The Lymphomas - This Battle Which I Must Fight: Cancer in Canada's Children and Teenagers

THE LYMPHOMAS

Along with central nervous system tumours, lymphoma is the second most common type of cancer in the young in Canada. It comprises approximately 17 percent of malignancies in the young (birth to 19 years) and is the most common cancer among teenagers aged 15 to 19 years. Approximately 200 Canadian children and teenagers are diagnosed with lymphoma each year (Table 1).

In most patients with lymphoma, no predisposing factors can be identified. Some rare genetic and immunologic disorders are associated with a higher than average likelihood of developing lymphoma.(107) The higher risk of lymphoma among individuals with immune-suppressed states, such as immunosuppression associated with organ transplantation, again suggests a relationship with immunologic and viral factors; however, the nature of this relationship is not clear.(41) Lymphoma may be related to exposure to an infectious agent and/or to proliferation of lymphoid cells as an immune response.(68)

Lymphoma usually originates within lymphoid tissue. The two main types of lymphoma, which are distinguished by the appearance of their cells, are Hodgkins disease/lymphoma and non-Hodgkins lymphoma.

Hodgkins Disease/Lymphoma
Usually the first indication of Hodgkins disease is an enlarged lymph node in an otherwise well child or teenager. Occasionally, fever, night sweats, weight loss, itchiness or cough are also present. The diagnosis is confirmed by a biopsy of the enlarged node.

Many aspects of the treatment of Hodgkins disease are similar in adults and children. The main difference is that decisions about treatment must take into account normal growth and development. For example, radiation therapy plays a less prominent role in the treatment of children than of adults because it stunts the growth of normal tissues within the radiation field. Treatment usually consists of a combination of chemotherapy and radiation therapy.(19,126,136)

Ninety percent of Canadian children and teenagers diagnosed with Hodgkins Disease between 1985 and 1988 were alive five years after diagnosis (Table 7).

Non-Hodgkins Lymphoma
Non-Hodgkins lymphoma, which is twice as common in boys than in girls (Table 1), arises in immature cells within lymph tissue, grows rapidly, and tends to spread to the bone marrow and central nervous system. It often originates in lymph nodes in the abdomen or chest. Enlarged lymph nodes in the chest can cause secondary symptoms of cough and difficulty breathing. In the abdomen, enlarged lymph nodes can cause abdominal pain, with or without vomiting. Other symptoms depend upon the location and extent of spread of the tumour. Childhood non-Hodgkins lymphoma is subtyped (classified) according to the type of lymphoid cell from which the cancer cells arose. This information is obtained by performing sophisticated tests on the biopsy specimen. Staging determines the extent of spread to the lymph nodes, bone marrow, meninges and other tissues.

Childhood non-Hodgkins lymphoma looks, acts, and is treated quite differently from its adult counterpart.(138) Treatment consists of multi-agent and intrathecal chemotherapy. The specific chemotherapy program depends on the type of non-Hodgkins lymphoma and the stage of disease.(12,54)

Almost 70 percent of Canadian children and teenagers diagnosed between 1985 and 1988 were alive five years after diagnosis (Table 7). The difference in survival between the two types of lymphoma can be explained by the fact that non-Hodgkins lymphoma is often more advanced at diagnosis than Hodgkins disease. Regardless of the type of lymphoma, approximately 90 percent of children with localized disease and 70 to 80 percent of children with advanced disease will be cured. (19,126,136)

[Previous] [Table of Contents] [Next]