Childhood Lymphoma Diagnosis

A diagnosis for lymphoma in children often starts with the disease’s symptoms leading to a trip to the doctor. A thorough physical exam then leads to tests that give a definitive diagnosis.

Because childhood lymphomas can be difficult to characterize, doctors may order several types of tests to diagnose the disease and to monitor how the patient is responding to treatment. These include:

Lymph node biopsy: In a biopsy, doctors remove suspected cancer tissue and study it under a microscope for the presence of cancer cells. In lymphoma, cancer cells gather in lymph nodes, causing them to swell, so doctors look for swollen lymph nodes to biopsy. If the swollen node is close to the surface of the skin, doctors can perform the biopsy with a local anesthetic. If it is deeper in the body, the patient may need to be put under general anesthetic for a surgical biopsy.
Blood tests: These measure the patient’s levels of red blood cells, white blood cells, platelets and hemoglobin.
Imaging exams: Imaging exams can show where lymphoma cells are gathering in the body. Exams used for lymphoma include:
- CT scan: A CT scan uses an X-ray machine to take several pictures from different angles, providing a highly detailed image.
- PET scan: During a positron emission tomography scan, or PET scan, patients are injected with a small dose of radioactive sugar. A scanner shows where the body distributes the sugar, allowing for the creation of an image. This image can help radiologists find cancer cells in the body.
- Ultrasound: Ultrasound operates with high-energy sound waves that bounce off internal tissues and organs and produce echo patterns. The echo patterns create a picture referred to as a sonogram, which can be seen on an ultrasound machine. 
- X-ray: X-rays use low doses of high-energy radiation that travel through the body to create an image. X-rays are used to image bone and can also help spot tumors.
Blood chemistry studies: These tests measure the amount of certain substances in the blood, including fats, proteins, sugars and electrolytes. They can help doctors understand how the disease is responding to treatment.

Childhood Lymphoma Staging

Following a diagnosis of childhood lymphoma, various tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body. The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. Doctors use the stage to help plan treatment.

Childhood Hodgkin lymphoma stages

(Source: National Cancer Institute)

Stage I

Stage I is divided into stage I and stage IE.

Stage I: Cancer is found in one of the following places in
the lymph system:
- One or more lymph nodes in one lymph node group.
- Waldeyer's ring.
- Thymus.
- Spleen.
Stage IE: Cancer is found outside the lymph system in one organ or area.

Stage II

Stage II is divided into stage II and stage IIE.

Stage II: Cancer is found in two or more lymph node groups either above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
Stage IIE: Cancer is found in one or more lymph node groups either above or below the diaphragm and outside the lymph nodes in a nearby organ or area.

Stage III

Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIE,S.

Stage III: Cancer is found in lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
Stage IIIE: Cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area.
Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm, and in the spleen.
Stage IIIE,S: Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.

Stage IV

In stage IV, the cancer:

is found outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
is found outside the lymph nodes in one organ and has spread to areas far away from that organ; or
is found in the cerebrospinal fluid (CSF) or has spread from areas far away to the lung, liver, or bone marrow.

In addition to the stage number, the letters A, B, E, or S may be noted.

The letters A, B, E, or S may be used to further describe the stage of childhood Hodgkin lymphoma.

A: The patient does not have B symptoms (fever, weight loss, or drenching night sweats).
B: The patient has B symptoms.
E: Cancer is found in an organ or tissue that is not part of the lymph system but which may be next to an area of the lymph system affected by the cancer.
S: Cancer is found in the spleen.

Childhood non-Hodgkin lymphoma stages

(Source: National Cancer Institute)

Stage I

In stage I childhood non-Hodgkin lymphoma, cancer is found:

in one group of lymph nodes; or
in one area outside the lymph nodes.

No cancer is found in the abdomen or mediastinum (area between the lungs).

Stage II

In stage II childhood non-Hodgkin lymphoma, cancer is found:

in one area outside the lymph nodes and in nearby lymph nodes; or
in two or more areas either above or below the diaphragm, and may have spread to nearby lymph nodes; or
to have started in the stomach or intestines and can be completely removed by surgery. Cancer may have spread to certain nearby lymph nodes.

Stage III

In stage III childhood non-Hodgkin lymphoma, cancer is found:

in at least one area above the diaphragm and in at least one area below the diaphragm; or
to have started in the chest; or
to have started in the abdomen and spread throughout the abdomen and cannot be completely removed by surgery; or
in the area around the spine.

Stage IV

In stage IV childhood non-Hodgkin lymphoma, cancer is found in the bone marrow, brain, or cerebrospinal fluid. Cancer may also be found in other parts of the body.

Childhood Lymphoma Diagnosis

Childhood Lymphoma Staging

Childhood Hodgkin lymphoma stages

Stage I

Stage II

Stage III

Stage IV

Childhood non-Hodgkin lymphoma stages

Stage I

Stage II

Stage III

Stage IV

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