Abstract
Malignant lymphomas make up 25-27% of cancers between the ages of 14 and 19 and are also another cancer in adolescents. In the Czech Republic, 25-30 adolescents suffer from lymphoma every year.
It is a diverse group of lymphoproliferative diseases, arising from malignant transforming lymphocytes at different levels of their maturation. Children with congenital or acquired immunodeficiency conditions (ataxia-telangiectasia, Wiskott-Aldrich syndrome, AIDS, organ transplant or bone marrow transplant patients) are at increased risk of developing lymphoma.
More often sick boys than girls, in a ratio of 2-3: 1. At adolescence, probably 60% of malignant lymphomas are Hodgkin's disease (HD), 40% of non-Hodgkin's lymphoma (NHL).
Malignant lymphomas in adolescents and young adults should be considered systemic diseases; at the time of diagnosis, not only lymphogenic but also hematogenous dissemination is common. The basic recalculation of their successful treatment is the precise histological and immunological classification and determination of the extent of the disease.
The most suitable imaging methods are chest X-rays, sonographic examination of peripheral lymph nodes, abdomen and small masters, CT examination of the chest and abdomen. Necessary examination of all areas where metastases could occur (bone marrow examination, neurological examination with cerebrospinal fluid examination and MRI examination of the brain and spinal canal).
Acceleration and refinement of the initial staging are also offered by positive emission tomography using fluorodeoxyglucose (1). Differential diagnosis is a necessary lymphoma different from infectious lymphadenopathies.
Among the cancers are metastases of nasopharyngeal carcinoma or histiocytosis, as well as soft tissue sarcomas, germinal tumors and neuroblastoma. Definitive diagnosis can be made only histologically from extirpated nodes, or from other infiltrated organs and tissues.
The main treatment method is combination chemotherapy, which must be accompanied by appropriate supportive treatment. Topical radiotherapy is used to treat persistent tumor residues.
Since the late 1970s, chemotherapeutic protocols have been developed in national and international randomized prospective studies. Treatment varies according to the degree of risk, based on clinical and laboratory prognostic features.
Patients at risk of adverse disease progression are indicated for autologous or allogeneic bone marrow transplantation. In less at-risk patients, reducing the intensity and duration of treatment will reduce the incidence of early and late treatment consequences during treatment or increase its success.
Malignant lymphomas are currently among the best treatable tumors in adolescents and young adults; 70-90% of patients can be cured. An unfavorable prognosis is in patients with initially refractory or recurrent relapsing disease.