the desired results or the disease recurs, they switch to chemotherapy with high doses. A bad factor in this type of therapy is its poor effect on the blood of the bone marrow. As a result, it is important to do a stem cell transplant - often resort to autologous bone marrow transplant.
Healinglymphocyte-dominated Hodgkin's disease
In the initial stages of the disease, one infected lymph node is removed (if there are no other affected ones), if there are no complications after that. Somewhere more than half of the patients in these cases are cured without resorting to radial and chemical therapy. They need to undergo a systematic examination to constantly monitor their condition. This process is called the expectant study strategy. If signs of lymphoma occur, this strategy ends.
Chemotherapy Direction
In traditional Hodgkin's disease, several chemotherapy blocks are done. The number of cycles, their duration and intensity are initially based on the stage of the disease in the child, and depend on which therapeutic group is used to treat the patient. Any block of therapy lasts no more than two months. The following substances are included in any of the treatments:
- "Prednisolone";
- "Vincristine";
- "It's a posit";
- "Doxorubicin".
In the intervals between therapy, it is necessary to do a two-week interval. On average, the course of treatment for lymphoma lasts at least two and no more than six months, in cases where no recurrence of the disease has been detected.
Radiation therapy
Currently, proctologists recommend for half of the patients to do radiation therapy of the disease after the chemical one. After observing thathow the patient's body responds to chemotherapy, raises the question of the possibility of radiation therapy.
If two blocks of PET chemotherapy have been performed and there are improvements, then there is no need for this therapy (this applies to any form of the disease). A positive response to this treatment means that the lymphoma is halved, and therefore there are no active tumor cells in its remnants.
Most often, radiation therapy is used two weeks after completion of chemotherapy. On average, a radiation dose equal to twenty grays is given. If the volume of lymphoma is reduced by approximately 75% after the first two blocks of chemotherapy, the radiation dose increases to thirty grays.
In order not to destroy he althy cells located next to the tumor, the required volume is given not at one time, but over several procedures. Treat the affected area in small portions. Radiation therapy lasts an average of two or three weeks. Days off are given to the body to rest and recover from the procedure.
Punctures for Hodgkin's disease
Treatment of lymphoma in children in public clinics in Moscow is possible, but will not bring the same result as abroad. In Germany, for children affected by lymphoma, only programs called therapy optimization studies are used for treatment. They are generally accepted hospital studies, setting themselvesthe task of treating patients with progressive programs and at the same time increasing the effect of therapy.
Chances of recovery
Thanks to modern and accurate diagnostic methods and standard punctures of active therapy, the chances of recovery and complete cure of the tumor are very high. Before proceeding to treatment, all patients are divided into different therapeutic groups, for each of them their own methods of treatment are provided. According to ongoing research, the disease often recurs, but in subsequent cases it can be successfully cured.
