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Childhood Hodgkin Lymphoma Treatment (PDQ®)

  • Last Modified: 08/22/2014

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General Information About Childhood Hodgkin Lymphoma



Childhood Hodgkin lymphoma is a disease in which malignant (cancer) cells form in the lymph system.

Childhood Hodgkin lymphoma is a type of cancer that develops in the lymph system, which is part of the body's immune system. The lymph system is made up of the following:

  • 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 are located 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.
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Lymph system; drawing shows the lymph vessels and lymph organs including the lymph nodes, tonsils, thymus, spleen, and bone marrow.  One inset shows the inside structure of a lymph node and the attached lymph vessels with arrows showing how the lymph (clear fluid) moves into and out of the lymph node. Another inset shows a close up of bone marrow with blood cells.
Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart.

Because lymph tissue is found throughout the body, Hodgkin lymphoma can start in almost any part of the body and spread to almost any tissue or organ in the body.

Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. (See the PDQ summary on Childhood Non-Hodgkin Lymphoma Treatment for more information.)

Hodgkin lymphoma often occurs in teenagers (age 15–19). The treatment for children and teenagers may be different than treatment for adults. (See the PDQ summary on Adult Hodgkin Lymphoma Treatment for more information.)

There are two types of childhood Hodgkin lymphoma.

The two types of childhood Hodgkin lymphoma are:

Classical Hodgkin lymphoma is divided into four subtypes, based on how the cancer cells look under a microscope:

  • Lymphocyte-rich classical Hodgkin lymphoma.
  • Nodular sclerosis Hodgkin lymphoma.
  • Mixed cellularity Hodgkin lymphoma.
  • Lymphocyte-depleted Hodgkin lymphoma.

Epstein-Barr virus infection can affect the risk of childhood Hodgkin lymphoma.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk. Risk factors for childhood Hodgkin lymphoma include the following:

Being exposed to common infections in early childhood may decrease the risk of Hodgkin lymphoma in children because of the effect it has on the immune system.

Signs of childhood Hodgkin lymphoma include swollen lymph nodes, fever, night sweats, and weight loss.

These and other signs and symptoms may be caused by childhood Hodgkin lymphoma or by other conditions. Check with a doctor if your child has any of the following:

  • Painless, swollen lymph nodes in the neck, chest, underarm, or groin.
  • Fever for no known reason.
  • Weight loss for no known reason.
  • Night sweats.
  • Fatigue.
  • Anorexia.
  • Itchy skin.
  • Pain in the lymph nodes after drinking alcohol.

Fever, weight loss, and night sweats are called B symptoms.

Tests that examine the lymph system are used to detect (find) and diagnose childhood 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.

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, or pelvis, 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.

  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the blood sample made up of red blood cells.
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    Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells.
    Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.

  • Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.

  • Sedimentation rate : A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.

  • Lymph node biopsy : The removal of all or part of a lymph node. The lymph node may be removed during a thoracoscopy, mediastinoscopy, or laparoscopy. One of the following types of biopsies may be done:

    A pathologist views the tissue under a microscope to look for cancer cells, especially Reed-Sternberg cells. Reed-Sternberg cells are common in classical Hodgkin lymphoma.

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    Reed-Sternberg cell; photograph shows normal lymphocytes compared with a Reed-Sternberg cell.
    Reed-Sternberg cell. Reed-Sternberg cells are large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma.

    The following test may be done on tissue that was removed:

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer.
  • The size of the tumor.
  • The type of Hodgkin lymphoma.
  • Whether there are B symptoms at diagnosis.
  • Certain features of the cancer cells.
  • Whether there are too many white blood cells or too few red blood cells at diagnosis.
  • How well the tumor responds to initial treatment with chemotherapy.
  • Whether the cancer is newly diagnosed or has recurred (come back).

The treatment options also depend on:

Most children and teenagers with newly diagnosed Hodgkin lymphoma can be cured.