Robert Wood Johnson University Hospital
 

Non-Hodgkin Lymphoma

Pediatric Cancers - Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma (NHL)?

Non-Hodgkin lymphoma is cancer in the lymphatic system. The lymphatic system is part of the immune system and functions to fight disease and infections.

The lymphatic system includes the following:

Non-Hodgkin lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually causing tumors to grow. The cells can also spread to other organs and tissues in the body.

Lymphomas (including both Hodgkin and non-Hodgkin lymphomas) are the third most common childhood cancer in the U.S. About 800 cases of NHL are diagnosed in children and teens in the U.S. each year. They can occur at any age from infancy to adulthood.

NHL affects males more often than females, and is more common among white children than among African-American children and children of other races.

Staging and classification of non-Hodgkin lymphoma is based on the extent of the disease and the specific cells involved.

What are the different types of non-Hodgkin lymphoma?

Non-Hodgkin lymphoma in children is almost always one of three types:

How is non-Hodgkin lymphoma staged?

Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging symptoms that are used for non-Hodgkin lymphoma. Always consult your child's doctor for information on staging. One method of staging non-Hodgkin lymphoma is the following:

What causes non-Hodgkin lymphoma?

The specific cause of non-Hodgkin lymphoma is unclear. It is possible that genetics and exposure to viral infections may increase the risk for developing this malignancy. Non-Hodgkin lymphoma has also been linked to chemotherapy and radiation therapy. Non-Hodgkin may be a second malignancy as a result of the treatment for certain cancers.

There has been much investigation into the association of the Epstein-Barr virus that causes the mononucleosis infection; as well as HIV, which causes AIDS. Both of these infectious viruses have been linked to the development of Burkitt's lymphoma.

Children and adults with certain hereditary immune system abnormalities have an increased risk of developing non-Hodgkin lymphoma, including patients with ataxia telangiectasia, X-linked lymphoproliferative disease, or Wiskott-Aldrich syndrome. People who have had organ transplants and need to take medicines to suppress their immune systems are also at increased risk.

What are the symptoms of non-Hodgkin lymphoma?

In many cases, non-Hodgkin lymphoma in children may not cause symptoms until it has grown or spread. Most children have stage III or IV disease at the time of diagnosis because of the sudden onset of symptoms and the fact that these lymphomas tend to grow very quickly. The disease can sometimes progress quickly from a few days to a few weeks. A child can go from otherwise healthy to having multisystem involvement in a short time period.

Some children with non-Hodgkin lymphoma have symptoms of an abdominal mass and have complaints of abdominal pain, fever, constipation, and decreased appetite due to the pressure and obstruction a large tumor in this area can cause.

Some children with non-Hodgkin lymphoma have symptoms of a mass in their chest and have complaints of respiratory problems, pain with deep breaths (dyspnea), cough, and/or wheezing. Lymphomas in the chest can also press on a main blood vessel (the superior vena cava), which can cause swelling and a bluish coloration in the head and arms. If left unchecked, it can also affect the brain and may even be life-threatening.

The following are the most common symptoms of non-Hodgkin lymphoma. However, each child may experience the symptoms differently. Symptoms may include:

The symptoms of non-Hodgkin lymphoma may resemble other blood disorders or medical problems. Always consult your child's doctor for a diagnosis.

How is non-Hodgkin lymphoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for non-Hodgkin lymphoma may include:

Treatment of non-Hodgkin lymphoma

Specific treatment for non-Hodgkin lymphoma will be determined by your child's doctor based on:

Treatment may include (alone or in combination):

Long-term outlook for a child with non-Hodgkin lymphoma

With modern treatments, most children with non-Hodgkin lymphoma can be cured. But the prognosis greatly depends on:

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with non-Hodgkin lymphoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of non-Hodgkin lymphoma. New methods are continually being discovered to improve treatment and to decrease side effects.

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