Lymphoma

What Is Lymphoma?

Lymphoma (lim-FOE-muh) is a type of cancer that develops in the white blood cells of the lymphatic system, which is part of the immune system. These systems work together to remove bacteria, viruses, and other harmful substances from the body.

The lymphatic system includes:

• the lymph nodes (also called lymph glands)
• thymus (a gland in the chest)
• spleen
• tonsils
• adenoids
• bone marrow
• tubes called lymphatics or lymph vessels that connect the parts of the lymphatic system

What Are the Types of Lymphoma?

There are several different types of lymphomas. They’re grouped together based on which blood cells they affect:

• Lymphomas that involve cells called Reed-Sternberg cells are called Hodgkin lymphoma.
• All other types of lymphoma don’t have these cells and are called non-Hodgkin lymphoma.

What Are the Signs & Symptoms of Lymphoma?

Lymphoma may cause enlarged (swollen glands) anywhere in the body. Often, it shows up in neck, above the collarbone, in the underarm area, or groin.

If cancer is in the chest, pressure from any swelling can cause a cough, trouble breathing or swallowing, or swelling of the face and neck. If cancer is in the belly, pain or swelling can happen there. 

Some kids can also have fatigue (tiredness), poor appetite, or itchy skin. Fever, night sweats, and weight loss are also common.

What Causes Lymphoma?

Lymphoma usually is caused by a change in the genes of growing blood cells. In most cases, doctors aren’t sure why this happens. 

Lymphoma is more common in kids who have:

• immune system problems
• HIV infection
• been given immunosuppressive drugs after organ transplants
• been treated with radiation therapy or chemotherapy for other types of cancer 

How Is Lymphoma Diagnosed?

To check for lymphoma, doctors look for swollen lymph nodes; breathing problems; or swelling in the belly, face, hands, or feet.  

Sometimes, when a child has an enlarged lymph node with no known cause, the doctor will watch the node closely to see if it shrinks or grows. If it stays enlarged or gets bigger, the next step is a biopsy to check in a lab for cancer cells. Doctors can do:

• Needle aspiration biopsy: Doctors numb part of the body with local anesthesia, then use a hollow needle to remove a tiny bit of tissue from the lymph node for testing.
• Incisional or excisional biopsy: This is done in an operating room. Kids get medicines (anesthesia) to sleep. Then, the doctor makes a small cut to remove a piece of the lymph node (incisional) or the whole lymph node (excisional).

Biopsies also can check for lymphomas that might involve the bone marrow, chest, or belly.

If lymphoma is found, other tests can tell the type of lymphoma and whether it has spread (metastasized). These tests may include:

• genetic tests to see the type of lymphoma
• blood tests, including those to check the number of blood cells and how well the kidneys and liver are working
• biopsy or aspiration of the bone marrow
• lumbar puncture (spinal tap) to see if the cancer spread to the central nervous system (brain and spinal cord)
• imaging tests like ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and X-rays
• bone scan and/or positron emisson tomography (PET) scan (when a radioactive material is put into the bloodstream to look for cancer cells throughout the body)

The test results will help doctors decide which treatments to use.

How Is Lymphoma Treated?

A pediatric oncologist (a doctor who specializes in childhood cancer) will lead the medical team caring for a child with lymphoma. The oncologist works with other specialists, including nurses, social workers, psychologists, and surgeons.

Treatment of childhood lymphoma is based on staging. Staging is a way to see if the disease has spread and, if it has, how much.

Chemotherapy is the main treatment for childhood lymphoma. This uses medicines to stop the growth of cancer cells. The dosages and drugs used may differ based on a child's age and the type of lymphoma.

Doctors also might use:

• radiation therapy: high-energy X-rays that kill cancer cells
• targeted therapy: specific drugs that find and attack cancer cells without hurting normal cells
• immunotherapy: medicine that uses the child’s own immune system to get rid of cancer cells
• stem cell transplants: healthy stem cells are put into the body
• surgery: sometimes, surgery can remove part of the tumor

Remission is when doctors see no cancer cells in the body. Childhood lymphomas can have very high remission rates, with some up to 90%. Most kids and teens are cured of the disease. This means that they're in permanent remission.

What Else Should I Know?

Having a child being treated for cancer can feel overwhelming for any family. But you're not alone. To find support, talk to anyone on the care team or a hospital social worker. Many resources are available to help you and your child.

You also can find more information and support online at:

• National Children’s Cancer Society (NCCS)
• American Childhood Cancer Organization
• American Cancer Society