CareTalk Blog: Nemours Center for Cancer and Blood Disorders

CareTalk: Blog for Cancer and Blood Disorders

Get insights and inspiration from Nemours’ experts in Hematology/Oncology.

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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.

Lumbar Puncture (Spinal Tap)

What It Is

A lumbar puncture (LP), often called a spinal tap, is a common medical test that involves taking a small sample of cerebrospinal fluid (CSF) for examination. CSF is a clear, colorless liquid that delivers nutrients and "cushions" the brain and spinal cord, or central nervous system.

In a lumbar puncture, a needle is carefully inserted into the lower spine to collect the CSF sample.

Why It's Done

Medical personnel perform lumbar punctures and test the CSF to detect or rule out suspected diseases or conditions through analysis of the white blood cell count, glucose levels, protein, and bacteria.

Special testing can look for certain bacteria and viruses, or find the presence of abnormal cells that can help identify specific diseases in the central nervous system.

Most LPs are done to test for meningitis, but they also can detect bleeding in the brain and certain conditions affecting the nervous system (such as Guillain-Barré syndrome and multiple sclerosis). LPs also can deliver chemotherapeutic medications.

Preparation

After the procedure is explained to you, you'll be asked to sign an informed consent form — this document states that you give permission for the procedure to be performed and that you understand the procedure, why it is being done, and any potential risks.

The doctor performing the lumbar puncture will know your child's medical history, but might ask additional questions such as whether your child is allergic to any medicines.

You might be able to stay in the room with your child during the procedure, or you can step outside to a waiting area.

The Procedure

A lumbar puncture takes about 30 minutes. The doctor carefully inserts a thin needle between the bones of the lower spine (below the spinal cord) to withdraw the fluid sample.

The patient will be positioned with the back curved out so the spaces between the vertebrae are as wide as possible. This allows the doctor to easily find the spaces between the lower lumbar bones (where the needle will be inserted).

Older kids might be asked to either sit on an exam table while leaning over with their head on a pillow or lie on their side. Infants and younger children are usually positioned on their sides with their knees under their chin.

Lumbar Puncture

Once the child in the correct position, the back is cleansed with an antiseptic like iodine solution and a sterile area is maintained to minimize infection risk. The doctor performing the procedure also wears sterile gloves while performing the procedure.

A small puncture through the skin on the lower back is made and liquid anesthetic medicine is injected into the tissues beneath the skin to prevent pain. In many cases, before the injected anesthesia medication is given, a numbing cream is applied to the skin to minimize discomfort.

The spinal needle is thin and the length varies according to the size of the patient. It has a hollow core, and inside the hollow core is a "stylet," another type of thin needle that acts kind of like a plug. When the spinal needle is inserted into the lower lumbar area, the stylet is carefully removed, which allows the cerebrospinal fluid to drip out into the collection tubes.

After the CSF sample is collected (this usually takes about 2-5 minutes), the needle is withdrawn and a small bandage is placed on the site. Collected samples are sent to a lab for analysis and testing.

Sometimes doctors also measure the amount of pressure in the CSF using a special device called a manometer. High CSF pressure can happen under certain conditions, like meningitis.

What to Expect

While some notice a brief pinch and some discomfort, most people don't consider a lumbar puncture to be painful. Depending on the doctor's recommendations, your child might have to lie on his or her back for a few hours after the procedure. Your child might feel tired and have a mild backache the day after the procedure.

Getting the Results

Some results from a lumbar puncture are available within 45 to 60 minutes. However, to look for specific bacteria growing in the sample, a bacterial culture is sent to the lab and these results are usually available in 48 hours. If it's determined there might be an infection, the doctor will start antibiotic treatment while waiting for the results of the culture.

Risks

A lumbar puncture is considered a safe procedure with minimal risks. Most of the time, there are no complications. In some instances, a patient may get a headache. It's recommended that patients lie down for a few hours after the test and drink plenty of fluids to help prevent headaches, which usually resolve with rest, pain medications, and fluids.

In rare cases, infection or bleeding can occur. Also, trauma to spinal cord is extremely rare when the procedure is done correctly, because the cord ends much higher in the back than the area where the needle is inserted for the LP.

Sometimes, sedation medication may be helpful for your child in order to perform the procedure. If sedation is necessary, be sure to discuss the risks and benefits with your doctor.

Helping Your Child

You can help prepare your child for a lumbar puncture by explaining that while the test might be uncomfortable, it shouldn't be painful and won't take long. Also explain the importance of lying still during the test, and let your child know that a nurse might hold him or her in place. After the procedure, make sure your child rests and follow any other instructions the doctor gives you.

If You Have Questions

It's important to understand any procedure your child undergoes. If you have questions or concerns about the lumbar puncture procedure, be sure to speak with your doctor.

Reviewed by: Yamini Durani, MD
Date reviewed: September 2011