Childhood Non-Hodgkin's Lymphoma
What is it?
Non-Hodgkin's lymphoma is one of a group of cancers called
"lymphomas" that develop in the lymphatic system. The lymphatic
system carries white blood cells called lymphocytes through a network of
thin tubes, called lymph vessels, to all parts of the body, including the
bone marrow. The lymphatic system also includes the spleen, thymus, and
tonsils. Lymph tissue is part of the body's immune system, and it sends
out lymphocytes and antibodies to fight infection. In non-Hodgkin's
lymphoma, lymphocytes become abnormal and crowd into the lymph nodes,
which causes them to swell. Groups of lymph nodes are found in the neck,
underarm, abdomen, and pelvis. Tumors develop and the body has difficulty
fighting infection. There are three major types of childhood non-Hodgkin's
lymphomas. They are called lymphoblastic lymphoma, small noncleaved cell
lymphoma (which includes Burkitt's lymphoma or non-Burkitt's lymphoma),
and large cell lymphoma.
Who gets it?
Non-Hodgkin's lymphoma occurs in children and adults. It is more common
among people with inherited immune deficiencies, autoimmune diseases, or
HIV/AIDS, and among people taking immunosuppressant drugs after organ
transplants. Human T-lymphotropic virus type I (HTLV-1) and Epstein-Barr
virus also increase the chance of developing non-Hodgkin's lymphoma.
People exposed to certain pesticides and ionizing radiation have also
shown a higher than average chance of developing this disease.
What causes it?
The exact cause of non-Hodgkin's lymphoma is not known.
What are the symptoms?
Early symptoms of non-Hodgkin's lymphoma are painless, swollen lymph nodes in the neck, armpits, or groin area. You child may also experience appetite and weight loss, nausea, vomiting, stomach pain, and indigestion. If the lymph nodes in the abdomen are enlarged, your child may complain of a feeling of fullness, and pressure or pain in the lower back. In the advanced stages, symptoms include bone pain, headaches, constant coughing, and abnormal pressure and congestion in the face, neck, and upper chest. Some may have fevers and night
sweats.
How is it diagnosed?
In most cases, children are taken to the doctor because they have
swollen glands. Your doctor will take a complete medical history and
perform a thorough physical examination. He or she will gently feel for
swelling or lumps in your child's neck, underarm, groin, and abdominal
areas. The doctor will order blood tests to check blood cell counts and
kidney and liver function. The final diagnosis of non-Hodgkin's lymphoma
depends on a biopsy. A surgeon will remove a sample of an affected lymph
node, which is examined under a microscope for cancer cells. The type of
non-Hodgkins lymphoma your child has is determined by the type of cancer
cells the doctor sees under a microscope.
Your doctor may also perform a bone marrow biopsy, where a
cylindrical piece of bone and marrow fluid is removed for study. These
tests will be performed with an appropriate type of anesthesia so your
child will feel as little discomfort as possible. Your doctor will also
use imaging tests, such as x rays, computed tomography (CT) scans,
magnetic resonance imaging (MRI), and abdominal ultrasound to determine
how far the lymphoma has spread. This is called "staging," and
helps determine treatment.
The stages of non-Hodgkin's lymphoma are:
Stage I: Cancer is found in only one area, which is outside of the abdomen or
chest.
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; or cancer has started in the digestive tract, with or without cancer in the lymph
nodes.
Stage III: Cancer is found in tumors or lymph nodes on both sides of the diaphragm; cancer has started in the chest; cancer is found in many locations in the abdomen; or there are epidural tumors, which is cancer in the area around the spine, in the outermost covering of the brain, or on the outermost covering of the
brain.
Stage IV: Cancer has spread to the bone marrow, to the brain, and/or the spinal
cord.
Recurrent: The cancer has come back after treatment. Recurrent
non-Hodgkin's lymphoma can return to the area where it first started or occur in another part of the body
altogether.
What is the treatment?
Non-Hodgkin's lymphoma in children can be cured. Treatment depends upon factors such as the stage of the cancer, the type of lymphoma, which symptoms are present, and your child's age and general health. The main treatment is chemotherapy. Chemotherapy involves doses of very strong medicine that kill cancer cells. Chemotherapy drugs can be taken orally, in pill form, or may be injected through a needle in either a vein or muscle. Chemotherapy can make your child feel sick and weak, and lose his or her hair. These side effects are temporary and will go away once the chemotherapy treatments are finished. Your doctor can prescribe medicine to counteract these side effects if your child cannot tolerate them. In special cases, radiation therapy may also be recommended to kill the cancer cells. Some patients also benefit from bone marrow transplants. In addition to destroying the cancer cells, radiation and chemotherapy can kill bone marrow cells. For this reason, the child's healthy bone marrow can be removed before treatment, and then replaced later. Diseased or destroyed bone marrow can also be replaced with healthy bone marrow from a donor, usually a family
member.
Self-care tips
Since the symptoms of non-Hodgkin's lymphoma are common to many other illnesses, it is important to seek medical attention if your child has any of the symptoms explained here, especially swollen glands, that persist for two weeks or more.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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