Non-Hodgkin Lymphoma (NHL) in Children
NHL is cancer that starts in the
lymphatic system. The lymphatic system is part of the immune system. It helps to fight
diseases and infections.
NHL results when the cells in the
lymphatic system (lymphocytes) are changed (mutated) and grow out of control. These
cells can spread to other organs and tissues in the body (metastasize). NHL is rare
children. But it can happen at any age. It tends to affect boys more often than
There are different types of NHL in
children. But most tend to grow quickly. Your child's treatment team may order different
tests based on what type of lymphoma is found. Treatment choices also depend on the
specific type of lymphoma.
Researchers don't know the exact
cause of NHL. Inherited gene changes and some viral infections may increase a child’s
risk of having NHL. Risk factors that might be linked to NHL
- Epstein-Barr virus infection, the
virus that causes mono (mononucleosis)
- Infection with HIV, the virus that
- Past cancer treatment
- Certain immune diseases passed on in
families (inherited syndromes)
- Taking antirejection medicines after
In many cases, NHL in children may
not cause symptoms until it has grown or spread. Many children have advanced disease
the time of diagnosis. This is because the symptoms start suddenly, and the tumors
to grow fast. A child can become very sick in a very short time (a few days or
Signs and symptoms depend on the
type of NHL and where it starts.
Symptoms of a belly (abdominal)
tumor can include:
- Abdominal swelling or pain
- Nausea and vomiting
- Trouble with bowel movements
- Poor appetite
- Feeling full after eating only a small amount
Symptoms of a chest tumor
- Trouble breathing or swallowing
- Pain with deep breaths
- Cough or wheezing
- High-pitched breathing sounds
- Swelling or skin looks blue on the
head and arms
Other symptoms may include:
- Painless swelling of the lymph nodes
in neck, chest, abdomen, underarm, or groin
- Fever for no known reason
- Sore throat
- Bone and joint pain
- Night sweats that soak pajamas and
- Tiring easily (fatigue)
- Weight loss
- Poor appetite
- Itching of the skin
- Recurring infections
The symptoms of NHL can be like
those of many other health problems. Make sure your child sees a healthcare provider
Your child's healthcare provider
will ask about your child's health history, family history, and symptoms. A physical
exam will be done. Based on the findings, your child may need tests such as:
Blood and urine tests. Blood and urine are
collected and tested in a lab.
Lymph node biopsy. A tiny piece of tissue, called
a sample, is taken from the lymph nodes (or other abnormal areas). This is often done
during surgery. The sample is tested for cancer cells. This type of biopsy is needed
to diagnose NHL.
Chest X-ray. A chest X-ray
shows the heart, lungs, and other parts of the chest. It can show NHL that has spread
to lymph nodes in the chest.
CT scan. This may be done to
look at the abdomen, chest, and pelvis. A CT scan uses a series of X-rays
and a computer to make detailed pictures of the inside of the body. Sometimes a dye
is put in the blood to get clearer pictures.
MRI scan. An MRI uses large magnets, radio waves,
and a computer to make detailed pictures of the inside of the body. This test can
be 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.
Ultrasound. This is also called sonography. Sound
waves and a computer are used to make pictures of blood vessels, tissues, and
PET scan. For this test, a radioactive sugar is put into
the blood. Cancer cells use the sugar faster than normal cells, so the sugar will
collect in cancer cells. A special camera is then used to scan the whole body to see
where the radioactive sugar has collected. A PET scan can sometimes spot cancer in
different parts of the body, even when they can’t be seen by other tests. This test
is often used together with a CT scan. This is called a PET/CT scan.
Bone marrow aspiration or
Bone marrow is a thick liquid found in the center of some bones.
It’s where blood cells are made. A small amount of bone marrow may be removed with
needle. This is called aspiration. Sometimes solid bone marrow tissue is taken with
bigger needle. This is called a core biopsy. Bone marrow is usually removed from the
back of the hip bones. This test is done to see if there are cancer cells in the bone
Lumbar puncture. A long, thin
needle is put into the lower back, between the bones of the spine, and into the
spinal canal. This is the area around the spinal cord and brain that contains fluid,
called cerebral spinal fluid or CSF. CSF cushions and supports the spinal cord and
brain. A small amount of CSF is removed and tested for cancer cells.
Pleural or peritoneal fluid sampling. Fluid is
removed from around the lungs (pleura) or abdomen (peritoneum). The fluid is checked
for cancer cells.
Part of diagnosing cancer is
called staging. Staging is the process of finding out how much cancer there is and
it has spread. Staging is used to decide the best treatment choices.
There are different ways of
staging NHL. Talk with your child's healthcare provider about the stage of your
child's cancer and what it means. The system most commonly used divides NHL into 4
Stage I (1). The lymphoma
is in only 1 place. It’s either in lymph nodes in only 1 part of the body or is
only 1 tumor that's not in a lymph node. Stage I NHL is not in the chest or the
Stage II (2). The lymphoma
is not in the chest and is 1 of these:
- It's only 1 tumor and is in
lymph nodes close to it
- It's in 2 or more places, but
it’s all in either the upper or lower part of the body (either all above or
all below the diaphragm)
- The lymphoma started in the digestive tract and all of
it can be removed with surgery, including any lymph nodes that have cancer
Stage III (3). Can be any
- The lymphoma is more than 1
tumor outside of the lymph nodes and might be in both the upper and lower
parts of the body (it's above and below the diaphragm). It might also be in
the bones or skin.
- It started in the chest.
- It started in the abdomen (belly) and is too widespread
to be removed with surgery.
- There's lymphoma next to the spine and maybe in other
parts of the body.
- There's lymphoma in more than 1 set of lymph nodes
above. And it's above and below the diaphragm.
- There's a lymphoma tumor in a bone that has spread to
Stage IV (4). The lymphoma
is in the bone marrow or the central nervous system (the brain and spinal cord)
when it's first found. It may also be in other parts of the body.
Treatment will depend on the
lymphoma type and stage. NHL can be treated with any of these:
Chemotherapy. Medicines that
kill cancer cells or stop them from growing are used for this treatment. They may
given by IV (intravenous) into the vein, injected into tissue (as a shot), or taken
by mouth. Chemo is the main treatment for NHL.
Immunotherapy. These medicines
work with your child's immune system to find and kill cancer cells.
Surgery. Surgery may be done
to remove tumors.
Targeted therapy. These
medicines target certain parts of cancer cells to kill them without harming a lot
healthy cells. The NHL cells must be tested to see if they have the targets these
medicines work on.
High-dose chemotherapy with a stem
Young blood cells (called stem cells) are taken from
the child or from someone else. The child is then given a large amount of
chemotherapy to damage or destroy the bone marrow. After the chemo, the stem cells
are put into the blood. Over time, they rebuild the bone marrow.
Radiation therapy. This treatment uses
high-energy X-rays or other types of radiation to kill cancer cells or help keep them
from growing. It's not often used to treat NHL in children. But it might be used to
treat serious problems caused by NHL tumors. For instance, it can shrink a tumor
that's causing pressure or pain.
Supportive care. Every kind
of cancer treatment can cause side effects. Medicines and other treatments can be
used to ease or help prevent side effects like pain, fever, infection,
nausea, and vomiting.
Clinical trials. Ask your
child's healthcare provider if there are any treatments being tested that may work
well for your child. Most children with cancer are treated as part of a clinical
Your child will need follow-up care during and after treatment to:
- Check on their response to the
- Manage the side effects of treatment
- Look for returning or spreading cancer
With treatment, most children with NHL go on to live long lives. With any cancer,
how well a child is expected to recover (prognosis) varies. Keep in mind:
- 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 outcomes and to lessen side effects.
- Most children with cancer are cured.
Possible complications depend on
the type and stage of the lymphoma. They also vary a lot based on where the lymphoma
and how it's treated. Problems can include things like:
- Heart and blood vessel damage
- Lung problems
- Changes in thinking, learning, and memory
- Increased chance of other cancers
later in life
- Trouble having children
- Developmental and growth delays
Treatment may also cause side
effects, such as:
- Increased risk of bleeding
- Increased risk for infection
- Nausea and vomiting
- Poor appetite
- Sores in the mouth
- Hair loss
Many treatment side effects can be dealt with to keep them from
getting worse. There may even be things you can do to help prevent some of them. Most
side effects go away over time after treatment ends. But some treatments can cause
long-term side effects that may not show up until many years after your child finishes
treatment. Ask your child's treatment team what you might expect.
You can help your child manage
their treatment in many ways. For instance:
- Get emotional support for your child. Find a counselor or child support group that
- Make sure your child goes to 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 lessen tiredness.
- If your child uses tobacco, help them
quit. If your child doesn’t use tobacco, make sure they know the dangers of it and
don't start. Also keep your child away from other people's tobacco smoke.
When to Call a Healthcare Provider
Talk to your child's treatment team
about problems you should watch for. Call the healthcare provider if your child has:
- Symptoms that get worse
- New symptoms
- Side effects from treatment
It's important to know what problems to watch for and when you need
to call the healthcare provider. Be sure you know what number to call to get help
office hours and on weekends and holidays.
- NHL is a type of cancer in the lymphatic system.
- Symptoms depend on what part of the
body is affected and where the tumor is. Common symptoms include painless swelling
lymph nodes, trouble breathing, night sweats, fever, and feeling tired.
- A lymph node biopsy is needed to diagnose NHL. Many other tests are also done.
- Treatment may include chemotherapy and
other medicines, stem cell transplant, radiation, 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
directions 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
- 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
provider after office hours and on holidays and weekends. This is important if your
child becomes ill and you have questions or need advice.