Childhood cancers

Childhood non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma is a disease of the lymph tissues, the main component of the body's infection-fighting immune system. The disease affects both children and adults. In children, it is the third most common childhood cancer, with about 1,704 cases diagnosed each year in the U.S. It is much more common than Hodgkin's disease in children.

Non-Hodgkin's lymphoma is three times more common in boys than in girls, and about twice as common in white children as in African-American children. Though the cancer can occur from infancy through adolescence, it most commonly occurs between ages seven and 11 years. It is rarely seen under age five. The five-year survival rate is above 90 percent for children diagnosed with early stage non-Hodgkin's lymphoma.

Risk factors
The majority of children and adults with non-Hodgkin's lymphoma have no known risk factors for the disease. It's important for parents to remember that for the most part there is nothing anyone could have done to prevent this cancer.

However, there are conditions or diseases that weaken the immune system are known risk factors for non-Hodgkin's lymphoma, such as:

	HIV infection
	Taking immune-suppressing drugs after an organ transplant
	Congenital conditions that affect the immune response
	Previous cancer treatment with radiation or chemotherapy. This can take years to develop so it usually affects only adults.

Symptoms
Symptoms vary widely, depending on the location of the tumor. The most common symptom is swollen glands. These glands can be in the head or neck, under the arms and in the abdomen. This swelling is usually noticed by the child, the parent or the health care provider. If a tumor is located near the windpipe (trachea), it can produce a cough or difficulty breathing.

Parents should realize that a swollen gland does not usually mean cancer. Normally, when glands swell, the child is fighting off a common childhood illness, such as a cold or other type of infection. Determining the cause of swollen glands therefore requires further investigation. Children with lymphoma also experience secondary symptoms, such as fever, chills and night sweats.

Questions to ask your child's doctor

Diagnosis
Because swollen lymph nodes are so common in children and infants, the diagnosis of lymphoma can be delayed. To see if the swelling is caused by an infection, a child with swollen glands might be given antibiotics before undergoing additional tests. If antibiotics are ineffective, a biopsy may be performed. This involves removing a small sample of the lymph tissue so it can be examined under a microscope and by other laboratory tests. Very large nodes or those that pose a threat because of their location are often biopsied immediately.

Tests
Lymphomas are most often diagnosed through biopsy. Pathologists classify lymphoma into three groups—by the size and shape of the cancerous cells and their pattern of growth. Further testing is usually needed to make this classification. All of these tests can help determine if cancer is present, what type of cancer it is and, in some cases, if it has spread. Diagnosing cancer

Treatment
Before cancer is treated, it has to be staged. Staging involves finding out where the cancer is located, the extent of the cancer and whether it has spread. Early stage cancers (Stage 1 and 2 that have not spread) are the easiest to treat.

The primary treatment for this disease is chemotherapy. Chemotherapy medications can be given by mouth, through a vein or into a muscle or cerebrospinal fluid. Surgery may be performed to obtain a biopsy or remove a tumor completely, but is always combined with chemotherapy. Radiation therapy is no longer commonly used to treat non-Hodgkin's lymphoma.

Chemotherapy causes side effects. Be sure to discuss these side effects thoroughly with the pediatric oncologist before your child begins therapy.

Bone marrow stem cell transplantation or peripheral stem cell transplantation are for children who relapse during or after treatment for non-Hodgkin's lymphoma.

Clinical trials, protocols and research

Learn more
• YNHH Health Library: Non-Hoddgkin's Lymphoma

Last revised: Jan. 8, 2008 (dh)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.