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What is Non-Hodgkin's Lymphoma?

Non-Hodgkin’s lymphoma [lim-FO-muh] is a type of cancer that affects the white blood cells in your child’s lymphatic system. The lymphatic [lim-FAT-ik] system is part of your child’s immune system, which helps your child’s body fight disease and infection. Additionally, the lymphatic system also helps move fluids around the body. Non-Hodgkin’s lymphoma starts in the lymphatic system and creates tumors from lymphocytes, which are a type of white blood cell.

There are 2 main types of lymphocytes:

  1. T lymphocytes (T cells). Some T-cells kill, or destroy the bad cells in the body, while other T-cells help slow or boost the activity of other immune system cells. 
  2. B lymphocytes (B cells). These cells create proteins, called antibodies, which attach to germs (viruses and bacteria) and mark them to be destroyed by other parts of the immune system.

Non-Hodgkin’s lymphoma can happen in either lymphocyte, but B-cell lymphomas tend to be more common in the U.S.

Although non-Hodgkin’s lymphoma is not common in children, it still happens sometimes. Both non-Hodgkin’s lymphoma and Hodgkin’s lymphoma are more common in adults, but can still happen in children and teens. Hodgkin’s lymphoma is a very rare kind of cancer of the lymphatic system. Children with Hodgkin lymphoma have cells in their lymphatic system that undergo a DNA change and start to grow and multiply when they shouldn’t. Non-Hodgkin’s lymphoma tends to affect younger children, while Hodgkin’s lymphoma is more likely to be found in older children and teens.

Non-Hodgkin’s lymphoma, as with most other cancers, is when cells in your child’s body begin to grow out of control. Almost any type of cell in your child’s body can become cancer. Although not always, sometimes these cells can spread to other parts of your child’s body.

Non-Hodgkin’s lymphoma can start anywhere there is lymph tissue, including in the:

  • Spleen
  • Thymus [THY-mus]
  • Lymph nodes
  • Adenoids [AH-din-OYDS] and tonsils
  • Bone marrow
  • Digestive tract

Non-Hodgkin’s lymphoma can spread or grow at different rates, based on the type your child may have. The different types are:

  • Indolent [in-DOE-lent] lymphomas, which grow and spread slowly, and may not need to be treated right away. Your child’s doctor may choose to observe this type instead of treating it right away. 
  • Aggressive lymphomas grow and spread very fast. Most of the time, they need to be treated right away.

Although most lymphomas will fall into 1 of the 2 types above, sometimes they fall in the middle or grow slower or faster.

Symptoms

The lymphatic system runs throughout the whole body, so non-Hodgkin’s lymphoma can start anywhere. The place where it starts or spreads will affect the types of symptoms your child may have. Some of the most common symptoms are:

  • Swollen belly
  • Shortness of breath
  • Cough
  • Fever
  • Lymph nodes that are larger than normal (sometimes they are so large they can be seen, but are most often felt as lumps under the skin) 
  • Hard time eating a normal amount of food, or feeling full after a small amount of food
  • Weight loss
  • Fatigue (very tired feeling)
  • Night sweats

When to See a Doctor

See your child’s doctor right away if your child has any of the symptoms of non-Hodgkin’s lymphoma. This type of cancer can spread to other parts of the body, like the brain, liver, or bone marrow. Your child’s doctor can help you figure out if your child has non-Hodgkin’s lymphoma and if so, your child’s doctor can help you create a treatment plan to help prevent it from spreading.

Causes

The exact cause of childhood non-Hodgkin’s lymphoma is unknown. Scientists have found that there may be a few risk factors, such as problems with the immune system, although not all children that have this type of cancer have these problems.

Other risk factors may include:

  • Inherited genes
  • Immune system problems
  • Epstein-Barr virus infection, which causes the condition called “mono” (usually in combination with an immune deficiency)

Diagnosis and Tests

Generally, the symptoms that are linked to non-Hodgkin’s lymphoma can also have other causes, so your doctor might call for other tests to find out if non-Hodgkin’s lymphoma or some other problem is causing these symptoms in your child. If your doctor finds that your child has lymphoma, more tests will be performed to find out what kind of lymphoma it is, and how it should be treated.

It’s important to get your child into the doctor as early as you can if your child has any of these symptoms so that your doctor can help you figure out the cause of the symptoms, and help you make a treatment plan if needed.

If your doctor thinks your child might have non-Hodgkin’s lymphoma, they may diagnose the condition after:

  • Taking your child’s health history. Your child’s doctor may ask you to provide a brief medical history for your child, including more information about the symptoms, and how long your child has had them.
  • Learning more about your family history. Your child’s doctor may also ask you if your child has a family history of cancer, especially lymphomas or immune system disorders. 
  • Performing a physical exam. Your child’s doctor will also conduct a physical exam. Your child’s doctor will check your child’s lymph nodes and belly. Your child’s doctor will also look for any signs of infection. As swollen lymph nodes are often a symptom of many different diseases, a cancer diagnosis can take some time while your child’s doctor rules out other conditions.
  • Performing a biopsy [BY-op-see]. If your doctor thinks your child may have a lymphoma, the doctor will likely order more tests to confirm the diagnosis and to figure out what type of lymphoma your child has. One of the tests your doctor may ask for is called a biopsy. A biopsy is where a small sample of the tissue is removed and sent to a lab for testing.
  • Referring your child to a medical specialist. Your child’s doctor may also refer you to see a pediatric oncologist [on-KOL-oh-jist], which is a doctor that specializes in childhood cancer. 
  • Conducting other tests. Other tests your doctor may ask for include genetic tests, blood tests, imaging tests (like an x-ray, CT scan, ultrasound, PET scan, or MRI), or bone scans.

Treatments

Childhood non-Hodgkin’s lymphoma is usually treated by a pediatric oncologist, although there may be several other doctors and specialists on your child’s care team, depending on the nature and severity of your child’s cancer.

Some treatment options include:

  • Chemotherapy [KEE-moh-THER-uh-PEE]. Chemotherapy is where your child is given medicine, either by a shot or by pill, to help kill the cancer. 
  • Stem cell transplant. This procedure is sometimes performed after chemotherapy if your child’s cells that are used to create blood have been killed as part of the chemotherapy. A stem cell transplant can help your child form their own blood again.
  • Targeted drugs. These medicines attack specific parts of the cancer cell. 
  • Immunotherapy [ih-MYOO-noh-THER-uh-PEE]. This type of treatment uses medicine to help your child’s immune system identify and fight cancer cells. 
  • Radiation therapy. This type of therapy involves using high-energy radiation to kill cancer cells.

Prevention

As the real cause of childhood non-Hodgkin’s lymphoma is not known at this time, there are known ways to prevent the disease. Most children and adults with this type of cancer have few, if any, risk factors that can be changed.

Non-Hodgkin’s lymphoma [lim-FO-muh] is a type of cancer that affects the white blood cells in your child’s lymphatic system. The lymphatic system is part of your child’s immune system, which helps your child’s body fight disease and infection. Additionally, the lymphatic system also helps move fluids around the body. As this cancer starts in the lymphatic system, it creates tumors from lymphocytes [lim-FO-sites], which are a type of white blood cell.