This document discusses pediatric oncology, specifically lymphoma in children. It begins with definitions of lymphoma and its types. Hodgkin lymphoma is more common in older children while non-Hodgkin lymphoma occurs more in younger children. The document describes the histology, clinical features, investigations, differential diagnosis, supportive treatment and chemotherapy-based management of Hodgkin and non-Hodgkin lymphoma in children. The goal of treatment is to cure the disease using multi-agent chemotherapy regimens tailored to the specific lymphoma type and stage.

1. Pediatric Oncology
Classification, Epidemiology, Clinical Features, Prognosis
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. It contains estimated 200 Billion Stars, the sun lies roughly 27,000 light-years
from the centre of the galaxy. And there are estimated minimum
100 Billion Galaxies in the Universe.

3. (God speaking to Prophet Muhammad (PBUH)
And (remember) Ayub (Job), when he called his Lord saying
“I have been afflicted by distress (disease), and
You are the most merciful of all those who have mercy”
The Holy Quran; surah Al-Anbiya 21:83
In the name of Our Creator Allah, the most Gracious, the most Merciful

4. Pediatric Oncology - Epidemiology
• Malignancies are one of the leading causes of death in
children under 15 years of age
• It is estimated that approximately 7500- 8000 children less
than 18 years get cancer, every year in Pakistan.

5. Pediatric Oncology – Types of Malignancies
Pakistan Data
Disease Percentage
Leukemia 35
Lymphoma 20
Bone Tumor 08
Soft Tissue Sarcoma 07
Brain Tumor 07
Retinoblastoma 06
Neuroblastoma 04
Wilms Tumor 04
Germ Cell Tumor 03
Others 06

7. Pediatric Oncology
Lymphoma in Children
Classification, Epidemiology, Clinical Features,
Diagnosis, Complications, Management
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

8. Lymphoma
Definition
• Lymphoma is an uncontrolled malignant proliferation of
Lymphoid cells
• Lymphoid cells are found in primary lymph organs and
secondary lymph organs
• Primary lymph organs – Bone marrow (B - cells) and Thymus
(T - cells)
• Secondary lymph organs – Lymph nodes, Spleen, and
Mucosa-associated lymphoid tissue (MALT).

9. Lymphoma
Types
• Hodgkin lymphoma – HL (Reed-Sternberg cells)
• Non-Hodgkin lymphoma – NHL

10. Lymphoma
Epidemiology
• Hodgkin lymphoma – HL
• Common Age = 10 – 20 years
• Slow growing in months to years
• Non-Hodgkin lymphoma – NHL
• Common Age = 5 - 10 years
• Fast growing in weeks to months

11. Lymphoma
Histology

12. Hodgkin Lymphoma
Histology
• Hodgkin lymphoma – HL
• Lymphocyte Predominance – 30 %
• Lymphocyte Depletion – 10 %
• Mixed cellularity – 50 %
• Nodular Sclerosis – 10 %

13. Non - Hodgkin Lymphoma
Histology
• Non - Hodgkin lymphoma – NHL
• Burkitt Lymphoma (B-cell) – 50 %
• Lymphoblastic Lymphoma (T-cell) – 15 %
• Diffuse Large Cell Lymphoma (B-cell) – 30 %

14. Lymphoma
Clinical Features

15. Hodgkin Lymphoma
Clinical Features
• Lymph node enlargement –
(Cervical, Axillary, Abdominal)
• Fever
• Weight loss
• Night sweats
• Anemia
• Hepatosplenomegaly

16. Non-Hodgkin Lymphoma
Clinical Features
• Abdominal mass
• Mediastinal mass
• Jaw swelling
• Fever
• Weight loss
• Anemia

17. Lymphoma
Differential Diagnosis

18. Hodgkin Lymphoma
Differential Diagnosis
• Acute lymphadenitis
• Chronic lymphadenitis
• Tuberculosis

19. Non - Hodgkin Lymphoma
Differential Diagnosis
• Tuberculosis
• Neuroblastoma (abdomen)
• Rhadomyosarcoma

20. Lymphoma
Investigations

21. Hodgkin Lymphoma
Investigations
• CBC, ESR, CRP
• LFT, RPM, LDH, Uric acid
• Coagulation profile
• US abdomen
• X-ray Chest
• CT scan Thorax / Abdomen
• Bone Marrow Biopsy
• Lymph Node Biopsy - Histopathology

22. Non – Hodgkin Lymphoma
Investigations
• CBC, ESR, CRP
• LFT, RPM, LDH, Uric acid
• Coagulation profile
• US abdomen
• X-ray Chest
• CT scan Thorax / Abdomen
• Bone Marrow Biopsy
• Tissue Biopsy - Histopathology

23. Lymphoma
Management

24. Lymphoma
Supportive Treatment
• Blood component transfusions (Packed RBCs, Platelets)
• Neutrophil stimulation factors (GM-CSF for neutropenia)
• Antibiotics – for prophylaxis and treatment of infections
• Anti-emetics – for chemotherapy induced emesis
• Tumor Lysis Syndrome – fluids, allopurinol
• Nursing Care – IV sites, mouth, skin
• Nutritional support – High calorie, palatable diet
• Psychosocial support – Patients and families

25. Hodgkin Lymphoma
Management
• Management is done in specific centres
• Multi-agent cytotoxic chemotherapy is given in the form of
monthly cycles
• ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine)
• COPP (Cyclophosphamide, Vincristine, Procarbazine,
Prednisolone)
• Total duration is 6 – 12 months

26. Non – Hodgkin Lymphoma
Management
• Management is done in specific centres
• Multi-agent cytotoxic Chemotherapy is given
• Cyclophosphamide, Vincristine, Daunorubicin, Asparaginase,
Methotrexate, Prednisolone are commonly used
• Dissemination of Lymphoblastic cells to blood (Acute
Lymphoblastic Leukemia) can occur
• Prognosis depends on histology and stsging of disease