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Pediatric Non-Hodgkins Lymphoma

What is non-hodgkin's lymphoma?

Childhood non-Hodgkin's lymphoma (NHL) is a disease in which malignant cancer 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 produce and store infection-fighting white 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 (an organ in the throat) are also part of the lymphatic system. Like lymph nodes, they contain infection fighting white cells. These cells may become malignant (cancer cells) in non-Hodgkin's Lymphoma.

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 any organ or tissue in the body, including the liver, bone marrow (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. These two types of lymphomas are treated differently.

There are three major types of non-Hodgkin's lymphoma that occur in children and adolescents: lymphoblastic lymphoma, small noncleaved cell lymphoma (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 "histology" of the cancer.

Childhood non-Hodgkin's lymphoma is best treated when it is found early. The presenting symptoms of the non-Hodgkin's lymphoma vary depending upon the location of the tumor. For example, if the primary site is abdominal, patients may present with abdominal pain, vomiting or diarrhea. If the primary tumor is in the chest (usually the upper front part called the anterior mediastinum), the patient may present with a swollen face and neck, shortness of breath (especially when lying down), headache, dizziness or altered mental status. Although systemic symptoms may occur (weight loss, fever), they are relatively uncommon. If your child has lymphoma 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 or CT scan may 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 refer you and your child to a surgeon who may need to cut out a small piece of tissue. This is called a biopsy. If at all possible this will be done with neck nodes that are easily accessible. The tissue will be looked at under the microscope to see if there are cancer cells present.

Your child's chance of recovery (prognosis) 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. More than 70% of children and adolescents with non-Hodgkin's lymphoma will be cured if treated with appropriate chemotherapy regimens.


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