- Cervical lymphadenopathy is common and usually self-limiting. If there is a larger node and lymphadenitis is possible, a trial of oral antibiotics and review is a good strategy
- Red flags for concern include lack of response to therapy or systemic symptoms but also remember diseases like hodgkins present with very well children with lymph nodes which wax and wane. Parental concern and repeat attending is a very useful red flag which warrants referral for paediatric advice.
Freya represents a rare cause of lymphadenopathy in children. In your practice you will see many children with benign self limiting lymphadenopathy post infection. You will also see a lot of children with cervical lymphadenitis, the majority of which respond to oral antibiotics but some may require admission for IV antibiotics to clear the infection of treat an associated cellulitis.
In this case Freya did not have the usual associated raised inflammatory markers expected in an acute infective process. She also did not respond to treatment as one would expect. this case highlights the need to keep re-challenging the diagnosis when the child does not respond as you would expect. It also highlights the red flags associated with a diagnosis of lymphoma in children.
Despite the extensive nature of her disease Freya is likely to have an excellent overall survival. In current treatment protocols overall survival from childhood cancer in the UK is 82%.
The treatment for hodgkins lymphoma has produced overall survival of 93% and the focus of care is now on reducing late effects from therapy. Its treatment consists mainly of chemotherapy and PET-scan directed radiotherapy.
Non-hodgkin lymphoma has an overall 5 year survival of 89% in the UK. The treatment consists of intensive chemotherapy for 4-6 months and the likely course is quite intensive in-patient admission during this time and holistic supportive care. One of the key things to remember about NHL is the rapidity with which it can progress, doubling in 24 hours and therefore the severity of the risks of tumour lysis syndrome.
Surgery is not normally required in lymphoma for treatment but may be required to treat acute complications such as in this case the requirement for chest drains and to treat acute complications such as intussusception which can be a presenting feature of burrikitts lymphoma.