General Information About Childhood Non-Hodgkin Lymphoma
Key Points for This Section
- Childhood non-Hodgkin lymphoma is a disease in which malignant (cancer) cells form in the lymph system.
- There are four major types of childhood non-Hodgkin lymphoma.
- Signs of childhood non-Hodgkin lymphoma include breathing problems and swollen lymph nodes.
- Tests that examine the body and lymph system are used to detect (find) and diagnose childhood non-Hodgkin lymphoma.
- Certain factors affect prognosis (chance of recovery) and treatment options.
Childhood non-Hodgkin lymphoma is a disease in which malignant (cancer) cells form in the lymph system.
- Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.
- Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
- Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes grow along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
- Spleen: An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. The spleen is on the left side of the abdomen near the stomach.
- Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.
- Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils make lymphocytes.
- Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow makes white blood cells, red blood cells, and platelets.
Non-Hodgkin lymphoma can occur in both adults and children. Treatment for children is different than treatment for adults. (See the PDQ summary on Adult Non-Hodgkin Lymphoma Treatment for more information on treatment in adults.)
There are four major types of childhood non-Hodgkin lymphoma.
There are other types of lymphoma that occur in children. These include the following:
- Lymphoproliferative disease associated with a weakened immune system.
- Rare non-Hodgkin lymphomas that are more common in adults than in children.
Signs of childhood non-Hodgkin lymphoma include breathing problems and swollen lymph nodes.
- Trouble breathing.
- High-pitched breathing sounds.
- Swelling of the head, neck, upper body or arms.
- Trouble swallowing.
- Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin.
- Painless lump or swelling in a testicle.
- Fever for no known reason.
- Weight loss for no known reason.
- Night sweats.
Tests that examine the body and lymph system are used to detect (find) and diagnose childhood non-Hodgkin lymphoma.
The following tests and procedures may be used:
- Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. One of the following types of biopsies may be done:
- Excisional biopsy : The removal of an entire lymph node or lump of tissue.
- Incisional biopsy : The removal of part of a lump, lymph node, or sample of tissue.
- Core biopsy : The removal of tissue or part of a lymph node using a wide needle.
- Fine-needle aspiration (FNA) biopsy : The removal of tissue or part of a lymph node using a thin needle.
- Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone.
The following tests may be done on the sample of tissue that is removed:
- Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.
- Cytogenetic analysis : A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
- Flow cytometry : A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of tumor markers on the cell surface. The cells are stained with a light-sensitive dye, placed in a fluid, and passed in a stream before a laser or other type of light. The measurements are based on how the light-sensitive dye reacts to the light.
- FISH (fluorescence in situ hybridization): A laboratory test used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA attach to certain genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light. This type of test is used to find certain gene changes.
- Immunophenotyping : A process used to identify cells, based on the types of antigens or markers on the surface of the cell. This process is used to diagnose specific types of lymphoma by comparing the cancer cells to normal cells of the immune system.
- Mediastinoscopy : A surgical procedure to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.
- Anterior mediastinotomy : A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and heart for abnormal areas. An incision (cut) is made next to the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. This is also called the Chamberlain procedure.
- Thoracentesis : The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Sometimes a PET scan and a CT scan are done at the same time. If there is any cancer, this increases the chance that it will be found.
- Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Lumbar puncture : A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
Certain factors affect prognosis (chance of recovery) and treatment options.
- The age of the child.
- The type of lymphoma.
- The stage of the cancer.
- The number of places outside of the lymph nodes to which the cancer has spread.
- Whether the lymphoma has spread to the bone marrow or central nervous system (brain and spinal cord).
- Whether there are certain changes in the chromosomes.
- The type of initial treatment.
- Whether the lymphoma responds to initial treatment.
- The patient’s general health.