Childhood Hodgkin's Lymphoma Treatment

by National Cancer Institute

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

Childhood Hodgkin's lymphoma is a type of cancer that develops in the lymph system, 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 substances in lymph and 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 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 at the back of 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, Hodgkin's 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's lymphoma and non-Hodgkin's lymphoma.

Hodgkin's lymphoma can occur in both children and adults; however, treatment for children may be different than treatment for adults.

There are two types of childhood Hodgkin's lymphoma.

The two types of childhood Hodgkin's lymphoma are:

• Classical Hodgkin's lymphoma.
• Nodular lymphocyte predominant Hodgkin's lymphoma.

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

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

Age, gender, and Epstein-Barr virus infection can affect the risk of developing childhood Hodgkin's lymphoma.

Risk factors include the following:

• Being between the ages of 5 and 14. In children younger than 14 years, it is more common in boys than in girls.
• Being infected with the Epstein-Barr virus.
• Having a brother or sister with Hodgkin's lymphoma.

Possible signs of childhood Hodgkin's lymphoma include swollen lymph nodes, fever, night sweats, and weight loss.

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

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

Tests that examine the lymph system are used to detect (find) and diagnose childhood 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 past illnesses and treatments will also be taken.

Lymph node biopsy: The removal of all or part of a lymph node that is then viewed under a microscope and checked for signs of disease. One of the following types of biopsies may be done:

• Excisional biopsy: The removal of an entire lymph node.
• Incisional biopsy or core biopsy: The removal of part of a lymph node.
• Needle biopsy or fine-needle aspiration: The removal of a sample of tissue from a lymph node with a needle.

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.

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.

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.

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 produces it.

Gallium scan: A procedure to detect areas of the body where cells, such as cancer cells, are dividing rapidly. A very small amount of radioactive material, gallium, is injected into a vein and travels through the bloodstream. The gallium collects in the bones or other tissues (organs) and is detected by a scanner.

Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out the type of malignant (cancerous) lymphocytes that are causing the lymphoma.

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 and how quickly it shrinks after initial treatment.
• The patient's symptoms when diagnosed.
• Certain features of the cancer cells.
• Whether the cancer is newly diagnosed, does not respond to initial treatment, or has recurred (come back).

The treatment options also depend on:

• The child's age and gender.
• The risk of long-term side effects.

Most children and adolescents with newly diagnosed Hodgkin's lymphoma can be cured.

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