Non-Hodgkin lymphoma - children

Non-Hodgkin lymphoma (NHL) is cancer of the lymph tissue. Lymph tissue is found in the lymph nodes, spleen, tonsils, bone marrow, and other organs of the immune system. The immune system protects us against diseases and infections.

This article is about NHL in children.

Causes

NHL tends to occur more often in adults. But children do get some types of NHL. NHL occurs more often in boys. It usually doesn't occur in children younger than age 3.

The exact cause of NHL in children is not known. But, the development of lymphomas in children has been associated with:

• Past cancer treatment (radiation treatment, chemotherapy)
• A weak immune system from an organ transplant
• Epstein-Barr virus, the virus that causes mononucleosis

  Mononucleosis

  Mononucleosis, or mono, is a viral infection that causes fever, sore throat, and swollen lymph glands, most often in the neck.

   

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• HIV (human immunodeficiency virus) infection

There are many types of NHL. One classification (grouping) is by how fast the cancer spreads. The cancer may be low grade (slow growing), intermediate grade, or high grade (fast growing).

NHL is further grouped by:

• How the cells look under the microscope
• What type of white blood cell it originates from
• Whether there are certain DNA changes in the tumor cells themselves

Symptoms

Symptoms depend on which area of the body is affected by the cancer and how fast the cancer is growing.

Symptoms may include:

• Swollen lymph nodes in the neck, underarm, stomach, or groin

  Swollen lymph nodes

  Lymph nodes are present throughout your body. They are an important part of your immune system. Lymph nodes help your body recognize and fight germ...

   

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• Painless swelling or lump in the testicle
• Swelling of the head, neck, arms or upper body
• Trouble swallowing
• Trouble breathing
• Wheezing
• Persistent cough
• Swelling in the belly
• Night sweats
• Weight loss
• Fatigue

  Fatigue

  Fatigue is a feeling of weariness, tiredness, or lack of energy.

   

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• Unexplained fever

  Unexplained fever

  Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...

   

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Exams and Tests

The health care provider will take your child's medical history. The provider will do a physical exam to check for swollen lymph nodes.

The provider may perform these lab tests when NHL is suspected:

• Blood chemistry tests including protein levels, liver function tests, kidney function tests, and uric acid level

  Blood chemistry tests

  A comprehensive metabolic panel is a group of blood tests. They provide an overall picture of your body's chemical balance and metabolism. Metaboli...

   

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• Complete blood count (CBC)

  Complete blood count

  A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...

   

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• ESR (sed rate)

  ESR (sed rate)

  ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate. "It is a test that indirectly measures how much inflammation is in...

   

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• Chest x-ray, which often shows signs of a mass in the area between the lungs

A lymph node biopsy confirms the diagnosis for NHL.

If a biopsy shows that your child has NHL, more tests will be done to see how far the cancer has spread. This is called staging . Staging helps guide future treatment and follow-up.

• CT scan of the chest, abdomen and pelvis

  CT scan

  A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...

   

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• Bone marrow biopsy

  Bone marrow biopsy

  A bone marrow biopsy is the removal of marrow from inside bone. Bone marrow is the soft tissue inside bones that helps form blood cells. It is foun...

   

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• PET scan

  PET scan

  A positron emission tomography scan is a type of imaging test. It uses a radioactive substance called a tracer to look for disease in the body. A po...

   

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Immunophenotyping is a laboratory test used to identify cells, based on the types of antigens or markers on the surface of the cell. This test is used to diagnose the specific type of lymphoma by comparing the cancer cells to normal cells of the immune system.

Treatment

You may choose to seek care at a children's cancer center .

Treatment will depend on:

• The type of NHL (there are many types of NHL)
• Stage (where the cancer has spread)
• Your child's age and overall health
• Your child's symptoms, including weight loss, fever, and night sweats

Chemotherapy is most often the first treatment:

• Your child may need to stay in the hospital at first. But most of the treatment for NHL can be given in a clinic, and your child will still live at home.
• Chemotherapy is given mainly into the veins (IV), but some chemotherapy is given by mouth.

Your child may also receive radiation therapy using high-powered x-rays at cancer-affected areas.

Other treatments may include:

• Targeted therapy that uses drugs or antibodies to kill cancer cells

  Targeted therapy

  Molecularly targeted anticancer agents; MTAs; Chemotherapy-targeted; Vascular endothelial growth factor-targeted; VEGF-targeted; VEGFR-targeted; Tyro...

   

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• High-dose chemotherapy may be followed by stem cell transplant (using your child's own stem cells)

  Stem cell transplant

  A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells. Bone marrow is the soft, fat...

   

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• Surgery to remove the cancer may be needed in some cases

Having a child with cancer is one of the hardest things you will ever deal with as a parent. Explaining what it means to have cancer to your child will not be easy. You will also need to learn how to get help and support so you can cope more easily.

Support Groups

Having a child with cancer can be stressful. Joining a support group where other parents or families share common experiences may help ease your stress.

American Childhood Cancer Organization - www.acco.org

Leukemia and Lymphoma Society has support groups for families and patients -  www.lls.org

Outlook (Prognosis)

Most forms of NHL are curable. Even late stages of NHL are curable in children.

Your child will need to have regular exams and imaging tests for years after treatment to make sure the tumor does not come back.

Even if the tumor comes back, there is a good chance of a cure.

Regular follow-ups will also help the health care team check for signs of the cancer returning and for any long-term treatment effects.

Possible Complications

Treatments for NHL may have complications. Side effects of chemotherapy or radiation therapy may appear months or years after treatment. These are called " late effects ." It is important to talk about treatment effects with your health care team. What to expect in terms of late effects depends on the specific treatments your child receives. The concern of late effects must be balanced by the need to treat and cure the cancer.

When to Contact a Medical Professional

Call your child's provider if your child has swollen lymph nodes with unexplained fever that does not go away or has other symptoms of NHL.

If your child has NHL, call the provider if your child has a persistent fever or other signs of infection.