Hodgkin Lymphoma in Children
Hodgkin lymphoma is also called
Hodgkin disease. It's a type of cancer that starts in the lymphatic system. The
lymphatic system is part of the immune system. It helps to fight diseases and
infections. The lymphatic system also helps balance fluids in different parts of the
Hodgkin lymphoma causes abnormal
growth of the cells in the lymphatic system. Over time, the body is less able to fight
infection and the lymph nodes swell. Hodgkin lymphoma cells can also spread
(metastasize) to other organs and tissues.
It’s a rare disease in children
under age 5. But Hodgkin lymphoma is the most common cancer diagnosed in teens ages
to 19. There are two main childhood Hodgkin lymphoma types:
- Classic Hodgkin lymphoma
- Nodular lymphocyte-predominant
Classic Hodgkin lymphoma is the most common type. It occurs mostly in teens.
Nodular lymphocyte-predominant Hodgkin lymphoma is not as common. It occurs mostly
children 10 years of age or younger.
The exact cause of Hodgkin lymphoma
is not known. Having a weak immune system and some viral infections may increase a
child’s risk of having Hodgkin lymphoma. Conditions that are linked to Hodgkin lymphoma
are listed below. But because Hodgkin lymphoma is so rare, the risk is still very
- Epstein-Barr virus infection, which
causes mononucleosis (mono)
- HIV infection, the virus that causes
- Having a family history of Hodgkin
- Certain immune system diseases
- Having a weakened immune system after an organ transplant or
from medicine given to stop the organ from being rejected by the body
Symptoms tend to be a bit different
in each child. It depends on twhere the Hodgkin lymphoma starts and the size of the
cancer. They can include:
- Painless swelling of the lymph nodes
in the neck, underarm, groin, or chest
- Trouble breathing
- B symptoms: Fever for no known reason,
drenching night sweats, and weight loss for no known reason
- Tiring easily (fatigue)
- Loss of appetite
- Itching skin
- Frequent infections
The symptoms of Hodgkin lymphoma
are a lot like those of other health conditions. It's important to take your child
healthcare provider if you notice these symptoms. Only a healthcare provider can tell
your child has cancer.
Your child's healthcare provider
will ask about your child's medical history and symptoms. A physical exam will be
done. Some tests might be done. too, such as:
Blood and urine tests.
These can be used to get an idea of your child's overall health and organ function.
Certain changes can be signs of disease.
Chest X-ray. The chest X-ray
shows the heart, lungs, and other parts of the chest.
Lymph node biopsy. A
tiny piece of tissue (called a sample) can be taken out of a swollen lymph node or
the whole lymph node may be removed. It’s sent to a lab and tested for cancer cells.
A lymph node biopsy is needed to diagnose Hodgkin lymphoma.
This may be done for the neck, abdomen, chest, pelvis, or a combination. A CT
scan uses a series of X-rays taken from different angles and a computer to make
detailed 3-D pictures of the inside of the body.
MRI scan. An MRI
uses large powerful magnets, radio waves, and a computer
to make detailed pictures of the inside of the body. This test is often used to check
the brain and spinal cord. Or it may be used if the results of an X-ray or CT
scan are unclear.
Positron emission tomography
For this test, a radioactive sugar is injected into the
bloodstream. Cancer cells use the sugar faster than normal cells, so it collects in
cancer cells. A special camera is used to see where the radioactive sugar is in the
body. A PET scan can sometimes show cancer cells in different parts of the body, even
when they can’t be seen on other tests. This test is often done along with a CT scan.
This is called a PET/CT scan.
Bone marrow aspiration or
Bone marrow is the thick liquid in the center of some bones.
It’s where blood cells are made. A small amount of bone marrow may be taken out with
a large needle. This is called aspiration. Or solid bone marrow tissue may be removed
with a needle. This is called a core biopsy. Bone marrow is usually taken from the
hip bone. This test may be done to see if cancer cells have reached the bone marrow.
It may be done when the cancer is advanced, if there are B symptoms present, or for
Part of diagnosing cancer is called
staging. The stage of a cancer is how much cancer there is and how far it has spread
the body. The stage is one of the most important things to know when deciding how
treat the cancer. Talk with your child's healthcare provider about the stage of your
There are different ways to stage
Hodgkin lymphoma. The system commonly used is the Lugano classification. It uses the
Roman numerals I (1), II (2), III (3), or IV (4). The higher the number, the more
advanced the cancer is. Letters can be added to the Roman numerals to give even more
Here is what the numbers mean:
Stage I. The cancer is
in 1 lymph node region or in1 organ or site outside the lymphatic system.
Stage II. Is one of
- The cancer is in 2 or more lymph node regions on the same
side of the diaphragm. (This is the thin sheet of muscle that separates the
chest and abdomen.)
- Or the cancer has spread from 1 lymph node region into a
nearby organ outside the lymphatic system, but on the same side of the
Stage III. The cancer is
in lymph node regions on both sides of the diaphragm (above and below). It might also
be localized in an organ outside the lymphatic system or in the spleen.
Stage IV. The cancer is in the
lymphatic system and has widely spread to one or more organs outside the lymphatic
system (metastasis) and possibly into nearby lymph nodes. Or the cancer has spread
1 organ outside the lymphatic system and also in distant lymph nodes.
Letters that might be added
A (for asymptomatic) means your
child does not have B symptoms, including those of fevers, night sweats, or weight
loss for no known reason.
is for B symptoms, which are fever, night sweats, or weight loss for no known
reason. If B is used, it means your child has these symptoms.
E is used if lymphoma cells
are found in tissues or organs outside your child's lymphatic system.
S is for spleen. It's used if
lymphoma cells have been found in your child's spleen.
Most children with Hodgkin lymphoma
can be cured. Treatment choices depend on the stage and other factors. Sometimes,
than one kind of treatment is used. Hodgkin lymphoma can be treated with any of the
strong medicines kill cancer cells or stop them from growing. They may be given right
into the blood through a vein (IV), injected (as a shot), or taken by mouth. Usually
more than one chemotherapy medicine is given. This is called combination
Radiation therapy. These
are high-energy beams of X-rays or other types of radiation. They're used to kill
cancer cells or stop them from growing.
High-dose chemotherapy with a
stem cell transplant.
Young blood cells (stem cells) are taken from
the child or from someone else (donor). This is followed by high doses of
chemotherapy. These doses damage the bone marrow. After the chemo, the stem cells
replaced. These go back into the bone marrow to make new, healthy blood cells.
Targeted therapy. These
medicines target changes on or in the lymphoma cells that make them different from
healthy cells. They can help kill cancer cells with less damage to normal cells.
Types of targeted therapy are monoclonal antibody therapy or proteasome inhibitor
Immunotherapy. This therapy
uses the child's immune system to fight the cancer. A type of immunotherapy is immune
checkpoint inhibitor therapy. Other types of immunotherapy are being researched.
Surgery. This treatment to
remove as much of the tumor as possible may be used for newly diagnosed localized
nodular lymphocyte-predominant Hodgkin lymphoma.
Supportive care. Hodgkin
lymphoma and its treatment can cause side effects. Medicines and many other
treatments can be used for pain, fever, infection, and nausea and vomiting.
Clinical trials. Most
children with Hodgkin lymphoma are treated in clinical trials. Taking part in a
clinical trial means your child gets the best treatment available today, and might
also get new treatments that are thought to be even better. Before starting
treatment, ask your child's healthcare provider if there are any treatments being
tested that may work well for your child.
Your child will need follow-up care during and after treatment to:
- Check on your child's response to the treatment
- Manage the side effects of treatment
- Look for returning or spreading cancer
Some treatments may be hard on your child, but they increase the chance of your child
living a long time. Discuss the side effects of treatment with your child's healthcare
With any cancer, how well a child is expected to recover (prognosis) varies. Keep
- Getting medical treatment right away
is important for the best outcomes.
- Ongoing follow-up care during and after treatment is needed.
- New treatments are being tested to
improve outcome and to reduce side effects.
Possible complications depend on
the type and stage of the lymphoma, and the type of treatment needed to treat the
disease. Possible complications include:
- Increased risk of infection
- Heart disease
- Lung problems
- Increased chance of having other
cancers later in life
- Fertility problems
- Delayed growth and development
- Changes in thinking, memory, and
- Increased risk of bleeding
- Increased risk of infection
- Nausea and vomiting
- Poor appetite
- Sores in the mouth
- Hair loss
Many side effects can be treated to keep them from getting worse.
There may even be things you can do to help prevent some of them. Most side effects
away over time after treatment ends. Still, some side effects can happen much later
life, and some can be permanent. Talk with your child's healthcare providers about
symptoms to watch for and when to call them.
You can help your child manage
their treatment in many ways. For example:
- Get emotional support for your child.
Find a counselor, psychologist, or child support group that can help.
- Make sure your child attends all follow-up appointments.
- Your child may have trouble eating. A dietitian may be able to help.
- Your child may be very tired. They
will need to balance rest and activity. Encourage your child to get some exercise.
This is good for overall health. And it may help to reduce tiredness. Ask your
child's provider what exercises are safe for your child.
When to Call a Healthcare Provider
Call the healthcare provider if
your child has:
- Symptoms that get worse
- New symptoms
- Side effects that don't get better
Talk to your provider about when you need to call them, what number
to call, and what you should do if you have problems after office hours or on weekends
- Hodgkin lymphoma is a type of cancer in the lymphatic system.
- Most children with Hodgkin lymphoma are treated successfully and cured.
- Symptoms of Hodgkin lymphoma include painless swelling of the lymph nodes in the neck,
underarm, groin, or chest, trouble breathing, night sweats, fever, and feeling tired.
- A lymph node biopsy is needed to diagnose Hodgkin lymphoma.
- Treatment may include medicines such
as chemotherapy, targeted therapy, or immunotherapy, radiation therapy, a stem cell
transplant, and surgery.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s
healthcare provider after office hours and on weekends and holidays. This is
important if your child becomes ill and you have questions or need advice.