Hodgkin's Disease (Childhood)


General Information

What is Hodgkin's disease?

Hodgkin's disease is a type of lymphoma. Lymphomas are cancers that develop in the lymph system, part of the body's immune system.

The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains white blood cells called lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, chest, and abdomen. The lymph nodes make and store infection-fighting cells. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (lymph tissue in the throat) are also part of the lymph system.

Because there is lymph tissue in many parts of the body, Hodgkin's disease can start in almost any part of the body. The cancer can spread to almost any organ or tissue in the body, including the liver, bone marrow (the spongy tissue inside the large bones of the body that makes blood cells), and the spleen.

Lymphomas are divided into 2 general types: Hodgkin's disease and non-Hodgkin's lymphomas. (Refer to Adult Non-Hodgkin's Lymphoma Treatment and Childhood Non-Hodgkin's Lymphoma Treatment for more information.) This summary covers only childhood Hodgkin's disease. Adult Hodgkin's disease is often treated differently. (Refer to Adult Hodgkin's Disease Treatment for more information.)

Hodgkin's disease is rare in children under 5 years of age. In children under age 10, it is more common in boys than girls. The symptoms of childhood Hodgkin's disease may include any of the following: painless swelling of the lymph nodes in the neck or underarm area that doesn't go away within a few weeks; fever that doesn't go away; night sweats; and weight loss without dieting. If the lymph nodes don't feel normal when examined by a doctor, the doctor may need to cut out a small piece of tissue and look at it under a microscope to see if there are any cancer cells. This is called a biopsy.

Most children with Hodgkin's disease receive combination chemotherapy and low-dose radiation therapy.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread throughout the body), the type of symptoms that are present, and the age and overall condition of the child.

Stage Information

Stages of childhood Hodgkin's disease:

Once childhood Hodgkin's disease is found, more tests will be done to find out if the cancer has spread from where it started to other parts of the body. This is called staging. It is important to know the stage of the disease to plan treatment.

The stage of disease may be determined by physical examination, blood tests, and different kinds of x-rays. This is called clinical staging. In some cases, an operation called a laparotomy is performed to determine the stage of the cancer. During this operation, the abdomen is opened to see if the organs inside contain cancer. Small pieces of tissue are removed during the operation and examined under a microscope to see whether they contain cancer. This type of staging is called pathologic staging. Pathologic staging is usually done only when it is needed to help plan treatment. During this operation, the spleen may be removed and the child may receive medicine to prevent infection.

If an operation is not possible, a needle biopsy may be performed. This is a procedure in which tissue is removed with a needle for examination under a microscope.

Each stage of childhood Hodgkin's disease is further divided into A and B categories based on whether the child has symptoms. Children with no symptoms are in the A category, while those who have symptoms (such as fever, weight loss, or night sweats) are in the B category. For example, a child with stage I disease without any symptoms is said to have stage IA disease; a child with stage I disease with symptoms is said to have stage IB disease.

The following stages are used for childhood Hodgkin's disease:

Stage I
Cancer is found in only 1 lymph node area or in only 1 area or organ outside of the lymph nodes.

Stage II
Either of the following means the disease is stage II:

-Cancer is found in 2 or more lymph node areas on the same side of the diaphragm (the thin muscle under the lungs that helps with breathing).
-Cancer is found in only 1 area or organ outside of the lymph nodes and in the lymph nodes around it. Other lymph node areas on the same side of the diaphragm may also have cancer.

Stage III
Cancer is found in lymph node areas on both sides of the diaphragm. The cancer may also have spread to an area or organ near the lymph node areas and/or to the spleen.

Stage IV
Either of the following means the disease is stage IV:

-Cancer has spread in more than 1 spot to an organ or organs outside of the lymph system.
Cancer cells may or may not be found in the lymph nodes near these organs.
-Cancer has spread to only 1 organ outside of the lymph system, but lymph nodes far away from that organ are involved.

Recurrent
Recurrent disease means that the cancer has come back after it has been treated. It may come back in the area where it first started or in another part of the body.

Treatment Option Overview

How childhood Hodgkin's disease is treated:

There are treatments for all patients with childhood Hodgkin's disease. The most common treatments are radiation therapy and/or chemotherapy, but treatment may be different depending on the stage of the cancer and whether the child has reached full growth. Bone marrow transplants are being studied in clinical trials for certain patients.

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for childhood Hodgkin's disease usually comes from a machine outside the body (external beam radiation therapy). Radiation therapy given to the neck, chest, and lymph nodes under the arms is called radiation therapy to the mantle. Radiation therapy given to the mantle and to the lymph nodes in the upper abdomen, the spleen, and the lymph nodes in the pelvis is called total nodal irradiation. Radiation therapy may be used alone or in addition to chemotherapy.

Chemotherapy is the use of drugs to kill cancer cells and shrink tumors. Chemotherapy may be taken by pill, or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Bone marrow transplantation is a newer type of treatment. Sometimes Hodgkin's disease becomes resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy the bone marrow, marrow is taken from the patient's bones before treatment. The marrow is then frozen and high-dose chemotherapy with or without radiation therapy is given to the patient to treat the cancer. The marrow that was taken from the patient is then thawed and given back through a needle into a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the patient is given marrow taken from another person, the transplant is called an allogeneic transplant.

Some patients develop another form of cancer as a result of their treatment for Hodgkin's disease; therefore, regular follow-up evaluations may be made. Female patients who received radiation therapy between the ages of 10 and 16 have an increased risk of breast cancer.

Treatment By Stage

Patients may be given vaccination shots against flu, pneumonia, and meningitis both before and every few years after treatment in order to guard against these infections.

Treatment for childhood Hodgkin's disease depends on the type and stage of disease and how the stage was determined, as well as the child's age, symptoms, and general health.

Patients may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or parents may choose to have their child treated in the context of a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients. Clinical trials are ongoing in most parts of the country for most stages of childhood Hodgkin's disease. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I Childhood Hodgkin's Disease
Treatment depends on whether the disease is stage IA or stage IB and where the cancer is found.

If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:

1. Chemotherapy with low-dose radiation therapy to areas that contain cancer.
2. A clinical trial of chemotherapy with or without radiation therapy.
3. A clinical trial of chemotherapy alone.

If the cancer is above the diaphragm and involves a large part of the chest, treatment may be one of the following:

1. Chemotherapy followed by radiation therapy to the chest or the mantle.
2. A clinical trial of chemotherapy plus low-dose radiation therapy.

Stage II Childhood Hodgkin's Disease
Treatment depends on whether the disease is stage IIA or stage IIB and where the cancer is found.

Stage IIA
If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:

1. Chemotherapy plus low-dose radiation therapy to areas that contain cancer.
2. A clinical trial of low-dose chemotherapy with or without radiation therapy.
3. A clinical trial of chemotherapy alone.

If the cancer is above the diaphragm and involves a large part of the chest, treatment may be one of the following:

1. Chemotherapy followed by radiation therapy to the chest or the mantle.
2. A clinical trial of chemotherapy plus low-dose radiation therapy.

Stage IIB
If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:

1. Chemotherapy followed by low-dose radiation therapy to areas that contain cancer.
2. Treatment in a clinical trial.

If the cancer is above the diaphragm and involves a large part of the chest, treatment may be one of the following:

1. Chemotherapy plus radiation therapy to the chest or the mantle.
2. A clinical trial of chemotherapy followed by low-dose radiation therapy.

Stage III Childhood Hodgkin's Disease
Treatment depends on whether the disease is stage IIIA or stage IIIB.

Stage IIIA
Treatment may be one of the following:

1. Chemotherapy alone.
2. Chemotherapy plus radiation therapy.
3. A clinical trial of chemotherapy with or without radiation therapy.

Stage IIIB
Treatment may be one of the following:

1. Chemotherapy alone.
2. Chemotherapy plus radiation therapy.
3. Treatment in a clinical trial.

Stage IV Childhood Hodgkin's Disease
Treatment may be one of the following:

1. Chemotherapy alone.
2. Chemotherapy plus radiation therapy.
3. A clinical trial of chemotherapy with or without radiation therapy to the lymph nodes.

Recurrent Childhood Hodgkin's Disease
Hodgkin's disease in children and adolescents that does not respond to treatment can be divided into 3 groups: refractory disease (that which does not respond to treatment), disease that recurs within 1 year of complete remission, and disease that recurs more than 1 year after complete remission. Most children with recurrent disease have received previous chemotherapy and different regimens of radiation therapy. Treatment for recurrent/refractory disease may include different chemotherapy regimens, peripheral stem cell transplantation, and/or radiation therapy.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.



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