Childhood lymphoma – How is it diagnosed?
There are two main types of lymphoma: non-Hodgkin lymphoma and Hodgkin lymphoma.
Non-Hodgkin lymphoma
These are very aggressive tumours that are fast-growing. They often present with enlarged lymph nodes or glands. These glands may occur
in the neck, above the collar bones, armpits, groin, or the glands in the chest that surround the heart. They may become so enlarged that they can block the drainage of blood from veins of the head and neck, leading to swelling and collapse.
Abnormal cancer cells may also cause enlargement of the liver and spleen (abdominal organs), and they may infiltrate the bone marrow, leading to bone pain, bleeding, pallor, and infections.
Diagnostic tests
To make the diagnosis, these children often undergo a chest X-ray, and a CT scan, depending on the location of the glands. The diagnosis is confirmed on biopsy or removal of one of the glands. If safe, these children undergo a general anaesthetic for the biopsy or removal. This is then sent to the laboratory and the diagnosis is then made.
If a CT scan hasn’t been performed in the workup to the biopsy, then a CT chest and abdomen is required for staging. A bone marrow aspirate and trephine and a lumbar puncture are also required for staging purposes. These children are then referred to a paediatric oncologist or haematologist for further treatment.
Hodgkin lymphoma
These are slower growing and usually also present with enlarged glands that may have been present for several months. The diagnosis is often made on just a biopsy, but a full lymph node or gland needs to be removed. This is done under a general anaesthetic.
These children also require a PET-CT scan. This requires a special diet for a day or two before the scan and an IV line or drip needs to be inserted prior to the scan. For young children, a general anaesthetic or conscious sedation may be necessary to keep them still for the scan.
The PET-CT scan shows the anatomy of the body as well as the metabolic or biochemical function of tissues and organs. In Hodgkin lymphoma, the glands and tissues that are infiltrated with Hodgkin lymphoma have a high metabolic rate and the scan can pick this up.
In addition to a PET-CT scan, these children also require a bone marrow biopsy to stage the lymphoma. Once diagnosed, these children are referred to a paediatric oncologist or haematologist for further treatment.
Childhood cancer is rare and comprises less than 1% of all malignant disease. It occurs in about 1 in 650 children, or 140 children per million. It’s estimated that almost half the children with cancer in SA will never be diagnosed.
The most common types are as follows:
- Leukaemia 34%
- Brain tumours 22%
- Lymphoma 11%
- Nephroblastoma 6%
- Neuroblastoma 6%
- Soft tissue sarcoma 6%
- Bone tumours 5%
Dr Kate Bennett is a paediatric oncologist; she qualified as a paediatrician in 2009 and then as a paediatric oncologist in 2011. She has a special interest in the treatment of paediatric leukaemia and lymphoma, immune thrombocytopaenia, and sickle cell anaemia.
Header image by Freepik
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