Dr. Sylvester Ikhisemojie
When this topic was first discussed on this page nearly nine years ago, many readers were incredulous that children could suffer from cancer. At that time, we broadly addressed the issues surrounding childhood malignant diseases, which are more formally known as childhood cancers. This week, we will focus on a specific subset of these cancers: lymphoma. Lymphoma is a cancer that affects the lymphatic system, a crucial part of the body’s network responsible for fighting germs that enter our system. The lymphatic system includes the lymph nodes, spleen, thymus gland, and bone marrow, meaning that lymphoma can impact various tissues and organs throughout the body.
Many of us have experienced swellings in different areas, particularly at the back of the neck, armpits, groin, and under the chin, during certain infections. These swellings are caused by lymph nodes, which are small, bean-sized collections of lymphocytes and other immune system cells located throughout the body. Some lymph nodes are found in the chest, abdomen, and pelvis. Swellings at the back of the neck may occur in response to hair treatments in females or barbing equipment in males, while a sore throat or persistent cough can lead to swelling in the front of the neck and around the jaw. Similarly, swellings in the groin may arise from injuries to the feet or infections affecting the lower limbs. Consequently, lymphoma can originate in any part of the body where these lymphatic tissues are present. When cells begin to grow uncontrollably, they can develop into a malignant disease that spreads to other parts of the lymphatic system and the body.
Lymphoma is a broad term encompassing cancers that originate in the cells of the lymphatic system. There are two main categories of lymphoma: Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). These two types develop in different areas of the body, exhibit different symptoms, and have varying outcomes. Hodgkin’s lymphoma, which we will refer to as HL, is classified into four distinct categories, while non-Hodgkin’s lymphoma (NHL) is divided into two broad classes. Patients with HL typically have a higher number of Reed-Steinberg cells, which are abnormal white blood cells with multiple nuclei. In contrast, these cells are rarely found in patients with NHL. HL is less common than NHL and has a better survival rate of nearly 90 percent, whereas NHL is approximately eight times more common but has a significantly lower five-year survival rate. Although HL can start anywhere in the body, it most frequently begins in the lymph nodes of the upper body, leading to swellings in the neck, chest, and armpits. Conversely, NHL can arise in almost any area where lymphatic tissues are present, including the stomach, intestinal tract, bone marrow, and the retroperitoneum—the space in the back of the abdominal cavity that houses vital organs such as the kidneys and pancreas.
Lymphomas rank as the third most common cancer in children, following leukemias and brain tumors, making them relatively rare. However, it is crucial to recognize their existence and understand how they typically present, as sick children often arrive late at hospitals due to inadequate attention before diagnosis. This delay may stem from the fact that the symptoms often do not appear serious. Lymphomas are rare in children under five years old but are most common between the ages of 10 and 20, with a particular prevalence among those aged 11 to 15. In Nigeria, where many ailments are reported late, this trend is no exception. While both HL and NHL are more common in adults, especially those over 50, parents should not be lulled into a false sense of security by the rarity of these diseases in children. In the past month alone, three children aged 10 to 14 have been diagnosed with lymphoma, and none presented for treatment until at least six months after the onset of symptoms.
In addition to swelling in the aforementioned areas, other symptoms of lymphoma include intermittent fever, excessive night sweats, recurrent cough (with or without shortness of breath), weight loss, and persistent fatigue. There may also be a generalized skin rash accompanied by itching, as well as changes in bowel habits, particularly if abdominal glands are involved, as is often seen with NHL. Many of these symptoms can also be present in illnesses caused by viruses or conditions like tuberculosis, making it essential to consult a doctor who can differentiate between potentially serious cases and benign ones. Therefore, seeking medical attention for your child, even if they do not appear gravely ill, can be crucial for ensuring their survival.
Early diagnosis of lymphoma increases the range of treatment options available to healthcare providers. While some symptoms may be readily apparent and lead to a swift diagnosis, others may present more subtly, such as a swelling in the armpit or neck above the collarbone. A routine full blood count may not provide significant information, but it can sometimes indicate anemia or an elevated white blood cell count. More often, the swellings in identified areas will yield the most reliable information. An ultrasound scan of the swelling should be conducted, followed by X-rays of the chest and neck to determine if there are any extensions into those areas. In well-equipped hospitals, a CT scan of the chest and neck can further clarify the situation. If there are indications that the swelling is not benign, preparations should be made for a biopsy. The tissue obtained will be sent to a specialized histopathology laboratory for detailed microscopic examination, which will confirm the diagnosis and guide the treatment plan for the patient.
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