1. What is Hodgkin Lymphoma (HL)?
It is a type of cancer in children affecting the lymphatic system in the body. It is more common in boys than girls. It can affect children at any age but is more common in older teens and young adults.
2. What is the lymphatic system?
The lymphatic system is part of your immune system which is the natural defence of the human body against infection and disease.
The lymphatic system is made up of the bone marrow, thymus, spleen, and lymph nodes (or lymph glands). A network of tiny pipe systems called the lymphatic vessels containing lymph fluid, connect the lymph nodes. Lymphomas can start anywhere in the lymphatic system such as the neck, above the collarbone, armpit, groin and inside the chest and abdomen.
3. Do I need to worry about cancer when my child has a swelling of the lymph gland?
Lymph glands can swell as part of the body’s response to infection. In most cases, swelling could be due to infection in the surrounding area. Therefore, there’s no need to worry about all lymph node swellings. If we cannot explain lymph node swelling by other reasons like an infection, a biopsy is needed to diagnose or rule out lymphoma.
4. Do I need to go for a lymph node biopsy for any swelling of the lymph node?
No. Lymph node biopsy is indicated only when the swelling grows very fast, and does not improve with antibiotics. But there are other factors that need to be considered, therefore it is always better to consult a paediatric doctor if you have any concerns.
5. What are the different types of Hodgkin Lymphoma?
There are two main types of Hodgkin lymphoma:
Classical Hodgkin lymphoma, which affects 95% of patients, Lymphocyte Predominant Hodgkin Lymphoma (LPHL), which only affects 5% of patients.
6. What causes Hodgkin lymphoma?
The exact cause of Hodgkin lymphoma is not known. it is not inherited from parents, and you cannot catch it from another person.
7. What are the signs and symptoms of Hodgkin lymphoma?
The first sign of Hodgkin lymphoma is usually a painless swelling of one, or a group of lymph glands, which continue to grow for some weeks or even months.
The first glands that are likely to be affected are in the neck or above the collarbone, most often only on one side. However, it’s important to remember that children’s glands can also become swollen when they have a common infection causing sore throat or a cold.
If glands in the chest are affected, this can cause cough or breathlessness. Sometimes, a child with Hodgkin lymphoma may have a high temperature (fever), night sweats, weight loss, or itchy skin.
8. How Hodgkin lymphoma is diagnosed.
The most important test to diagnose Hodgkin lymphoma is by doing a biopsy of a swollen lymph node. A biopsy is a procedure where a swollen lymph node is removed partially or fully and its cells are looked at under a microscope. It’s a small operation, which can be done under general anaesthetics.
9. What other tests are to be done If Hodgkin lymphoma is diagnosed after the biopsy?
Further tests are carried out to find out the exact size and position of the lymphoma, and to see whether it has spread beyond the original area. These tests that are carried out are called staging investigations. These tests include x-rays, blood tests, CT, MRI, and PET scans.
The stage of Hodgkin lymphoma describes the size and position of the cancer and where it has spread. Staging is very important because this guides how much treatment the child needs.
10. What other clinical features are important in the case of Hodgkin’s lymphoma?
Your child may have one or more of the following symptoms: a fever, night sweats or significant weight loss.
11. How are children with Hodgkin Lymphoma treated?
Children with Hodgkin lymphoma are usually treated with chemotherapy, but sometimes radiotherapy is also needed. The type and amount of treatments given depends on the stage of the disease when it is diagnosed. Requirement of radiation therapy is determined by the response of the cancer with initial chemotherapy. Your child’s doctor will discuss the treatment options with you.
12. How long do children with Hodgkin lymphoma receive chemotherapy?
All children receive chemotherapy as this is the main treatment. The number of months/cycles of chemotherapy your child will need is based on the stage of the disease. Low stage patients receive less and high stage receive more cycles of chemotherapy which means we can keep the cure rates high for all patients.
13. Which children with Hodgkin lymphoma require radiotherapy?
Radiotherapy is used in less than half of the children and recommended only when actually needed. Usually, two cycles of chemotherapy are given and then a PET scan is done. If the PET scan is clear, then radiotherapy is usually not required but if the PET scan shows active cancer still present, then radiotherapy will be given.
14. What are the consequences after treating children with Hodgkin lymphoma?
The cure rate for Hodgkin lymphoma is very high, however some children may develop side effects many years after the treatment. It depends on the type of treatment your child received. When your child completes treatment, they will have to visit their doctor for regular follow ups. There will be occasional scans, x-rays, and blood tests done for several years even after completing the treatment.
15. What are the treatments available if Hodgkin lymphoma has come back after treatment?
The cure rate of Hodgkin lymphoma is very high. Therefore, It is very rare that it would come back after treatment. If the cancer comes back, a different course of treatment can be given.
