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.

Childhood Cancer

Every bodily cell is tightly regulated with respect to growth, interaction with other cells, and even its life span. Cancer occurs when a type of cell has lost these normal control mechanisms and grows in a way that the body can no longer regulate.

Different kinds of cancer have different signs, symptoms, treatments, and outcomes, depending on the type of cell involved and the degree of uncontrolled cell growth.

About Cancer

All kinds of cancer, including childhood cancer, have a common disease process — cells grow out of control, develop abnormal sizes and shapes, ignore their typical boundaries inside the body, destroy their neighbor cells, and ultimately can spread (or metastasize) to other organs and tissues.

As cancer cells grow, they demand more and more of the body's nutrition. Cancer takes a child's strength, destroys organs and bones, and weakens the body's defenses against other illnesses.

Cancer affects only about 14 of every 100,000 children in the United States each year. Among all age groups, the most common childhood cancers are leukemia, lymphoma, and brain cancer. As kids enter the teen years, there is an increase in the incidence of osteosarcoma (bone cancer).

The sites of cancer are different for each type, as are treatment and cure rates.

Typically, factors that trigger cancer in kids usually differ from those that cause cancer in adults, such as smoking or exposure to environmental toxins. Rarely, there may be an increased risk of childhood cancer in kids who have a genetic condition, such as Down syndrome. Those who have had chemotherapy or radiation treatment for a prior cancer episode may also have an increased risk of cancer.

In most cases, however, childhood cancers arise from noninherited mutations (or changes) in the genes of growing cells. Because these errors occur randomly and unpredictably, there's no effective way to prevent them.

Sometimes, a doctor might spot early symptoms of cancer at regular checkups. However, some of these symptoms (such as fever, swollen glands, frequent infections, anemia, or bruises) are also associated with other infections or conditions that are much more common than cancer. Because of this, both doctors and parents might suspect other childhood illnesses when cancer symptoms first appear.

Once cancer has been diagnosed, it's important for parents to seek help from a medical center that specializes in pediatric oncology (treatment of childhood cancer).

Cancer Treatment

The treatment of cancer in children can include chemotherapy (the use of medical drugs to kill cancer cells), radiation (the use of radiant energy to kill cancer cells), and surgery (to remove cancerous cells or tumors). The type of treatment needed depends on the type and severity of cancer and the child's age.

Surgery

For children with leukemia or lymphoma, surgery generally plays a minor role. This is because leukemia and lymphoma involve the circulatory system and lymphatics, two systems that are located all throughout the body, making it difficult to treat by operating on one specific area.

In children with solid tumors that haven't spread to other parts of the body, however, surgery can often effectively remove cancer when used in combination with chemotherapy and/or radiation.

Chemotherapy

Chemotherapy is medication which is used as a tool to eliminate cancer cells in the body. Kids with cancer can be given the chemotherapy medications intravenously (through a vein) or orally (by mouth). Some forms of chemotherapy can be given intrathecally, or into the spinal fluid. The drugs enter the bloodstream and work to kill cancer in all parts of the body.

The duration of chemotherapy treatment and type and number of different of drugs used depends on the type of cancer and the child's response to the drugs. Every child's treatment differs, so a child may receive daily, weekly, or monthly chemotherapy treatments. The doctor may also recommend cycles of treatment, which allow the body to rest and recover between periods of chemo.

All of the medications used as chemotherapy also carry the risk of both short-term and long-term problems. Short-term side effects may include nausea, vomiting, hair loss, fatigue, anemia, abnormal bleeding, and increased risk of infection due to destruction of the bone marrow, as well as kidney damage and menstrual irregularities. Some drugs carry a risk of bladder inflammation and bleeding into the urine, hearing loss, and liver damage. Others may cause heart and skin problems. Longer-term effects can include infertility, growth problems, organ damage, or increased risk of other cancers.

Your doctor will use precautions as well as other medications to counteract as many of the side effects as possible.

Bone Marrow Transplants

Kids with certain types of cancer may receive bone marrow transplants. Bone marrow is a spongy tissue inside certain bones of the body that produces blood cells. If a child has a type of cancer that affects the function of blood cells, a bone marrow transplant (along with chemotherapy to kill the defective cells) may allow new, healthy cells to grow. Bone marrow transplant is also sometimes used to treat cancer that does not involve blood cells because it lets doctors use higher doses of chemo than would otherwise be tolerated.

Radiation

Radiation is one of the most common treatments for cancer. A child who receives radiation therapy is treated with a stream of high-energy particles or waves that destroy or damage cancer cells. Many types of childhood cancer are treated with radiation along with chemotherapy or surgery.

Radiation has many potential side effects (such as increased risk of future malignancy and infertility), which you should discuss with the doctor.

The primary goal when treating kids with cancer is to cure them; this takes priority over all other aspects of care. However, many medications and therapies can make kids more comfortable while undergoing treatment for cancer.

Coping With Cancer

When possible, older kids should be involved with their own cancer treatment. Facts about the specific type of cancer and its effects should be explained in language suitable for the child's age. However, when cancer affects younger children — toddlers and those under age 4 — simply telling them that they are "sick" and need "medicine" to get better is often enough explanation. For all age groups, the goal is to prevent fear and misunderstanding.

Many kids might feel guilty, as if the cancer is somehow their fault. Psychologists, social workers, and other members of the cancer treatment team can be a great help in reassuring and helping them with their feelings.

The cancer treatment team can guide patients and families through the pain, uncertainty, and disruptions caused by cancer. If necessary, team can also contact or visit the child's school to explain the diagnosis to teachers and classmates. Replacing fear and misunderstanding with compassion and information is a goal in helping kids with cancer cope with the illness.

The diagnosis and treatment of childhood cancers takes time, and there are both short-term and long-term side effects. But thanks to medical advances, more and more kids with cancer are finishing successful treatment, leaving hospitals, and growing up just like everybody else. Today, up to 70% of all children with cancer can be cured.

Reviewed by: Robin E. Miller, MD
Date reviewed: September 2010