DIAGNOSIS AND REFERRAL OF HODGKIN LYMPHOMA
SIOP Childhood Cancer Early Diagnosis & Appropriate Referral (CEDAR) Project
Dr. Maya
Prasad and Dr. Reineke Schoot (Members, SIOP Education and Training Committee)
On behalf of
the SIOP Education and Training Committee and IPA SAG on NCD
The SIOP CEDAR
Project is improving the knowledge and understanding of healthcare providers
who are involved in the initial care, diagnostic workup, and referral of
pediatric patients suspected of having cancer.
The fifth
CEDAR webinar, “Diagnosis and referral of Hodgkin Lymphoma” is taking place on 20th
January 2023. SIOP and IPA encourage Pediatricians, Family Practitioners,
Community Nurses, and other healthcare professionals who are involved in the
care of children to register for
this webinar.
What is Hodgkin Lymphoma?
Misdiagnosis or late diagnosis of Hodgkin Lymphoma
The commonest presentation of childhood HL is painless adenopathy,
predominantly in the cervical or supraclavicular location. The lymph nodes are
typically firm, rubbery, non-tender, matted, and have contiguous spread.
Children may also present with pallor, fatigue, anorexia, enlargement of other
lymphoid organs, mediastinal masses (more frequent in adolescents) or “B
symptoms” (fever, weight loss, night sweats). Childhood HL may also present as
an emergency with +/- superior vena cava syndrome and/or airway obstruction due
to large mediastinal masses and pleural or pericardial effusion.
Since the presentations of HL overlap significantly with non-malignant
childhood conditions, including HIV and tuberculosis (TB), children often
receive inappropriate, empirical treatment for these conditions, leading to
delayed diagnosis and advanced presentation of HL. Analysis of a recent
childhood HL trial from India found that 29% of
children had received empirical antitubercular treatment (ATT) prior to
establishing a definitive diagnosis of HL, with a significant proportion of
these children presenting with advanced-stage disease and B symptoms. Cervical
lymphadenopathy in children warrants investigation if there is either/ and
progressive increase in size, generalized lymphadenopathy, nodes at unusual
sites (mediastinal, epitrochlear, supraclavicular ), firm, rubbery or matted
nodes, associated organomegaly, fever, anemia, thrombocytopenia and are
non-responsive to antibiotics / ATT.
Diagnosis of HL ideally requires an excision biopsy from the largest and
firmest node. Enlarged axillary lymph nodes are more likely to be pathological
than cervical or inguinal nodes. Hodgkin lymphoma in children may
also present concurrently with HIV and TB, further confounding diagnosis and
complicating treatment.
Treatment of Hodgkin Lymphoma
The current management of childhood HL is based on risk
stratification and adapted to the response to initial treatment. Prognostic
factors used to determine include stage, presence of B symptoms, bulky disease,
extranodal involvement, and/or erythrocyte sedimentation rate.
Current trials in childhood HL focus on decreasing the toxicities
of treatment while maintaining excellent outcomes. Multiagent chemotherapy is
used in all children, with or without low-dose involved-field or involved-site
radiation therapy. Recent trials have found improved outcomes in high-risk HL
with the addition of targeted therapy. Immunotherapy and
high-dose chemotherapy with stem cell transplant are used in relapsed HL. Children
treated for HL need long-term follow-up for late medical effects of treatment
as well as surveillance for late recurrences which may occur rarely.
SIOP
CEDAR Project
The
International Society of Pediatric Oncology (SIOP) has launched
“Childhood Cancer Early Diagnosis and Appropriate Referral” (CEDAR)
project in collaboration with the International Pediatric Association (IPA). In the
first phase of the CEDAR project, SIOP and IPA are organizing a series of
monthly webinars (started in September 2022) to highlight the importance of
early diagnosis, with a focus on the six WHO
index cancers (acute lymphoblastic leukemia, Hodgkin lymphoma, Burkitt’s
lymphoma, Wilms tumor, retinoblastoma, and low-grade glioma). Each CEDAR
webinar is accredited by the European Accreditation Council for Continuing
Medical Education (EACCME) with 1 credit point. These webinars are free to
attend and open to everyone, and we are offering simultaneous Spanish
translation.
Recordings of
the first two webinars are available on the following links:
1.
Outcomes of childhood cancers: Gaps and Disparities to be
addressed
https://www.youtube.com/watch?v=3d2U0sajKr4
2.
Diagnosis and Referral of Acute Leukemia
3. Diagnosis and Referral of Retinoblastoma
https://www.youtube.com/watch?v=nFQMMh-2GlE
CEDAR
Webinar – Diagnosis and referral of Hodgkin Lymphoma
The fifth
CEDAR webinar is on 20th January 2023 at 2-3 PM UTC/GMT on
“Diagnosis and referral of Hodgkin Lymphoma”. This webinar will be co-moderated
by SIOP Education and Training Committee members Dr. Maya Prasad (India) and
Dr. Reineke Schoot (UK) and a member of IPA SAG on NCD Dr. Basim Al-Zoubi
(Jordan). The agenda of this educational session is as follows:
1.
Case presentation: Dr. Ganda Ilmana (Indonesia)
2.
When to suspect Hodgkin Lymphoma? : Dr. Mauricio Castellanos
(Guatemala)
3.
Approach for diagnosis, initial management, and referral: Dr.
Jennifer Geel (South Africa)
4.
Panel Discussion with Expert Panelists
a.
Dr. Ramandeep Arora (India)
b.
Dr. Francesco Ceppi (Switzerland)
c.
Dr. Szymon Skoczen
(Poland)
Link for registration: https://bit.ly/3uDmNpW
FUTURE
CEDAR WEBINARS
Please save
the dates and register for our future CEDAR webinars:
|
Date |
Subject |
Link to
register |
|
Webinar 6: 3rd February 2023 |
Diagnosis and Referral of Burkitt’s Lymphoma |
|
|
Webinar
7: 10th March 2023 |
Diagnosis
and Referral of Wilms Tumor |
For queries
or further information, please visit siop-online.org/cedar
or email info@siop-online.org
Dr. Reineke Schoot (MD)
is paediatric oncologist at Princess
Máxima Center for Pediatric Oncology, Utrecht, the Netherlands. She is an active member of SIOP Europe
(SIOPE) and the SIOP Education and Training Committee. She has a special interest in soft tissue sarcoma and early
phase clinical trials.
SIOP
The International Society of Paediatric Oncology (SIOP) is the
only global multidisciplinary society entirely devoted to pediatric and
adolescent cancer. SIOP, as a non-state actor in official relations with WHO,
is committed to contribute substantially to WHO Global Initiative for Childhood
Cancer. We have over 2,600 members worldwide including doctors, nurses, other
healthcare professionals, scientists, and researchers.
Visit siop-online.org
for more information.
IPA
The International Pediatric Association (IPA) exists to create a
world where all children, regardless of age, location, or family situation can
live healthy lives. IPA advocates globally, nationally, and locally for
high-quality, evidence-based, and child-centered pediatric care. We are a
respected partner of WHO and UNICEF and provide global leadership on emerging
child health issues through our work with leading global health players. Visit ipa-world.org
for more information.
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