A team of doctors, led by our paediatrician specialising in oncology, will design a treatment plan inclusive of a thorough history and physical exam to determine the story and presentation of a child's illness.
Tests and procedures that may be carried out include the following:
These include tests to examine the blood and marrow profile. Other additional tests may include biochemistry and liver function tests.
For children with lymphoma, they often have an inflammatory picture on their full blood count (FBC). This is associated particularly with certain types of lymphoma such as Hodgkin lymphoma, ALCL, BL and DLBCL.
An inflammatory picture on the FBC may present as elevated leukocyte count, elevated neutrophils, elevated eosinophils, lymphopenia, elevated platelet count or anaemia.
- X-ray of the chest
- Computed Tomography (CT) scan
- Positron Emission Tomography (PET) scan - A small amount of radioactive glucose (sugar) is injected into a vein to test for malignant tumour cells in the body. These cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Other Additional Tests
- Lumbar puncture: The removal of some spinal fluid to test for involvement of the central nervous system.
- Bone marrow aspiration and trephine biopsy: The removal of bone marrow and a small piece of bone by inserting a hollow needle into the hipbone or breastbone.
- Directed biopsy: A sample of the tissue (biopsy) will be taken depending on where the rash, lump or lymph node is.
Chemotherapy is the mainstay of cancer treatment, including lymphoma. The medications are very effective in killing cancer cells or stopping them from growing or dividing but there are side effects involved. These medications are usually injected into the bloodstream but some may be given by mouth. A combination therapy of various chemotherapy drugs are usually employed at the same time. The duration of treatment depends on the type and stage of cancer.
Please approach your paediatrician specialising in oncology if you have questions regarding chemotherapy and its side effects such as hair loss and future fertility problems.
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing. The side effect of radiation therapy is that it may disrupt the growth of bones and soft tissues in young children. It may also increase the risk of heart disease and second cancers as patients grow older. Radiation therapy is not commonly used for treating children with Hodgkin lymphoma.
There is often no specific tumour site for lymphoma since it spreads throughout the lymph system. However, large numbers of lymphoma cells may collect in one area for some children. In this case, doctors may suggest surgery to remove the tumour.
Targeted therapy is increasingly popular as it is effective in the treatment of advanced lymphomas and also those that are resistant to treatment. Targeted therapy fights cancer by finding a specific substance (target), such as a protein on cancer cells or a substance that helps cancer grow, without harming normal cells. Different targeted therapies work in different ways.
An example of this include using Brentuximab, which is an anti-CD30 antibody-drug conjugate. This medication seeks out CD30, a target found on lymphoma cells, and delivers chemotherapy drug only to these cells.
Crizotinib, an anti-Anaplastic Lymphoma Kinase (ALK) inhibitor, is used as upfront therapy to target ALK-positive ALCL for high-risk cases.
Stem Cell Transplant
High-dose chemotherapy treats tumours more effectively than lower-dose chemotherapy but the drugs will damage the bone marrow's ability to make new blood cells. If the lymphoma is difficult to treat or returns after receiving chemotherapy, high doses of chemotherapy may be suggested followed by a transplant of the child's own blood-forming (haematopoietic) stem cells. This is called an autologous transplant. Before high-dose chemotherapy starts, doctors will remove stem cells from the child, after which they are frozen and stored, and subsequently returned to the child's body through a vein.
In some cases, a donor's stem cells may be required. This is called an allogeneic transplant and it may be recommended if the child's lymphoma relapses or has failed autologous stem cell transplant.
During treatment, follow-up care is essential. The follow-up routine will depend on the child's cancer and the treatments. Children under treatment may be followed up weekly to monthly.
Follow-up care is also required for all children with cancer after their treatment ends. The follow-up visits generally happen about every 3 months for the first year, then twice a year for the next year. After that, the child may have 1 follow-up visit each year.
During these visits, blood tests and possibly imaging tests such as PET-CT scans will be scheduled to ensure that there is no recurrence of the lymphoma. We will also look for late effects of cancer treatment such as growth and hormone disturbances as well as problems with various body organ functions in the liver, kidney, lung and heart.