Hodgkin Lymphoma in Children What is Hodgkin lymphoma? Hodgkin lymphoma is a type of cancer in the lymphatic system. The lymphatic system is part of the immune system. It helps to fight diseases and infections. The lymphatic system also helps with balancing fluids in different parts of the body. The lymphatic system includes: Lymph. This is a fluid that contains lymphocyte cells. Lymph vessels. These are tiny tubes that carry lymph fluid throughout the body. Lymphocytes. These are a type of white blood cells that fight infections and disease. Burkitt lymphoma grows from B-cells, one type of lymphocyte. Lymph nodes. These are small bean-shaped organs. They are in the underarm, groin, neck, chest, abdomen, and other parts of the body. They filter the lymph fluid as it moves around the body. Other organs and body tissues. The lymphatic system includes the bone marrow where blood is made. And it includes the spleen, thymus, tonsils, and digestive tract. Hodgkin lymphoma causes abnormal growth of the cells in the lymphatic system. Over time, the body is less able to fight infection and the lymph nodes swell. Hodgkin lymphoma cells can also spread (metastasize) to other organs and tissues. It’s a rare disease in children. It affects boys more often than girls. What causes Hodgkin lymphoma? The exact cause of Hodgkin lymphoma is not known. Genes and some viral infections may increase a child’s risk of having Hodgkin lymphoma. Conditions that are linked to Hodgkin lymphoma include: Epstein-Barr virus, which causes mononucleosis (mono) HIV, the virus that causes AIDS Having a brother or sister with Hodgkin lymphoma What are the symptoms of Hodgkin lymphoma? Symptoms can occur a bit differently in each child. They can include: Painless swelling of the lymph nodes in the neck, underarm, groin, or chest Trouble breathing (dyspnea) Coughing Chest pain Fever Night sweats Tiring easily (fatigue) Loss of appetite Weight loss Itching skin (pruritus) Frequent viral infections such as colds, flu, sinus infections The symptoms of Hodgkin lymphoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis. How is Hodgkin lymphoma diagnosed? Your child's healthcare provider will ask about your child's medical history and symptoms. He or she will examine your child. Your child may have tests such as: Blood and urine tests. Blood and urine are tested in a lab. Chest X-ray. The chest X-ray shows the heart, lungs, and other parts of the chest. Lymph node biopsy. A sample of tissue is taken from the lymph nodes. It’s checked with a microscope for cancer cells. A lymph node biopsy is needed to diagnose Hodgkin lymphoma. CT scan. This may be done for the abdomen, chest, and pelvis. A CT scan uses a series of X-rays and a computer to make detailed pictures of the body. MRI scan. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the body. This test is used to check the brain and spinal cord. Or it may be used if the results of an X-ray or CT scan unclear. Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan. Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test may be done to see if cancer cells have reached the bone marrow. Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging used for Hodgkin lymphoma. Talk with your child's healthcare provider about the stage of your child's cancer. One method of staging Hodgkin lymphoma is the following: Stage I. The cancer is in a single lymph node region or organ. Stage II. The cancer is in 2 or more lymph node regions on the same side of the body. Or the cancer has spread from one lymph node into a nearby organ. Stage III. The cancer is in lymph node regions on both sides of the body. It also includes which organs and areas involved. Stage IV. The cancer is in the lymphatic system and has spread to other areas of the body (metastasis). Staging also includes whether a child has certain symptoms, and includes: Asymptomatic (A). No fever, night sweats, or weight loss. Symptomatic (B). Symptoms of fever, night sweats, or weight loss. How is Hodgkin lymphoma treated? Treatment will depend on the stage and other factors. Hodgkin lymphoma can be treated with any of the below: Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV), injected into tissue, or taken by mouth. Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing. Surgery. Surgery may be done to remove tumors. High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced. Monoclonal antibodies. This is a type of targeted therapy that kills cancer cells without harming healthy cells. Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. Your child will need follow-up care during and after treatment to: Check on your child's response to the treatment Manage the side effects of treatment Look for returning or spreading cancer Some treatments may be hard on your child, but they increase the chance of your child living a long time. Discuss the side effects of treatment with your child's healthcare provider. With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind: Getting medical treatment right away is important for the best prognosis. Ongoing follow-up care during and after treatment is needed. New treatments are being tested to improve outcome and to lessen side effects. What are possible complications of Hodgkin lymphoma? Possible complications depend on the type and stage of the lymphoma, and can include: Increased risk of infection Heart disease Lung problems Increased chance of growing other cancers Trouble reproducing (infertility) Death Treatment may also cause complications. They include: Increased risk of bleeding Increased risk of infection Nausea and vomiting Diarrhea Poor appetite Sores in the mouth Hair loss How is Hodgkin lymphoma managed? You can help your child manage his or her treatment in many ways. For example: Your child may have trouble eating. A dietitian may be able to help. Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness. If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking. Get emotional support for your child. Find a counselor or child support group can help. Make sure your child attends all follow-up appointments. When should I call my child's healthcare provider? Call the healthcare provider if your child has: Symptoms that get worse New symptoms Side effects from treatment Key points about Hodgkin lymphoma Hodgkin lymphoma is a type of cancer in the lymphatic system. Symptoms of Hodgkin lymphoma include painless swelling of the lymph nodes in the neck, underarm, groin, or chest, trouble breathing, night sweats, fever, and feeling tired. A lymph node biopsy is needed to diagnose Hodgkin lymphoma. Treatment may include a medicines, radiation, stem cell transplants, and surgery. Next stepsTips to help you get the most from a visit to your child’s healthcare provider: Before your visit, write down questions you want answered. At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child. If your child has a follow-up appointment, write down the date, time, and purpose for that visit. Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice. Medical Reviewers: Alteri, Rick, MD Holloway, Beth, RN, M.Ed.