Lymphoma: Cancer in Children

 

Transcript:

 

Guest:  Dr. David White – Pediatric Otolaryngology

Host:  Dr. Linda Austin –Psychiatry

 

Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m talking with Dr. David White who is Assistant Professor of ENT, Otolaryngology, here at the Medical University of South Carolina.  We’re talking, now, about neck masses in children.  Dr. White, in an earlier podcast, we talked about, in general, that most neck masses are pretty benign.  But, every once in awhile, they’re not, there could be a lymphoma involved.  Can you explain, a little bit, what a lymphoma is?

 

Dr. David White:  A lymphoma is a cancer that is composed of the type of cells that we see in a lymph node.  We worry about lymphoma in the neck of children, specifically, when we see neck masses that don’t get better after a month or so, especially when these are accompanied by weight loss, loss of appetite, low-grade fever, night sweats.  These would be some of the symptoms that we would see classically associated with a lymphoma. 

 

Lymphomas, oftentimes, present as enlarged lymph nodes.  Enlarged lymph nodes typically get better within a relatively short amount of time, as in several weeks.  If they don’t get better then we typically treat them with antibiotics, which would make a lymph node that’s enlarged, for benign reasons, shrink down over time.  If there’s a lymph node that is enlarged for a longer period of time then we usually do recommend a biopsy to rule out the possibility of lymphoma.  This is typically done through a very minimally invasive incision that’s done right over the site of the mass.  We typically need to remove a small piece of that for the pathologist to look at under the microscope to make the diagnosis of lymphoma. 

 

Dr. Linda Austin:  Now, one hears the terms Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma a good bit.  Tell us about those two forms of lymphoma.

 

Dr. David White:  Those are two types of lymphoma which are determined by what the mass looks like under a microscope.  Whether it’s a Hodgkin’s lymphoma or a Non-Hodgkin’s lymphoma would direct the way the lymphoma is treated and that is usually addressed by the pediatric hematologist/oncologist.

 

Dr. Linda Austin:  So, both of those types can be seen in children?

 

Dr. David White:  Certainly.

 

Dr. Linda Austin:  I would imagine that whether it’s Hodgkin’s or Non-Hodgkin’s probably directs what type of treatment that child will received.  Am I right about that?

 

Dr. David White:  That’s true to some degree.  The extent of the lymphoma will also direct treatment.  For example, is it confined to the neck?  Is it present in other parts of the body, the chest or the abdomen?  Those will also play into any decisions about treatment.  Treatment for lymphoma, typically, is not surgical.  The treatment is usually chemotherapy, radiation or a combination of both.

 

Dr. Linda Austin:  I see.  So, you, then, as a surgeon, once you’ve made the diagnosis, you would typically refer the patient on, then, to an oncologist?  Is that right?

 

Dr. David White:  That’s correct, usually a pediatric oncologist.  They have various protocols which are defined for the specific types of lymphoma, Hodgkin’s or Non-Hodgkin’s, and then the different subdivisions within those groups. 

 

Dr. Linda Austin:  I’m sort of a casual observer.  I’m a physician but certainly not an oncologist or pediatrician.  One hears of folks with lymphomas who seem to do very well for many years after the diagnosis of Non-Hodgkin’s or Hodgkin’s lymphoma.  Am I right in my perception about that?

 

Dr. David White:  Well, again, it will depend on the specific type of lymphoma within those various subgroups as to what the overall prognosis is.  There are some types that respond very well to chemotherapy.  There are some types that respond less well.  Another important factor would be the amount of spread of the lymphoma at the time of diagnosis.  For example, something that involves the neck, chest and abdomen, generally speaking, would not respond as well as the same type of lymphoma that involved only the neck.

 

Dr. Linda Austin:  So, all the more reason to get these checked out sooner rather than later?

 

Dr. David White:  Certainly.  So, what we usually recommend is that any enlarged lymph node that has been present for more than a month needs to be treated with a prolonged course of antibiotics, usually about three weeks.  If the lymph node doesn’t improve after the treatment with antibiotics then I usually recommend moving forward with a biopsy.

 

Dr. Linda Austin:  Dr. White, thank you so much.

 

Dr. David White:  Thanks.

 

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