Signs of Hodgkin’s lymphoma in children and its symptoms

What is Hodgkin’s lymphoma?

Hodgkin’s lymphoma (also known as Hodgkin’s disease) is a malignant disease of the lymphatic system, which forms part of the body's immune system. The disease is characterised by the presence of specific abnormal cells known as Reed-Sternberg (Reed-Berezovsky-Sternberg) cells. These cells play a special role in the diagnosis of Hodgkin’s lymphoma, as their presence distinguishes the disease from other types of lymphomas.

Hodgkin’s lymphoma usually begins in the lymph nodes, often in the neck, chest, or armpits, and can spread to other lymph nodes and organs, such as the spleen, liver, bone marrow, and lungs.

Depending on the extent of the disease, there are four Hodgkin’s lymphoma stages:

• Stage I: Lymph nodes in only one area or one organ outside the lymph nodes are affected.
• Stage II: Lymph nodes are affected in two or more areas on one side of the diaphragm, or one group of lymph nodes and one organ also on one side of the diaphragm.
• Stage III: Lymph nodes on both sides of the diaphragm are affected; Involvement of the spleen and other organs outside the lymph nodes is also possible.
• Stage IV: There is extensive involvement of one or more internal organs, such as the liver, bone marrow, lungs and intestines; this may or may not be accompanied by lymph node involvement.

When and who may develop Hodgkin’s lymphoma.

Hodgkin’s lymphoma can develop in people of any age, but it is most commonly diagnosed in the following age groups: adolescents between the ages of 9 and 17, young adults and seniors over 55 years of age. The disease is somewhat more common in men than in women. The exact causes of Hodgkin’s lymphoma are not fully understood, but researchers identify some risk factors that may contribute to the development of this disease. These factors include, but are not limited to, a family history of lymphoma; a weakened immune system; autoimmune diseases and previous organ transplants; and immunosuppressive medications. Although having one or more risk factors increases the likelihood of developing Hodgkin’s lymphoma, many people with these factors never become ill, while others can become ill without any obvious predisposing conditions. Therefore, it is important to have regular physical examinations and see a doctor if signs of Hodgkin’s lymphoma appear.

What are the signs of Hodgkin’s lymphoma and how does it manifest itself?

Hodgkin’s lymphoma presents with a variety of symptoms, many of which may be nonspecific and resemble signs of other diseases. One of the most characteristic symptoms is painless swollen lymph nodes, often in the neck, armpits, or groin. These nodules may become hard to the touch and gradually increase in size.

In addition to swollen lymph nodes, patients with developing Hodgkin’s lymphoma may have several other significant signs that may be a signal of disease:

• Unexplained weight loss: This is one of the most worrying signs that often accompanies Hodgkin’s lymphoma. Patients can lose more than 10% of their body weight within six months for no apparent reason. This weight loss is due to increased metabolism and inflammation in the body caused by the disease.
• Increased fatigue: Patients often feel a constant feeling of fatigue and weakness that does not pass even after a long rest. This may be due to systemic inflammation and exposure to malignant cells that require a lot of energy to grow and spread.
• Night sweats: Heavy night sweats, often resulting in soaked bedding, is another characteristic sign of Hodgkin’s lymphoma. It can occur due to a disturbance in the body's thermoregulation, caused by the disease, and is often accompanied by chills or a feeling of heat.
• Fever: Patients may experience periodic fevers, often referred to as "fever of undetermined origin." Fever can be low-grade and persistent or high and intermittent. This fever is the result of the body's immune response to the presence of tumour cells and may be accompanied by other symptoms such as night sweats and fatigue.

Other signs of Hodgkin’s lymphoma may include coughing, difficulty breathing, and chest pain, especially if the lymph nodes in the chest area enlarge and begin to compress the airways or other organs. Some patients may experience a feeling of fullness or abdominal pain due to an enlarged spleen or liver. These symptoms, together with swollen lymph nodes, can greatly affect the patient's quality of life and indicate the presence of a serious disease that requires medical intervention. However, since these symptoms can be associated with many different diseases, it is important to consult a doctor in a timely manner for an accurate diagnosis.

Diagnosis of Hodgkin’s lymphoma at SJD Barcelona Children’s Hospital

In the case of signs of Hodgkin’s lymphoma in children, at the SJD Children ́s Hospital we perform a biopsy procedure that involves taking a sample of the entire affected lymph node for further testing. This is different from the typical method used in adults, which consists of obtaining a sample using an injection. A biopsy of the entire lymph node provides a more complete picture of the nature and extent of the disease, which is essential for an accurate diagnosis and optimal treatment.

Once a diagnosis of Hodgkin’s lymphoma is established, the most effective and safest treatment is given to the child, adapted specifically for paediatric age. This may include chemotherapy, radiotherapy, or a combination of both, depending on the stage and nature of the disease. The goal of treatment is not only to control the disease, but also to cure it completely with minimal side effects and consequences for the child's health in the long term, which is why at SJD Barcelona Children ́s Hospital we are constantly updating the possible treatments for Hodgkin’s lymphoma in children. We are part of the European Group, which has developed a treatment protocol, the main goal of which is to treat and completely cure the disease, mainly with chemotherapy. In this approach, radiotherapy is used only in very rare cases. It is important to note that all forms of Hodgkin’s lymphoma, including paediatric lymphoma, are successfully treated with chemotherapy, and only a few cases may require additional radiotherapy, without the need for surgery.

Our current efforts are aimed at minimising the use of radiotherapy in children, as we expect to see potential side effects of this procedure only after 30 years. Therefore, our strategy is to avoid the use of radiotherapy in paediatric treatment of Hodgkin’s lymphoma in order to protect children from possible negative consequences in the long term.