Non-Hodgkin (Non-Hodgkin's) Lymphoma

What Is Non-Hodgkin Lymphoma?

Non-Hodgkin lymphoma (lim-FOE-muh) is a type of cancer that develops in the white blood cells of the lymphatic system, which is part of the immune system. These systems work together to remove bacteria, viruses, and other harmful substances from the body.

The lymphatic system includes:

• the lymph nodes (also called lymph glands)
• thymus (a gland in the chest)
• spleen
• tonsils
• adenoids
• bone marrow
• tubes called lymphatics or lymph vessels that connect the parts of the lymphatic system

There are many different types of lymphomas. With Hodgkin lymphoma, the tumors usually have large cancer cells called Reed-Sternberg cells. Lymphomas that don’t have these cells are called non-Hodgkin lymphomas.

What Are the Signs & Symptoms of Non-Hodgkin Lymphoma?

Symptoms of non-Hodgkin lymphoma vary depending on what part of the body is affected. Some kids might have stomach pain, constipation, and decreased appetite. Others may have trouble breathing or swallowing, coughing or wheezing, or chest pain.

Other symptoms can include:

• swollen lymph nodes in the neck, above the collarbone, in the armpit, or in the groin
• fever, chills, or night sweats
• itchy skin
• weight loss
• tiredness

What Causes Non-Hodgkin Lymphoma?

This type of cancer usually is caused by a change in the genes of growing white blood cells. Doctors aren’t sure why this happens.

Non-Hodgkin lymphoma is more common in kids who have:

• immune system problems
• HIV infection
• been given immunosuppressive drugs after organ transplants
• been treated with radiation therapy or chemotherapy for other types of cancer
• have had Epstein-Barr viral infection (mononucleosis)

How Is Non-Hodgkin Lymphoma Diagnosed?

To check for non-Hodgkin lymphoma, doctors look for swollen lymph nodes; breathing problems; or swelling in the belly, face, hands, or feet.

Sometimes, when a child has an enlarged lymph node with no known cause, the doctor will watch the node closely to see if it shrinks or grows. If it stays enlarged or gets bigger, the next step is a biopsy to check in a lab for cancer cells. Doctors can do:

• Needle aspiration biopsy: Doctors numb part of the body with local anesthesia, then use a hollow needle to remove a tiny bit of tissue from the lymph node for testing.
• Incisional or excisional biopsy: This is done in an operating room. Kids get medicines (anesthesia) to sleep. Then, the doctor makes a small cut to remove a piece of the lymph node (incisional) or the whole lymph node (excisional).

Biopsies also can check for lymphomas that might involve the bone marrow, chest, or belly.

If lymphoma is found, other tests can tell the type of lymphoma and whether it has spread (metastasized). These tests may include:

• blood tests, including checking the number of blood cells and how well the kidneys and liver are working
• imaging tests like ultrasound, computed tomography (CT) , magnetic resonance imaging (MRI) and X-rays
• biopsy or aspiration of the bone marrow
• imaging tests like ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and X-rays
• bone scan and/or positron emisson tomography (PET) scan (when a radioactive material is put into the bloodstream to look for cancer cells throughout the body)

How Is Non-Hodgkin Lymphoma Treated?

A pediatric oncologist (a doctor who specializes in childhood cancer) will lead the medical team caring for a child with non-Hodgkin lymphoma. The oncologist works with other specialists, including nurses, social workers, and psychologists, and surgeons.

Treatment of this disease is based on staging. Staging is a way to see if the disease has spread and, if it has, how much. This information helps the care team choose the best treatments.

Treatment may include:

• chemotherapy (chemo): medicines that kill cancer cells and stop their growth
• radiation therapy: high-energy X-rays that kill cancer cells
• targeted therapy: specific drugs that find and attack cancer cells without hurting normal cells
• : medicine that uses the child’s own immune system to get rid of cancer cells
• stem cell transplants: healthy stem cells are put into the body
• surgery: sometimes, surgery can remove part of the tumor
• enrollment in a clinical trial: tests of new cancer treatments or comparing them with current treatments. Many clinical trials focus on reducing side effects of current treatments.

Remission is when doctors see no cancer cells in the body. Non-Hodgkin lymphoma can have very high remission rates. Most kids and teens are cured of the disease. This means that they're in permanent remission and will have long-term cancer-free survival.

After treatment, anyone who has had non-Hodgkin lymphoma should have regular checkups throughout their life to make sure the lymphoma hasn't come back.

What Else Should I Know?

Having a child being treated for cancer can feel overwhelming for any family. But you're not alone. To find support, talk to anyone on the care team or a hospital social worker. Many resources are available to help you and your child.

You also can find more information and support online at:

• National Children’s Cancer Society (NCCS)
• American Childhood Cancer Organization
• American Cancer Society