Childhood Hodgkin Lymphoma
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What is Hodgkin lymphoma in children?
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
- 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
- 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 in a child?
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 are listed below. But because Hodgkin lymphoma is so rare, the
risk is still very low.
- 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 in a child?
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)
- Chest pain
- 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 in a child?
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 in a child?
Most children with Hodgkin lymphoma are treated successfully and cured. 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
- 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
With any cancer, how well a child is expected to recover (prognosis) varies. Keep
- 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 in a child?
Possible complications depend on the type and stage of the lymphoma. They include:
- Increased risk of infection
- Heart disease
- Lung problems
- Increased chance of growing other cancers
- Trouble reproducing (infertility)
Treatment may also cause complications. They include:
- Increased risk of bleeding
- Increased risk of infection
- Nausea and vomiting
- Poor appetite
- Sores in the mouth
- Hair loss
How can I help my child live with Hodgkin lymphoma?
You can help your child manage his or her treatment in many ways. For example:
- Get emotional support for your child. Find a counselor or child support group can
- Make sure your child attends all follow-up appointments.
- 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.
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 in children
- Hodgkin lymphoma is a type of cancer in the lymphatic system.
- Most children with Hodgkin lymphoma are treated successfully and cured.
- 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.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- 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.
Online Medical Reviewers:
- Levy, Adam S, MD
- Watson, L Renee, MSN, RN