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Non-Hodgkin's Lymphoma

Every year about 35-50 children in the Netherlands have a malignant lymphoma other than Hodgkin's disease. In a non-Hodgkin's Lymphoma (NHL), there is a malignant proliferation of lymphocytes, a special kind of white blood cells. These divide rapidly and form a tumor in the lymphatic system that can spread and sometimes also spreads to organs and tissues outside the lymphatic system.

There are different types of lymphocytes, such as B cells (leads to a B-NHL) and T cells (T-NHL). The B-lymphocytes are found mainly in the abdomen and in the head/neck area, and the T-lymphocytes in the thymus, a gland behind the breastbone (between the lungs). We also have the large-cell Anaplastic Lymphoma (ALCL) during childhood. This is a very rare form.

Symptoms of this disease

Non-Hodgkin's lymphomas usually show very rapid growth. For example, children with a B-NHL present with abdominal pain because the tumor causes a closure of the intestine. Large, usually non-painful swellings in the neck or in the throat nose and ear area also occur; these often feel very hard. A T-NHL can quickly cause shortness of breath by the swelling pressing against the trachea. Pressure on some large blood vessels can give rise to a red, swollen face and headache. Rapid growth can also cause expansion to elsewhere: for example, to the bone marrow or to the central nervous system. The picture in children with an ALCL is often much less clear; there are often general symptoms like fever, pain or weight loss.

How do we make the diagnosis?

The diagnosis of Hodgkin's lymphoma is made with the help of a biopsy. This means that an enlarged lymph node is removed under narcosis and then examined under the microscope. Determining the extent of Hodgkin lymphoma (staging) is important for treatment and prognosis; this is done using CT and/or MRI scans and a PET scan. A bone marrow puncture or epidural often need to be done. 

Treatment of Non-Hodgkin's Lymphoma

The treatment of a Non-Hodgkin's lymphoma consists of chemotherapy. The intensity of the treatment depends on the type and extent of the lymphoma. Irradiation is in principle no longer applied. Current chemotherapy provides good healing opportunities, so radiation can often be omitted.