CareTalk Blog: Nemours Center for Cancer and Blood Disorders

CareTalk: Blog for Cancer and Blood Disorders

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Lymphoma

Lymphomas are cancers that start in a child's lymphatic system — the part of the body that works with the immune system to help fight infections and diseases.

There are two types of pediatric lymphoma:
  • Non-Hodgkin’s lymphoma (also called NHL, non-Hodgkin’s disease, or just non-Hodgkin’s, for short) is the most common type of pediatric lymphoma. This type of cancer develops when there are too many white blood cells in the lymph nodes, bone marrow, spleen, and other areas. Non-Hodgkin’s lymphoma is usually diagnosed in children between the ages of 7 and 11, but older kids and adults can have it, too.
  • Hodgkin’s lymphoma (also called Hodgkin’s disease) develops when abnormal B cells (called Reed-Sternberg cells) start to form in the lymph nodes, spleen, and other areas of the body. Although associated with progressive swelling in the lymph nodes (or glands), Hodgkin’s lymphoma is often hard to diagnosis because symptoms can seem like the flu. Most kids with Hodgkin’s lymphoma are diagnosed around age 15.
 
Signs and Symptoms of Lymphoma in Children

Each individual child’s symptoms can vary, but common signs and symptoms of pediatric lymphoma may include:

  • swelling (typically where lymph nodes are found such as the neck, chest, abdomen, underarms, and groin areas)
  • fever
  • sore throat
  • bone and joint pain 
  • night sweats
  • fatigue (more tired than usual)
  • sudden and increased weight loss
  • burning and itching skin

IMPORTANT NOTE: These signs and symptoms together or on their own do not automatically mean that a child has lymphoma. Any or all of these could be a sign of something else. And not all need be present to indicate lymphoma or any other kind of cancer.

 
Diagnosing Pediatric Lymphoma

Our pediatric cancer care experts will conduct a complete exam of your child and a medical history evaluation. Other diagnostic tests for pediatric lymphoma may include:

  • X-rays
  • blood and urine tests
  • lymph node biopsy (taking a sample of cells or tissues for examination)
  • CAT scan (which stands for computed tomography) — a painless test that uses a special X-ray machine to take black-and-white pictures of the lungs, heart, blood vessels, airway passages, ribs, and lymph nodes
  • PET scan (which stands for positron emission tomography) — an imaging test that helps doctors see how the organs and tissues inside your child’s body are functioning
  • lumbar puncture (also called a spinal tap – when a thin needle is placed in the lower-back area of the spinal cord so we can take and then examine a sample of spinal fluid)

We know that tests can be scary – for you and your child. Whatever kind of tests your child might need, know that your Nemours pediatric cancer care team will do everything we can to make the experience as comfortable as possible – physically and emotionally. We’ll give sedation or anesthesia as needed and offer support and guidance at every step.

Learn more about what to expect with certain medical tests »

 
Treating Lymphoma in Children

Depending on your child’s age, overall health, extent of the disease, and other factors, pediatric lymphoma treatment may include one or a combination of
the following:

  • chemotherapy
  • radiation therapy   
  • blood or bone marrow transplant (also sometimes called a BMT, BBMT, stem cell transplant, or cord blood transplant)
  • medications/antibiotics
  • blood transfusions
  • surgery
  • antibiotics

At Nemours, we know that getting a cancer diagnosis can be very frightening and overwhelming for your whole family. That’s why Nemours’ board-certified pediatric hematologists-oncologists, specialty nurses, cancer researchers, and other cancer experts are focused on helping not only your child, but your family, too.

From diagnosis to treatment (and beyond) we’ll be here to help guide your family through your lymphoma journey – and to strive and hope, with you, for a better tomorrow.

Spleen and Lymphatic System

The lymphatic system is an extensive drainage network that helps keep bodily fluid levels in balance and defends the body against infections. It is made up of a network of lymphatic vessels that carry lymph — a clear, watery fluid that contains protein molecules, salts, glucose, urea, and other substances — throughout the body.

The spleen, which is located in the upper left part of the abdomen under the ribcage, works as part of the lymphatic system to protect the body, clearing worn out red blood cells and other foreign bodies from the bloodstream to help fight off infection.

About the Spleen and Lymphatic System

One of the lymphatic system's major jobs is to collect extra lymph fluid from body tissues and return it to the blood. This process is crucial because water, proteins, and other substances are continuously leaking out of tiny blood capillaries into the surrounding body tissues. If the lymphatic system didn't drain the excess fluid from the tissues, the lymph fluid would build up in the body's tissues, and they would swell.

The lymphatic system also helps defend the body against germs like viruses, bacteria, and fungi that can cause illnesses. Those germs are filtered out in the lymph nodes, small masses of tissue located along the network of lymph vessels. The nodes house lymphocytes, a type of white blood cell. Some of those lymphocytes make antibodies, special proteins that fight off germs and stop infections from spreading by trapping disease-causing germs and destroying them.

The spleen also helps the body fight infection. The spleen contains lymphocytes and another kind of white blood cell called macrophages, which engulf and destroy bacteria, dead tissue, and foreign matter and remove them from the blood passing through the spleen.

Basic Anatomy

The lymphatic system is a network of very small tubes (or vessels) that drain lymph fluid from all over the body. The major parts of the lymph tissue are located in the bone marrow, spleen, thymus gland, lymph nodes, and the tonsils. The heart, lungs, intestines, liver, and skin also contain lymphatic tissue.

One of the major lymphatic vessels is the thoracic duct, which begins near the lower part of the spine and collects lymph from the pelvis, abdomen, and lower chest. The thoracic duct runs up through the chest and empties into the blood through a large vein near the left side of the neck. The right lymphatic duct is the other major lymphatic vessel and collects lymph from the right side of the neck, chest, and arm, and empties into a large vein near the right side of the neck.

Lymph nodes are round or kidney-shaped, and can be up to 1 inch in diameter. Most of the lymph nodes are found in clusters in the neck, armpit, and groin area. Nodes are also located along the lymphatic pathways in the chest, abdomen, and pelvis, where they filter the blood. Inside the lymph nodes, lymphocytes called T-cells and B-cells help the body fight infection. Lymphatic tissue is also scattered throughout the body in different major organs and in and around the gastrointestinal tract.

The spleen helps control the amount of blood and blood cells that circulate through the body and helps destroy damaged cells.

How A Healthy Lymph System Typically Works

Carrying Away Waste

Lymph fluid drains into lymph capillaries, which are tiny vessels. The fluid is then pushed along when a person breathes or the muscles contract. The lymph capillaries are very thin, and they have many tiny openings that allow gases, water, and nutrients to pass through to the surrounding cells, nourishing them and taking away waste products. When lymph fluid leaks through in this way it is called interstitial fluid.

Lymph vessels collect the interstitial fluid and then return it to the bloodstream by emptying it into large veins in the upper chest, near the neck.

Fighting Infection

Lymph fluid enters the lymph nodes, where macrophages fight off foreign bodies like bacteria, removing them from the bloodstream. After these substances have been filtered out, the lymph fluid leaves the lymph nodes and returns to the veins, where it re-enters the bloodstream.

When a person has an infection, germs collect in the lymph nodes. If the throat is infected, for example, the lymph nodes of the neck may swell. That's why doctors check for swollen lymph nodes (sometimes called swollen "glands" — but they're actually lymph nodes) in the neck when your throat is infected.

Problems of the Lymphatic System

Certain diseases can affect the lymph nodes, the spleen, or the collections of lymphoid tissue in certain areas of the body.

  • Lymphadenopathy. This is a condition where the lymph nodes become swollen or enlarged, usually because of a nearby infection. Swollen lymph nodes in the neck, for example, can be caused by a throat infection. Once the infection is treated, the swelling usually goes away. If several lymph node groups throughout the body are swollen, that can indicate a more serious disease that needs further investigation by a doctor.
  • Lymphadenitis. Also called adenitis, this inflammation of the lymph node is caused by an infection of the tissue in the node. The infection can cause the skin overlying the lymph node to swell, redden, and feel warm and tender to the touch. This infection usually affects the lymph nodes in the neck, and it's usually caused by a bacterial infection that can be easily treated with an antibiotic.
  • Lymphomas. These cancers start in the lymph nodes when lymphocytes undergo changes and start to multiply out of control. The lymph nodes swell, and the cancer cells crowd out healthy cells and may cause tumors (solid growths) in other parts of the body.
  • Splenomegaly (enlarged spleen). In healthy people, the spleen is usually small enough that it can't be felt when you press on the abdomen. But certain diseases can cause the spleen to swell to several times its normal size. Usually, this is due to a viral infection, such as mononucleosis. But in some cases, more serious diseases such as cancer can cause it to expand. Doctors usually tell someone with an enlarged spleen to avoid contact sports like football for a while because a swollen spleen is vulnerable to rupturing (bursting). And if it ruptures, it can cause a huge amount of blood loss.
  • Tonsillitis. Tonsillitis is caused by an infection of the tonsils, the lymphoid tissues in the back of the mouth at the top of the throat that normally help to filter out bacteria. When the tonsils are infected, they become swollen and inflamed, and can cause a sore throat, fever, and difficulty swallowing. The infection can also spread to the throat and surrounding areas, causing pain and inflammation. A child with repeated tonsil infections may need to have them removed (a tonsillectomy).

Reviewed by: Yamini Durani, MD
Date reviewed: October 2012