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 from abnormal growth
of the cells in the lymphatic system. The cells can also spread to other organs and
tissues in the body (metastasis). NHL is rare in children. It can happen at any age,
affects boys more often than girls.
There are different types of NHL in
children. But most tend to grow quickly. Your child's care team may order different
tests based on what type of lymphoma is found. Treatment options also depend on the
specific type of lymphoma.
Researchers don't know the exact
cause of NHL. Genes 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, this
virus causes mono (mononucleosis)
- HIV, the virus that causes AIDS
- Past cancer treatment with radiation
- Certain hereditary immune
system conditions present at birth
- Taking anti-rejection medicines after organ transplant
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. Symptoms of a belly (abdominal) tumor can include:
- Abdominal pain
- Nausea and vomiting
- Trouble with bowel movements (constipation)
- Poor appetite
Symptoms of a chest tumor include:
- 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
- Sore throat
- Bone and joint pain
- Night sweats
- Tiring easily (fatigue)
- Weight loss
- Poor appetite
- Itching of the skin
- Recurring infections
The symptoms of NHL can be like
other health problems. Make sure your child sees a healthcare provider for a
Your child's healthcare provider
will ask about your child's health history and symptoms. He or she will examine your
child. 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.
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
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 bloodstream. Cancer cells use more sugar than
normal cells, so the sugar will collect in cancer cells. A special camera is used
scan the whole body to see where the radioactive sugar has collected. A PET scan can
sometimes spot cancer cells 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 biopsy. 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 a needle. This is called
aspiration. Sometimes solid bone marrow tissue is taken with a bigger needle. This
called a core biopsy. Bone marrow is usually removed from the hip bones. This test
done to see if cancer cells have reached the bone marrow.
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
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 options. 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 St. Jude system is most commonly
used. It divides NHL into 4 stages:
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 lymph node. Stage I NHL is not in the chest or the abdomen (belly).
Stage II (2). The lymphoma is not in the chest
and is 1 of these:
- The lymphoma is only 1 tumor
and the 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 of these:
- The lymphoma is in both the
upper and lower parts of the body (it's above and below the diaphragm)
- 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
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 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 be given by IV
(intravenous) into the vein, injected into tissue (as a shot), or taken by
Radiation therapy. These are high-energy X-rays
or other types of radiation. They're used to kill cancer cells or help keep them from
Surgery. Surgery may be done to remove
Monoclonal antibodies. This is a type of targeted
therapy that uses medicines to kill cancer cells without harming healthy cells.
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 to the bone marrow. After the chemotherapy, the stem cells
Supportive care. 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 trial.
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 outcome and to lessen side effects.
- Over 80% of 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
You can help your child manage his
or her 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. He or she 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 him
or her quit. If your child doesn’t use tobacco, make sure he or she knows the dangers
of it and doesn't start.
When to Call a Healthcare Provider
Call the healthcare provider if your child has:
- Symptoms that get worse
- New symptoms
- Side effects from treatment
- 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 medicines, radiation, stem cell transplants, 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
- 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. This is important if your child becomes ill and you have
questions or need advice.