Hodgkin Lymphoma (pediatric)

What is Hodgkin lymphoma?
Lymphoma is cancer that begins in the cells of the immune system, specifically in the white blood cells that are designed to fight infection and protect the body from disease. Lymphoma is categorized by Hodgkin lymphoma and non-Hodgkin lymphoma.

Hodgkin Lymphoma is characterized by the presence of a type of cell called Reed-Sternberg. There are two main types:
• Classical Hodgkin lymphoma
• Nodular lymphocyte predominant- Hodgkin lymphoma

What causes Hodgkin lymphoma?
Hodgkin lymphoma starts when a certain type of white blood cells called b-cells starts to grow abnormally. This abnormally-shaped cell is called the Reed-Sternberg cell, and is much larger than a normal cell. Reed-Sternberg cells grow and start to divide, creating more abnormal cells, which in turn start to prevent the immune system from doing its job of protecting the body, as these cells don’t fight infections like normal cells do.

No exact cause of Hodgkin lymphoma is known but several risk factors have been identified that may increase the risk of children developing it:
• Being infected with Epstein-Barr virus (EBV), a common viral infection which causes a disease named mononucleosis
• Family history – having a brother or sister with this disease
• Being between the ages of 15 and 19

Having one or more of these risk factors does not mean that a person will definitely get Hodgkin lymphoma.

What are the symptoms of Hodgkin lymphoma?
• Painless swelling in the lymph nodes
• Swelling of the head, neck, upper body or arms
• Fever
• Weight loss for no known reason
• Night-sweating
• Persistent cough
• Shortness of breath
• High-pitched breathing sound

These symptoms could also be indicative of other conditions, so please consult a doctor if you or your child is experiencing any of them. 
How is Hodgkin lymphoma diagnosed?
At KHCC, physicians use different procedures and tests to properly diagnose and stage Hodgkin lymphoma:
• A biopsy is necessary to make a correct diagnosis and to determine subtype of the disease
• X-ray of the chest
• CT scan of the involved areas and internal organs to screen for spread of the cancer especially in the chest and abdomen
• PET scan (a machine is available at KHCC that works on combining images of CT and PET scans for more accuracy)
• Bone marrow biopsy
• Blood tests: including ESR, complete blood count (CBC), kidney and liver function tests
How is Hodgkin lymphoma treated at KHCC?
No two patients are alike even if they have the same type of lymphoma. Each case is potentially approached differently.

The treating physician will present the case to the MDC panel . The patient’s pathology samples and radiology results are carefully reviewed and relevant questions will be asked about the case, upon which a comprehensive treatment plan is decided.

It’s important to establish correct staging (which determines how much the disease has spread throughout the body) by determining all involved regions in the body. Most patients will often need a combination of chemotherapy and radiotherapy. The amount of chemotherapy and radiation therapy that a patient will need depends on the stage of the disease. In refractory (cancer that is not responding to the prescribed treatment) or relapsed cases, patients usually undergo bone marrow or peripheral stem cell transplants with good results. Surgery is not usually an option for lymphoma patients.

Pediatric patients receive top quality care from a multidisciplinary team of pediatric oncology specialists that is entirely devoted to diagnosing and treating childhood cancers.

Supportive Care
The pediatric multidisciplinary clinic works in close cooperation with other departments at KHCC so that pediatric cancer patients receive the most comprehensive care possible. Supportive care services at KHCC include: