Key Points for This Section

Childhood non-Hodgkin¡¯s lymphoma is a disease in which malignant (cancer) cells form in the lymph system. There are three major types of childhood non-Hodgkin¡¯s lymphoma. Possible signs of childhood non-Hodgkin¡¯s 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¡¯s lymphoma. Certain factors affect prognosis (chance of recovery) and treatment options.

Childhood non-Hodgkin¡¯s lymphoma is a disease in which malignant (cancer) cells form in the lymph system.

The lymph system is part of the immune system and 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.
• Lymph nodes: Small, bean-shaped structures that filter substances in lymph and 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, and abdomen.
• Spleen: An organ that produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located 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 in the throat. The tonsils produce lymphocytes.
• Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow produces white blood cells, red blood cells, and platelets.

Because lymph tissue is found throughout the body, childhood non-Hodgkin¡¯s lymphoma can begin in almost any part of the body. Cancer can spread to the liver and many other organs and tissues.

Non-Hodgkin¡¯s lymphoma can occur in both adults and children. Treatment for children is different than treatment for adults. (Refer to the PDQ summary on Adult Non-Hodgkin¡¯s Lymphoma Treatment for more information.)

There are three major types of childhood non-Hodgkin¡¯s lymphoma.

The specific type of lymphoma is determined by how the cells look under a microscope. The 3 major types of childhood non-Hodgkin¡¯s lymphoma are:

• Lymphoblastic lymphoma.
• Small noncleaved cell lymphoma (either Burkitt¡¯s lymphoma or non-Burkitt¡¯s lymphoma).
• Large cell lymphoma.

Possible signs of childhood non-Hodgkin¡¯s lymphoma include breathing problems and swollen lymph nodes.

These and other symptoms may be caused by childhood non-Hodgkin¡¯s lymphoma or by other conditions. A doctor should be consulted if any of the following problems occur:

• Shortness of breath.
• Difficulty breathing.
• Wheezing.
• High-pitched breathing sounds.
• Swelling of the head or neck.
• Difficulty swallowing.
• Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin.
• Unexplained fever.
• Unexplained weight loss.
• Night sweats.

Tests that examine the body and lymph system are used to detect (find) and diagnose childhood non-Hodgkin¡¯s 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 to check for signs of cancer. One of the following types of biopsies may be done:
  • Excisional biopsy: The removal of an entire lump, lymph node, or suspicious tissue.
  • Incisional biopsy or core biopsy: The removal of part of a lump, lymph node, or suspicious tissue.
  • Needle biopsy or fine-needle aspiration: The removal of part of a lump, lymph node, or suspicious tissue with a needle.
  • Bone marrow aspiration and biopsy: The removal of a small piece of bone, and blood and tissue from the bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the sample under a microscope to look for cancer cells.
• Thoracentesis: The removal of fluid from the sac that surrounds the lung, using a needle inserted between the ribs. A pathologist views the fluid under a microscope to look for cancer cells.
• 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.
• 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.

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

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

• The stage of the cancer.
• The number of places outside of the lymph nodes to which the cancer has spread.
• The type of lymphoma.
• The patient¡¯s general health.