Lymphoma (Hodgkin's Disease and

Dr.
Vijay Shah
Associate Professor
Depart. Of Pediatrics
NOBEL MEDICAL COLLEGE, TEACHING
HOSPITAL
Lymphoma is a type of cancer involving cells of the
immune system, called lymphocytes.
Lymphoma is a group of cancers that affect the cells
that play a role in the immune system and primarily
represents cells involved in the lymphatic system of
the body.
Lymphoma is the 3rd most common cancer among
children in USA.
Annual incidence of 15/million children <14 yr of age.
Two broad categories of Lymphoma: HD and non
NHL.
HODGKIN DISEASE
Hodgkin's disease, is a type of lymphoma, which is
a cancer originating from white blood cells called
lymphocytes.
HD is a malignant process of the lymphoreticular
system that constitutes 6% of childhood cancers.
EPIDEMIOLOGY:
In Developing countries, the early peak occurs before
adolescence.
 A Male: Female with a ratio of 4:1 for children 3-7 yr
of age, 3:1 for children 7-9 yr of age and 1.3:1 for
children >10 yr of age.
Cause
There are no guidelines for preventing Hodgkin's lymphoma;
this is because the cause is unknown or multifactorial.
A risk factor is something that statistically increases one's
chance of contracting a disease or condition.
Risk factors for Hodgkin's lymphoma include:
Sex: male
Ages: 15–40 and over 55
Family history
History of infectious mononucleosis or infection with Epstein-
Barr virus, a causative agent of mononucleosis
Weakened immune system, including infection with HIV or the
presence of AIDS
Prolonged use of human growth hormone
Exposure to exotoxins
RYE CLASSIFICATION
Lymphocyte predominance
Mixed cellularity
Nodular sclerosis
Lymphocyte depletion
Classification systems for HD: NEW
WHO/REAL Classification
Nodular lymphocyte predominance
Classical Hodgkin lymphoma

Lymphocyte rich
Mixed cellularity
Nodular sclerosis
Lymphocyte depletion
Anaplastic large cell lymphoma Hodgkin-like
Staging classification:
 The Ann Arbor staging classification scheme is a common
one):
Stage I is involvement of a single lymph node region
(mostly the cervical region) or single extralymphatic site.
Stage II is involvement of two or more lymph node regions
on the same side of the diaphragm or of one lymph node
region and a contiguous extralymphatic site .
Stage III is involvement of lymph node regions on both
sides of the diaphragm, which may include the spleen
and/or limited contiguous extralymphatic organ or site .
Stage IV is disseminated involvement of one or more
extralymphatic organs.
Presentation of Hodgkin’s
Disease
Age: adolescents >> young child
Painless lymphadenopathy
 Progresses over weeks  months
Location
 Cervical/supraclavicular  LNS
 unilateral or bilateral 95%
 Mediastinum ± hilum
 LNs below diaphragm and spleen

 Liver, lung, bone marrow
Presentation of Hodgkin’s Disease
Systemic symptoms
 Fevers
 Night sweats “B” symptoms
 Weight loss 25%
 Pruritus
• Superior Mediastinal Syndrome (SMS)

– Orthopnea, SOB, stridor, hypoxia
•Tracheal
•Bronchial compression
•Cardiac = Oncologic Emergency

HD in 16 y/o girl HD in 9 y/o boy
 left cervical LNs, wt cough, fever, night sweats
loss Pruritus shins, + orthopnea
cough, no orthopnea
Superior Mediastinal Syndrome (SMS)

= Oncologic Emergency
HD – 9 y/o CT scan with SMS
Ant. mediastinal mass Pericardial effusion

compressing trachea; with tamponade
Pleural effusion
Superior Vena Cava (SVC) Syndrome in
10 y/o with Lymphoblastic Lymphoma
Facial swelling, plethora, cyanosis,  neck veins
Mediastinal mass: tracheal

and SVC compression
Lymphoblastic Lymphoma (T-cell, thymus)
Same boy 1 week after initial treatment
• rapid onset • rapid response
Signs and tests
Biopsy of suspected tissue, usually a lymph node
biopsy
Bone marrow biopsy
Blood chemistry tests including protein levels, liver
function tests, kidney function tests, and uric acid
level
CT scans of the chest, abdomen, and pelvis
Complete blood count (CBC) to check for anemia and
white blood count
PET scan (positron emission tomography )
Treatment depends on your age and stage of the
cancer.
Stages I and II (limited disease) can be treated with
radiation therapy, chemotherapy, or both.
Stages III is treated with chemotherapy alone or a
combination of radiation therapy and chemotherapy.
Stage IV (extensive disease) is most often treated with
chemotherapy alone.
Additional treatments depend on other symptoms.
They may include:
Transfusion of blood products, such as platelets or red
blood cells, to fight low platelet counts and anemia.
Rx,
Chemo and Radiation therapy are effective in the
treatment of HD.
HD in Ped. Involves the use of combined chemo with
or without low-dose involved field radiation therapy.
Radiation doses of 3,500-4,000 cGy.
Chemo. Agents commonly used to treat children and
adolescents with HD include:
Cyclophosphamide, procarbazine, Vincristine or
Vinblastine, Prednisone or dexamethasone,
doxorubicin, bleomycin,
decarbazine,etoposide,methotrexate and cytosine.
Combined chemotherapy
COPP: (cyclophosphamide, vincristine[oncovin],
procarbazine, and prednisone) OR ABVD:
Adriamycin, bleomycin, vinblastine, and dacarbazine
Takes between six and eight months, although longer
treatments may be required.
BEACOPP ( bleomycin, etoposide, doxorubicin,
cyclophosphamide, vincristine, procarbazine,
prednisone) used for patients with advanced stage
disease.
Antibiotics to fight infection, especially if a fever
occurs.
Prognosis:
With the right treatment, more than 90% of people
with stage I or II Hodgkin's lymphoma survive for at
least 10 years.
If the disease has spread, the treatment is more intense
but 90% of people with advanced disease survive 5
years.
Patients who survive 15 years after treatment are more
likely to later die from other causes than Hodgkin’s
disease.
Complications
Long-term complications of chemotherapy or
radiation therapy include:
Bone marrow diseases (such as leukemia)
Heart disease
Inability to have children (infertility)
Lung problems
Other cancers
Thyroid problems
Chemotherapy can cause low blood cell counts, which
can lead to an increased risk of bleeding, infection,
and anemia.
Infection should always be taken seriously during
cancer treatment.
THANK YOU!!!!

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Dr.

Classical Hodgkin lymphoma

 LNs below diaphragm and spleen

• Superior Mediastinal Syndrome (SMS)

•Cardiac = Oncologic Emergency

Superior Mediastinal Syndrome (SMS)

Ant. mediastinal mass Pericardial effusion

Mediastinal mass: tracheal

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