LYMPHOMA

Earlier this year, I was surprised to see a somewhat familiar name as a Facebook friend request. On clicking the request, I was happy and thrilled to see an old patient of mine, who had now grown up into a cheerful young girl.

I remembered her distinctly, several years back as a teenager. She had presented with complaints of a right neck globular swelling along with a significant weight loss over three months, in spite of a good appetite. She was otherwise well, attending her school regularly and had no other complaints whatsoever. She had been treated with antibiotics a couple of times by her physician, with no reduction in the neck swelling. She had undergone a left cervical nodal biopsy which showed a Hodgkin’s lymphoma. She was then referred to our team for further management. The family were quite aware of the disease.

After interacting with the girl and the family, I advised a complete workup. In addition to checking her blood counts and viral markers, I also advised a whole-body PET CT scan. In some lymphomas, we also do a bone marrow examination to assess the stage of her disease. We confirmed her stage III Hodgkin’s lymphoma, without any bulk disease. The family were obviously stressed, but a good counselling and a frank talk with the young teenager, and I could sense the strength in them to undergo the therapy.

Lymphomas are a malignancy of the lymphatic system. The lymphatic system is a part of our immune system, and since it is present almost everywhere in the body, this cancer can present in almost every part of the body.

Lymphomas are mainly classified into Hodgkin and Non-Hodgkin Lymphoma. In general, Hodgkin’s Lymphoma tends to carry a good prognosis, i.e. a good outcome with standard chemotherapy. In children, Hodgkin’s Lymphoma (HL) is more commonly seen in the adolescent age group. These children may present with painless swellings in the neck, axilla(armpits), groin or chest, or with prolonged unexplained fever, weight loss and night sweats. Often, in our country, tuberculosis tends to accompany Hodgkin’s lymphoma. A lymph node biopsy is essential for the diagnosis of lymphoma. Further characterisation of the subtype and the aggressiveness also requires immunohistochemistry (IHC), a special test that helps in identifying the prominent antigens on the tumour.

Once diagnosed and appropriately staged, the primary modality of treatment in Classical HL is a combination of chemotherapy and radiotherapy. The chemotherapy regimens in HL are well tolerated, and in children with low and intermediate-risk disease, the cure rates are upward of 90%. This teenager underwent all her six cycles (arm A + arm B) smoothly. There were periods of low blood counts, with two episodes of severe infections which recovered with antibiotic support and certain injections called growth factors, which help in pumping up the blood counts during the phase of neutropenia (A period of low blood count). She did have several common side effects of her chemotherapy like nausea, vomiting and loss of hair. But it was time-bound, and as she completed her chemotherapy cycle, her hair grew back up to her original beautiful self once again.

Lymphomas are mainly classified into Hodgkin and Non-Hodgkin Lymphoma. In general, Hodgkin’s Lymphoma tends to carry a good prognosis, i.e. a good outcome with standard chemotherapy. In children, Hodgkin’s Lymphoma (HL) is more commonly seen in the adolescent age group. These children may present with painless swellings in the neck, axilla(armpits), groin or chest, or with prolonged unexplained fever, weight loss and night sweats. Often, in our country, tuberculosis tends to accompany Hodgkin’s lymphoma. A lymph node biopsy is essential for the diagnosis of lymphoma. Further characterisation of the subtype and the aggressiveness also requires immunohistochemistry (IHC), a special test that helps in identifying the prominent antigens on the tumour.

I must say, she fought it out like any energetic teenager would.

It’s been six long years, and I had almost forgotten about her. She had last visited me four years back, and then the family had decided to shift to another city and were regularly following up with an oncologist friend of mine! It was indeed a wonderful day for us, to see a young adolescent blossom into adulthood.