Childhood Non-Hodgkin Lymphoma
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What is non-Hodgkin lymphoma (NHL) in children?
NHL is cancer that starts in the lymphatic system. The lymphatic system is part of
the immune system. It helps to fight diseases and infections.
NHL results when the cells in the lymphatic system (lymphocytes) are changed (mutated)
and grow out of control. These cells can spread to other organs and tissues in the
body (metastasize). NHL is rare in children. But it can happen at any age. It tends
to affect boys more often than girls.
There are different types of NHL in children. But most tend to grow quickly. Your
child's treatment team may order different tests based on what type of lymphoma is
found. Treatment choices also depend on the specific type of lymphoma.
What causes non-Hodgkin lymphoma in a child?
Researchers don't know the exact cause of NHL. Inherited gene changes and some viral
infections may increase a child’s risk of having NHL. Risk factors that might be linked
to NHL include:
Epstein-Barr virus infection, the virus that causes mono (mononucleosis)
Infection with HIV, the virus that causes AIDS
Past cancer treatment
Certain immune diseases passed on in families (inherited syndromes)
Taking antirejection medicines after organ transplant
What are the symptoms of non-Hodgkin lymphoma in a child?
In many cases, NHL in children may not cause symptoms until it has grown or spread. Many
children have advanced disease at the time of diagnosis. This is because the symptoms start
suddenly, and the tumors tend to grow fast. A child can become very sick in a very
short time (a few days or weeks).
Signs and symptoms depend on the type of NHL and where it starts.
Symptoms of a belly (abdominal) tumor can include:
Abdominal swelling or pain
Nausea and vomiting
Trouble with bowel movements (constipation)
Feeling full after eating only a small amount
Symptoms of a chest tumor include:
Trouble breathing or swallowing
Pain with deep breaths
Cough or wheezing
High-pitched breathing sounds
Swelling or skin looks blue on the head and arms
Other symptoms may include:
Painless swelling of the lymph nodes in neck, chest, abdomen, underarm, or groin
Fever for no known reason
Bone and joint pain
Night sweats that soak pajamas and bedding
Tiring easily (fatigue)
Itching of the skin
The symptoms of NHL can be like those of many other health problems. Make sure your
child sees a healthcare provider for a diagnosis.
How is non-Hodgkin lymphoma diagnosed in a child?
Your child's healthcare provider will ask about your child's health history, family
history, and symptoms. A physical exam will be done. Based on the findings, your child
may need tests such as:
Blood and urine tests. Blood and urine are collected and tested in a lab.
Lymph node biopsy. A tiny piece of tissue, called a sample, is taken from the lymph nodes (or other abnormal
areas). This is often done during surgery. The sample is tested for cancer cells. This
type of biopsy is needed to diagnose NHL.
Chest X-ray. A chest X-ray shows the heart, lungs, and other parts of the chest. It can show NHL
that has spread to lymph nodes in the chest.
CT scan. This may be done to look at the abdomen, chest, and pelvis. A CT scan uses a series
of X-rays and a computer to make detailed pictures of the inside of the body. Sometimes
a dye is put in the blood to get clearer pictures.
MRI scan. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the
inside of the body. This test can be used to check the brain and spinal cord. Or it
may be used if the results of an X-ray or CT scan are unclear.
Ultrasound. This is also called sonography. Sound waves and a computer are used to make pictures
of blood vessels, tissues, and organs.
PET scan. For this test, a radioactive sugar is put into the blood. Cancer cells use the sugar
faster than normal cells, so the sugar will collect in cancer cells. A special camera
is then used to scan the whole body to see where the radioactive sugar has collected. A
PET scan can sometimes spot cancer in different parts of the body, even when they
can’t be seen by other tests. This test is often used together with a CT scan. This
is called a PET/CT scan.
Bone marrow aspiration or biopsy. Bone marrow is a thick liquid found in the center of some bones. It’s where blood
cells are made. A small amount of bone marrow may be removed with a needle. This is
called aspiration. Sometimes solid bone marrow tissue is taken with a bigger needle.
This is called a core biopsy. Bone marrow is usually removed from the back of the
hip bones. This test is done to see if there are cancer cells in the bone marrow.
Lumbar puncture. A long, thin needle is put into the lower back, between the bones of the spine, and
into the spinal canal. This is the area around the spinal cord and brain that contains
fluid, called cerebral spinal fluid or CSF. CSF cushions and supports the spinal cord
and brain. A small amount of CSF is removed and tested for cancer cells.
Pleural or peritoneal fluid sampling. Fluid is removed from around the lungs (pleura) or abdomen (peritoneum). The fluid
is checked for cancer cells.
Part of diagnosing cancer is called staging. Staging is the process of finding out
how much cancer there is and if it has spread. Staging is used to decide the best
There are different ways of staging NHL. Talk with your child's healthcare provider
about the stage of your child's cancer and what it means. The system most commonly
used divides NHL into 4 stages:
Stage I (1). The lymphoma is in only 1 place. It’s either in lymph nodes in only 1 part of the
body or is only 1 tumor that's not in a lymph node. Stage I NHL is not in the chest
or the abdomen (belly).
Stage II (2). The lymphoma is not in the chest and is 1 of these:
It's only 1 tumor and is in lymph nodes close to it
It's in 2 or more places, but it’s all in either the upper or lower part of the body
(either all above or all below the diaphragm)
The lymphoma started in the digestive tract and all of it can be removed with surgery,
including any lymph nodes that have cancer in them.
Stage III (3). Can be any of these:
The lymphoma is more than 1 tumor outside of the lymph nodes and might be in both
the upper and lower parts of the body (it's above and below the diaphragm). It might
also be in the bones or skin.
It started in the chest.
It started in the abdomen (belly) and is too widespread to be removed with surgery.
There's lymphoma next to the spine and maybe in other parts of the body.
There's lymphoma in more than 1 set of lymph nodes above. And it's above and below
There's a lymphoma tumor in a bone that has spread to nearby tissues.
Stage IV (4). The lymphoma is in the bone marrow or the central nervous system (the brain and spinal
cord) when it's first found. It may also be in other parts of the body.
How is non-Hodgkin lymphoma treated in a child?
Treatment will depend on the lymphoma type and stage. NHL can be treated with any
Chemotherapy. Medicines that kill cancer cells or stop them from growing are used for this treatment.
They may be given by IV (intravenous) into the vein, injected into tissue (as a shot),
or taken by mouth. Chemo is the main treatment for NHL.
Immunotherapy. These medicines work with your child's immune system to find and kill cancer cells.
Surgery. Surgery may be done to remove tumors.
Targeted therapy. These medicines target certain parts of cancer cells to kill them without harming
a lot of healthy cells. The NHL cells must be tested to see if they have the targets
these medicines work on.
High-dose chemotherapy with a stem cell transplant. Young blood cells (called stem cells) are taken from the child or from someone else. The
child is then given a large amount of chemotherapy to damage or destroy the bone marrow.
After the chemo, the stem cells are put into the blood. Over time, they rebuild the
Radiation therapy. This treatment uses high-energy X-rays or other types of radiation to kill cancer
cells or help keep them from growing. It's not often used to treat NHL in children.
But it might be used to treat serious problems caused by NHL tumors. For instance,
it can shrink a tumor that's causing pressure or pain.
Supportive care. Every kind of cancer treatment can cause side effects. Medicines and other treatments can
be used to ease or help prevent side effects like pain, fever, infection, 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. Most children with cancer are treated as part of a clinical
Your child will need follow-up care during and after treatment to:
Check on their response to the treatment
Manage the side effects of treatment
Look for returning or spreading cancer
With treatment, most children with NHL go on to live long lives. 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 outcomes.
Ongoing follow-up care during and after treatment is needed.
New treatments are being tested to improve outcomes and to lessen side effects.
Most children with cancer are cured.
What are possible complications of non-Hodgkin lymphoma in a child?
Possible complications depend on the type and stage of the lymphoma. They also vary
a lot based on where the lymphoma is and how it's treated. Problems can include things
Heart and blood vessel damage
Changes in thinking, learning, and memory
Increased chance of other cancers later in life
Trouble having children (infertility)
Developmental and growth delays
Treatment may also cause side effects, such as:
Many treatment side effects can be dealt with to keep them from getting worse. There
may even be things you can do to help prevent some of them. Most side effects go away
over time after treatment ends. But some treatments can cause long-term side effects
that may not show up until many years after your child finishes treatment. Ask your
child's treatment team what you might expect.
How can I help my child live with non-Hodgkin lymphoma?
You can help your child manage their treatment in many ways. For instance:
Get emotional support for your child. Find a counselor or child support group that
Make sure your child goes to all follow-up appointments.
Your child may have trouble eating. A dietitian may be able to help.
Your child may be very tired. They 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 uses tobacco, help them quit. If your child doesn’t use tobacco, make
sure they know the dangers of it and don't start. Also keep your child away from other
people's tobacco smoke.
When should I call my child’s healthcare provider?
Talk to your child's treatment team about problems you should watch for. Call the
healthcare provider if your child has:
It's important to know what problems to watch for and when you need to call the healthcare
provider. Be sure you know what number to call to get help after office hours and
on weekends and holidays.
Key points about non-Hodgkin lymphoma in children
NHL is a type of cancer in the lymphatic system.
Symptoms depend on what part of the body is affected and where the tumor is. Common
symptoms include painless swelling of lymph nodes, trouble breathing, night sweats,
fever, and feeling tired.
A lymph node biopsy is needed to diagnose NHL. Many other tests are also done.
Treatment may include chemotherapy and other medicines, stem cell transplant, radiation,
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 directions 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 and on holidays
and weekends. This is important if your child becomes ill and you have questions or
Online Medical Reviewers:
- Adam Levy MD
- Jessica Gotwals BSN MPH
- Kimberly Stump-Sutliff RN MSN AOCNS