Childhood Lymphoma

Types 

Hodgkin's Lymphoma (HL) mostly occurs in adolescents and young adults aged 15 to 35. It's slightly more common in males and tends to be more aggressive in older patients.

Burkitt's Lymphoma (BL) is an aggressive, fast-moving cancer affecting B cell lymphocytes. It is quite rare in the U.S., but much more common in countries near the equator, particularly Africa and South America.

Lymphoblastic Lymphoma (LBL) mostly affects T cell lymphocytes and is similar to acute lymphoblastic leukemia (ALL). It makes up about one-third of all childhood NHL, and is more common in boys.

Large Cell Lymphoma (LCL) includes two subtypes: diffuse large B-cell lymphoma (DLBCL) mostly affects pre-adolescent and teenaged children; and anaplastic large cell lymphoma (ALCL) is more common in adolescents.

Symptoms 

Specific lymphoma symptoms vary according to disease type, but most have the following symptoms in common:

• Painless swelling or enlargement of lymph nodes, especially in the neck, armpits and groin
• Excessive night sweats
• Unexplained fever
• Undetermined weight loss
• Loss of appetite
• Itchy skin

Tests & Procedures

A lymph node biopsy is a procedure that removes a piece of lymph node or a whole lymph node for examination under a microscope. Using various tests, the pathologist can determine the type of lymphoma so that the appropriate treatment can be chosen. Because lymphomas can be difficult to characterize, several tests may have to be done. If the lymph node is superficial (close to the surface of the skin), the biopsy can be done with a local anesthetic, meaning that the biopsy area is numbed, but the patient remains awake. Surgery, in which the patient is put to sleep, may be required if the suspicious lymph node is deeper in the body.

Other tests are conducted to determine the stage of disease. These tests may include: 

• X-rays
• Ultrasound
• PET scan
• MRI
• CT scan
• Bone marrow biopsy

Treatment 

Chemotherapy is the most common treatment for lymphomas. Depending on the type and stage of disease, various combinations of drugs are administered in cycles to reduce or eliminate cancer cells. Chemotherapy can be administered in four ways:

• Orally (taking pills by mouth)
• Intravenously (injected into the vein)
• Intrathecal (injected directly into the cerebrospinal fluid)
• Subcutaneously (beneath the skin)

Some types of lymphoma have a tendency to spread to the brain and central nervous system (CNS). To prevent that from occurring, your pediatric oncologist may recommend CNS prophylaxis treatment. Chemotherapy drugs are injected directly into the cerebrospinal fluid surrounding the spinal cord and brain to protect these areas from invasion by lymphoma cells.

Radiation therapy is sometimes used in conjunction with chemotherapy to treat large areas, or to minimize discomfort caused by cancerous lymph nodes that are affecting nearby organs or structures.

Clinical Trials 

The most innovative treatments for childhood lymphoma are offered as part of clinical trials, which are closely monitored studies to test the safety and effectiveness of new treatments. Go to M. D. Anderson's list of current pediatric clinical trials to see if your child might be eligible.

Ataxia-Telangiectasia (AT) Clinic 

AT is a rare genetic disorder with progressive neurodegeneration and a markedly increased risk for leukemias and lymphomas. The Children’s Cancer Hospital has a unique clinic for AT patients with lymphomas and leukemias. Because these patients are very sensitive to chemotherapy and radiotherapy, special protocols have been designed to treat AT.