Lymphoma (Childhood Non-Hodgkin's)


General Information

What is childhood Non-Hodgkin's Lymphoma?

Childhood non-Hodgkin's lymphoma is a disease in which cancer (malignant) cells are found in the lymphatic system. The lymphatic 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, and abdomen. The lymph nodes make and store infection- fighting cells. These cells become the cancer (malignant) cells in non- Hodgkin's lymphoma. 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 (an organ in the throat) are also part of the lymphatic system.

Because there is lymph tissue in many parts of the body, non-Hodgkin's lymphoma 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 two general types: Hodgkin's disease and non-Hodgkin's lymphomas. Both of these diseases are treated differently and occur in both children and adults. (Refer to the PDQ summaries on Adult Hodgkin's Disease Treatment; Childhood Hodgkin's Disease Treatment; and Adult Non-Hodgkin's Lymphoma Treatment for more information.)

There are three major types of childhood non-Hodgkin's lymphomas: lymphoblastic lymphoma, small noncleaved cell lymphoma (either Burkitt's lymphoma or non-Burkitt's lymphoma), and large cell lymphoma. The type is determined mainly by what the cancer cells look like under a microscope. The way the cells look under a microscope is called the "histology" of the cancer.

If your child has symptoms, your doctor will examine your child carefully and check for swelling or lumps in the neck, underarms, groin, and abdomen. A chest x-ray will usually be done to check for swellings in the chest. If the lymph nodes don't feel normal, or a lump is found in the chest or abdomen, your child's doctor may need to cut out a small piece of tissue and look at it under the microscope to see if there are any cancer cells. This is called a biopsy.

Your child's chance of recovery (prognosis) and choice of treatment depend on the stage of your child's cancer (whether it is just in one area or has spread throughout the body), the type of lymphoma, and your child's age and overall condition.

Stage Information

Stages of childhood non-Hodgkin's lymphoma:

Once childhood non-Hodgkin's lymphoma 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. Your child's doctor needs to know the stage of the disease to plan treatment.

The following stages are used for childhood non-Hodgkin's lymphoma:

Stage I
Cancer is found in only one area outside of the abdomen or chest.

Stage II
Any of the following mean the disease is stage II:

-Cancer is found in only one area and in the lymph nodes around it.
-Cancer is found in two or more lymph nodes or other areas on the same side of the diaphragm (the thin muscle under the lungs that helps you breathe).
-Cancer is found to have started in the digestive tract. The lymph nodes in the area may or may not have cancer.

Stage III
Any of the following mean the disease is stage III:

-Cancer is found in tumors or lymph nodes on both sides of the diaphragm.
-Cancer is found to have started in the chest.
-Cancer is found in many places in the abdomen.
-Cancer is found in the area around the spine, around the outermost covering of the brain, or on the outermost covering of the brain (these tumors are called epidural tumors).

Stage IV
Cancer has spread to the bone marrow or to the brain and/or the spinal cord.

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

There are treatments for all patients with childhood non-Hodgkin's lymphoma and patients can be cured. The main treatment used is chemotherapy (using drugs to kill cancer cells and shrink tumors). Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors) is sometimes used in special situations. Bone marrow transplantation is being tested in clinical trials for certain patients.

Chemotherapy uses drugs to kill cancer cells and shrink tumors. Chemotherapy may be taken by pill, or it may be put into the body by a needle in 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. Chemotherapy may also be put into the fluid that surrounds the brain through a needle in the brain or back (intrathecal chemotherapy) to treat certain types of non-Hodgkin's lymphoma that spread to the brain.

Bone marrow transplantation is a newer type of treatment. Sometimes lymphoma cells become 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 bones before treatment. The marrow is then frozen and high-dose chemotherapy with or without radiation therapy is given to treat the cancer. The marrow that was taken out is then thawed and given back through a needle in a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow given is taken from another person, the transplant is called an allogeneic transplant.

Treatment By Stage

Treatment for childhood non-Hodgkin's lymphoma depends on the stage of your child's disease, how the cancer cells look under a microscope (the histology), and your child's age and general health.

Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child go into 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 advanced stages of childhood non-Hodgkin's lymphoma. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I and II Childhood Lymphoblastic Lymphoma
Your child's treatment will probably be systemic chemotherapy plus intrathecal chemotherapy.

Stage III and IV Childhood Lymphoblastic Lymphoma
Your child's treatment will probably be systemic chemotherapy plus intrathecal chemotherapy. Radiation therapy is sometimes given if there is a large mass in the chest.

Recurrent Childhood Lymphoblastic Lymphoma
Your child's treatment will depend on where the cancer comes back, the type of treatment that was given before, and your child's overall condition. Your child's treatment may be one of the following:

1. Allogeneic bone marrow transplantation.
2. Systemic chemotherapy with different drugs than were used before.
3. A clinical trial of new methods of treatment.

Stage I and II Childhood Small Noncleaved Cell Lymphoma
(includes Burkitt's and non-Burkitt's)

Your child's treatment will probably be systemic chemotherapy with or without intrathecal chemotherapy.

Stage III and IV Childhood Small Noncleaved Cell Lymphoma
(includes Burkitt's and non-Burkitt's)

Your child's treatment will probably be systemic chemotherapy plus intrathecal chemotherapy. Clinical trials are testing new combinations and doses of drugs.

Recurrent Childhood Small Noncleaved Cell Lymphoma
(includes Burkitt's and non-Burkitt's)

Your child's treatment will depend on where the cancer comes back, the type of treatment that was given before, and your child's overall condition. Your child's treatment may be one of the following:

1. Systemic chemotherapy.
2. Allogeneic or autologous bone marrow transplantation.
3. Systemic chemotherapy plus intrathecal chemotherapy.
4. A clinical trial of new methods of treatment.

Stage I and II Childhood Large Cell Lymphoma
Your child's treatment will probably be systemic chemotherapy with or without intrathecal chemotherapy.

Stage III and IV Childhood Large Cell Lymphoma
Your child's treatment will probably be systemic chemotherapy with or without intrathecal chemotherapy. Clinical trials are testing new combinations of drugs.

Recurrent Childhood Large Cell Lymphoma
Your child's treatment will depend on where the cancer comes back, the type of treatment that was given before, and your child's overall condition. Your child's treatment may be one of the following:

1. Allogeneic or autologous bone marrow transplantation.
2. Systemic chemotherapy with or without intrathecal chemotherapy.
3. A clinical trial of new methods of treatment.






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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