What is Lymphoma?
Lymphocytes are white blood cells in the immune system. They fight off infections so we can stay healthy. If these cells grow and multiply uncontrollably, they can form a type of cancer called lymphoma.
Lymphoma is more common in adults, but it is actually the third most common form of cancer in children, after leukemia and brain tumors
There are many types of lymphoma. We provide advanced, comprehensive care for young people with all types of Hodgkin lymphoma and non-Hodgkin lymphoma. Thanks to advances in the understanding and treatment of these diseases, approximately 90 percent of children with Hodgkin lymphoma and non-Hodgkin lymphoma now remain cancer free after treatment.
A Team of Lymphoma Experts for Your Child
If your child has been diagnosed with lymphoma, we understand your concerns. We provide you with information and support to help you make the best decisions.
. We have compassion and expertise in treating children and teens with lymphoma. Together, we customize the most-effective care plan with the fewest effects on your child’s quality of life.
What types of lymphoma affect children?
There are two main types of lymphoma: Hodgkin lymphoma (also called Hodgkin’s disease) and non-Hodgkin lymphoma. Each type has several subtypes. These differ according to how lymph node tissue appears under a microscope, the cells affected, and other factors. After your child has had diagnostic testing, your doctor will let you know what type of lymphoma your child has and the best way to treat it.
Hodgkin Lymphoma
Hodgkin lymphoma most commonly affects children age 13and older. It results in abnormal cells called Reed-Sternberg cells in the cancerous lymph node. Doctors don’t yet know what causes Hodgkin lymphoma. There is a connection between the Epstein-Barr virus, which causes mononucleosis, and Hodgkin lymphoma in many young patients.
Children and young adults with Hodgkin lymphoma usually have one of three subtypes:
- nodular sclerosis ‒ lymph nodes contain scar tissue (sclerosis), normal and abnormal lymphocytes, and Reed-Sternberg cells; this subtype affects 70 percent of children who have Hodgkin lymphoma.
- mixed cellularity ‒ lymph nodes contain inflammatory immune cells and Reed-Sternberg cells; this form is most commonly diagnosed in children younger than 10.
- nodular lymphocyte predominant ‒ abnormal lymphocytes and Reed-Sternberg cells are concentrated in the cancerous lymph node; this form is also more common in younger children.
Non-Hodgkin Lymphoma
Non-Hodgkin lymphoma in children behaves differently than in adults. It tends to be aggressive and fast-growing, and requires intensive therapy.
Four main subtypes affect children:
- Burkitt’s lymphoma
- diffuse large B-cell lymphoma
- anaplastic large-cell lymphoma
- lymphoblastic lymphoma
Low-grade lymphomas, such as follicular or marginal cell lymphoma, are rare in children.
Boys are two-to three-times more likely to develop non-Hodgkin lymphoma than girls. It is also more common in Caucasians than in African-Americans.
Symptoms of Lymphoma in Children
What are the symptoms of lymphoma in children?
Lymphoma most often causes one or more swollen lymph nodes, usually in the neck, underarm, or groin. These are painless. Lymphoma can also cause these symptoms:
- unexplained fever
- night sweats
- loss of appetite or weight loss
- coughing or difficulty breathing
- swelling in the belly (lymphomas in the chest or belly can grow very large before they cause symptoms)
Lymph nodes often swell in response to infection, and the other symptoms may have other causes. If your child has a lymph node that has become swollen for no apparent reason and remains enlarged, or if they have any of the other symptoms and those don’t go away, it’s a good idea to visit a doctor to find out why. Your doctor may prescribe antibiotics for your child in case there is an infection. If the symptoms persist after the antibiotics are done, the doctor may recommend a more thorough evaluation of your child to find out what is causing them.
How is lymphoma diagnosed?
If your child has symptoms of lymphoma, the doctor will do a full physical exam. A biopsy may be needed for diagnosis. During a biopsy, some or all of an abnormal lymph node is taken out and looked at in the lab under a microscope. It is possible that the doctor will use a hollow needle instead. The needle is put into the abnormal lymph node and a little bit of tissue is taken into the needle.
During this test, children are often put to sleep with general anesthesia. Sometimes, only numbing medicine on the skin is used (local anesthesia). In that case, children may also get medicines to make them feel calm and sleepy (sedation)
Is lymphoma hereditary?
Researchers have not found a clear pattern for lymphoma running in families. For Hodgkin lymphoma, having a brother or sister with the disease increases the risk of getting it. The risk is also high for an identical twin of a person with Hodgkin lymphoma. But most people with Hodgkin lymphoma do not have a family history of it.
For non-Hodgkin lymphoma, there may be a small increase in risk if a parent, brother or sister has the disease. Scientists are still studying this question, but most people with non-Hodgkin lymphoma do not have a family history of it.
How is lymphoma treated?
Different types of treatment may be used for children with lymphoma:
- Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing. Chemo is given to children with either type of lymphoma (Hodgkin or non-Hodgkin).
- Chemo may be injected into the bloodstream, so that it can travel through the body.
- Some chemo may be given by mouth.
- Combination therapy uses more than one type of chemo at a time.
- Radiation therapy—uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing. This is only used for some children who have Hodgkin lymphoma that has not spread through the body.
- Targeted therapy—uses medicines or other treatments to target and attack specific cancer cells without harming healthy cells. Some targeted therapies can be used for children with Hodgkin lymphoma.
What are the survival rates for lymphoma?
Different forms of childhood lymphoma have different survival rates.
- Hodgkin lymphoma—The survival rate among children who are diagnosed and treated early is between 90% and 95% by five years after diagnosis. For children whose disease has spread through the body by the time they are diagnosed and treated, the survival rate is about 90% after five years.
- Non-Hodgkin lymphoma—After treatment, about 80% of children are disease-free five years after diagnosis. If the cancer is caught early and has not spread through the body, about 90% of children who are treated are disease-free five years after diagnosis.
What is non-Hodgkin lymphoma?
Non-Hodgkin lymphoma (NHL) is the group name for all types of lymphomas except Hodgkin lymphoma.
Lymphomas are cancers that begin in the body’s lymphatic system. This system transports white blood cells called lymphocytes through the body. Lymphocytes help the body to filter out dead cells and foreign organisms, such as bacteria. This helps the body fight off infection.
NHLs can arise in many sites including the lymph nodes, thymus gland, spleen and abdominal organs such as the bowel.
How common is non-Hodgkin lymphoma?
- NHLs account for 55 percent of childhood lymphomas.
- Each year in the United States, about 800 new cases of NHL are diagnosed in children up to age 19.
- Out of a million children, about nine white children younger than age 15 develop NHL each year.
- NHL occurs in two to three times more boys than girls.
- The likelihood of developing NHL is higher for people who take certain medications or who have the following:
- A brother or sister with NHL
- Disorders affecting the immune system, such as those caused by HIV and other viruses
What are the symptoms of non-Hodgkin lymphoma?
- Coughing
- Wheezing
- Unexplained weight loss
- Night sweats
- A painless lump or swelling of the testicle(s)
- Trouble swallowing
How is non-Hodgkin lymphoma treated?
Combination chemotherapy is most often used to treat non-Hodgkin lymphoma. Radiation therapy is rarely needed.
- Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells:
- Chemo may be injected into the bloodstream, so that it can travel throughout the body.
- Some chemo may be given by mouth.
- Combination therapy uses more than one type of chemo at a time.
The treatment of Burkitt, diffuse large B-cell, or anaplastic large cell lymphoma comprises of intensive cycles of chemotherapy over a period of 4-9 months. For all patients, treatment of the central nervous system with injection of chemotherapy into the cerebrospinal fluid is an essential part of therapy.
Monoclonal antibodies are a group of novel agents. These are proteins that recognize and tightly bind specific markers on the surface of the lymphoma cells. Once bound, these antibodies prevent cell proliferation and induce cell death through a variety of mechanisms. Rituximab is an example of such an agent that may be beneficial when combined with chemotherapy for the treatment of mature B-cell lymphomas.
Radiotherapy has a limited role in the treatment of non-Hodgkin lymphoma in children. It involves the delivery of high intensity X-rays that kill cancer cells.
For patients whose lymphoma comes back (relapse) or does not respond adequately to the initial treatment, high dose chemotherapy and hematopoietic stem cell transplantation may offer the best chance of cure. This involves very high doses of chemotherapy with or without radiation followed by infusion of blood forming stem cells from either the patient or a donor.
Although non-Hodgkin lymphoma is a serious disease, 70-95% of newly diagnosed children and adolescents can be cured with current therapy. After completion of therapy long term followup is needed to monitor for disease relapse and long term complications of therapy.
What are the survival rates for non-Hodgkin lymphoma?
- About 80 percent of patients treated for non-Hodgkin lymphoma remain disease-free.
- This positive outlook increases to about 90 percent for children with early, localized NHL.
What is Hodgkin lymphoma?
Hodgkin lymphoma is a cancer that starts in the lymph system (part of the immune system) and causes affected lymph nodes to get larger. This cancer may spread to the spleen, liver, bone marrow or lungs.
Children are more likely to develop Hodgkin lymphoma if they:
- have been infected with the Epstein-Barr virus or had mononucleosis (“mono,” caused by this virus);
- have been infected with HIV (human immunodeficiency virus);
- have a weakened immune system, either from an inherited disease or from medication to suppress the immune system after an organ or bone marrow transplant; or
- have a close relative, especially a brother or sister, who also has or had Hodgkin lymphoma.
How common is Hodgkin lymphoma?
- In the United States, 6,000 to 7,000 new cases of Hodgkin lymphoma are diagnosed each year.
- Children younger than age 5 rarely develop Hodgkin lymphoma. The likelihood of developing it increases as children grow older, peaking in young adulthood and later in older adults.
- Hodgkin lymphoma is more common in boys than in girls.
What are the symptoms of Hodgkin lymphoma?
If your child has Hodgkin lymphoma, the following symptoms may be present:
- Swollen (but not sore) lymph nodes in the neck, chest, armpit or groin
- Extreme fatigue
- Loss of appetite
- Weight loss
- Fever
- Night sweats
- Itchy skin
How is Hodgkin lymphoma treated?
- Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells:
- Chemo may be injected into the bloodstream, so that it can travel throughout the body.
- Some chemo may be given by mouth.
- Combination therapy uses more than one type of chemo at a time.
- Chemotherapy alone or combined chemotherapy and low-dose radiation therapy are the standard treatments for young patients and those who have more advanced disease. Depending on the type of Hodgkin lymphoma and the extent of its spread, surgery may be done first to remove as much of the tumor as possible.
- Radiation therapy—uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing.
- Radiation therapy works well for Hodgkin lymphoma that has not spread. However, radiation therapy may disrupt the growth of bones and soft tissues in young children. It may also increase the risk of heart disease and second cancers as patients grow older. Radiation is being used less for treating children with Hodgkin lymphoma.
- Targeted therapy—uses medicines or other treatments that target and attack specific cancer cells without harming normal cells. The most recent St. Jude clinical trial includes this kind of approach.
What are the survival rates for Hodgkin lymphoma?
In general, five-year survival rates for Hodgkin lymphoma are very good:
- Between 90 and 95 percent for those with early diagnoses.
- About 90 percent for children whose disease has spread.
Why should I come to a cancer center when my child may not have cancer?
We offers the experience, knowledge, and compassion to understand and treat all causes of lymphadenopathy. We understand it can be scary to come to a cancer center when there is a very good chance that your child does not have cancer. If your child receives such a diagnosis, though, you can take comfort in knowing that you are in an extraordinarily experienced and compassionate place to begin their care. Finally, if your child’s swollen lymph nodes are not a sign of cancer, you can rest assured that we took every step to rule it out.
Determining next steps. Depending on the cause of your child’s swollen lymph nodes, we may connect you with other doctors, . If the hematologist-oncologist and surgeon feel that your child should see an infectious disease doctor before taking any other steps, they will arrange for this appointment too. Other physicians may also be consulted, such as rheumatologists, who are experts in joint diseases and autoimmune disorders, sometimes a cause of enlarged lymph nodes. Based on your child’s evaluation, we will develop a set of recommendations for their care.
