What is non-Hodgkin’s lymphoma?

Non-Hodgkin’s lymphoma is a type of cancer that originates in the lymphatic system. This system is made up of vessels that run throughout the body. A colorless liquid called lymph travels through these vessels and carries white blood cells called lymphocytes. The lymph nodes, spleen, and thymus are organs in the lymphatic system. These are the organs that produce and store infection-fighting cells (lymphocytes). Other organs like the tonsils, stomach, small intestines and skin also contain lymphatic tissue. Non-Hodgkin’s lymphoma is the result of an uncontrolled growth and spread of cells called lymphoblasts.

Several types of non-Hodgkin’s lymphomas are seen in children:

• Lymphoblastic lymphoma
• Small non-cleaved cell lymphoma (either Burkitt’s lymphoma or non-Burkitt’s lymphoma)
• Large cell lymphoma

Non-Hodgkin’s lymphoma can begin at any time during life and may start almost anywhere in the body. In children, non-Hodgkin’s lymphoma can occur from infancy to teenage years. Its peak incidence is between ages seven and eleven years. Boys are affected more than girls. The cause is not known. Non-Hodgkin’s lymphoma is not contagious, and nothing you have done or not done is responsible for your child’s tumor. Genetic, viral, environmental, and immunologic factors are currently being studied.

What are the symptoms of non-Hodgkin’s lymphoma?

Symptoms may vary among patients. The first sign is often swollen lymph nodes. The most common site for these nodes to swell is in the abdomen and chest, but nodes in the neck, under the arm, and in the groin may also be enlarged. Symptoms of difficulty breathing, a persistent cough or swelling in the face may indicate enlarged lymph nodes of the chest. Lymphoma in the abdomen may lead to pain in the abdomen or a change in bowel habits.

How is non-Hodgkin’s lymphoma diagnosed?

Non-Hodgkin’s lymphoma may be found in a single piece of lymphoid tissue in an organ or one lymph node. Occasionally, it may spread to many areas before it is detected. Because this disease may spread to many different areas, various tests must be done to determine the extent of the disease. An accurate diagnosis is essential to determine the most effective treatment for your child.

Tests to help diagnosed non-Hodgkin’s lymphoma may include any or all of the following:

• Surgical biopsy. Tissue must be obtained to diagnose non-Hodgkin’s lymphoma. A pathologist closely examines cells from the suspected area under a microscope.
• X-rays. X-rays of the chest and/or abdomen to look for evidence of the disease.
• Blood tests. A complete blood count and/or blood chemistries may be ordered.
• Bone marrow aspirate and biopsy. This can help determine if the disease has invaded the bone marrow.
• Lumbar puncture (LP), also called a spinal tap. This test can help determine if the disease has spread to the fluid that bathes the brain and spinal cord.
• Computed tomography (CT scan). This test produces images of the scanned body part. A scan is used to see the size of the tumor and whether it has spread.
• Position emission tomography (PET) scan. A PET scan creates computerized images of chemical changes that take place in tissue. It involves injecting a small amount of radioactive compound into the blood stream and seeing how much of it collects in areas of lymphoma.

An accurate staging diagnosis is very important to effective treatment of the disease. After all tests are completed and the diagnosis has been made, a group of doctors including oncologists, radiologists, pathologists, and surgeons will determine the stage of the disease and the most effective treatment for it. The classification system used is as follows:

• Stage I. Cancer is found in a single area or lymph node outside of the abdomen or chest.
• Stage II. Cancer is found:
  – In only one area and in the lymph nodes around it
  – In two or more areas or lymph nodes on one side of the diaphragm (membrane that separates the chest and abdomen)
  – To have started in the stomach or intestine and is completely removed by surgery, and lymph nodes in the area may or may not have cancer.
• Stage III. Cancer is found:
  – In areas or lymph nodes on both sides of the diaphragm
  – To have started in the chest
  – In more than one place in the abdomen
  – In the area around the spine.
• Stage IV. Cancer is found in the bone marrow, brain, or spinal cord. It may also be found in other parts of the body.

How is non-Hodgkin’s lymphoma treated?

Treatment includes multi-drug chemotherapy usually given over four to nine months. Your oncologist will explain what chemotherapy drugs are recommended. Your oncologist and nurses will explain which drugs must be given in the hospital and which may be given in the outpatient clinic. Surgery may be used to get a sample of a tumor for diagnosis.

What research is currently underway?

Current studies are evaluating the use of the monoclonal antibody, rituximab, used in combination with chemotherapy for treated non-Hodgkin’s lymphoma. The antibodies attach to the substances and kill the cancer cells or block their growth.

About treatment for non-Hodgkin’s lymphoma at Children’s

Children’s hematology/oncology program consistently achieves treatment results ranking it as one of the top ten programs in the U.S. Children’s treats the majority of children with cancer and blood disorders in Minnesota and provides patients with access to a variety of clinical trials of groundbreaking new treatments. Through our renowned leukemia/lymphoma program, patients experience unparalleled family support, a nationally renowned pain management team, and compassionate, coordinated care.

Contact Us

If you are a family member looking for a Children’s hematologist or oncologist or wanting to schedule an appointment, please call our clinic at Children’s – Minneapolis at 612-813-5940.

If you are a health professional looking for consultation or referral information, please call Children’s Physician Access at 1-866-755-2121 (toll-free) and ask for the on-call hematologist/oncologist.