What is Hodgkin lymphoma?

Lymphomas, both non-Hodgkin and Hodgkin lymphoma, are the third most common cancer in children. Hodgkin lymphoma can occur at any time during life, but is found more often in adolescents than younger children.

There are no known environmental toxins that increase the risk of lymphoma in children. However, children who are born with or acquire conditions that affect the immune system are more likely to develop lymphomas. Having a sibling with lymphoma also slightly raises a child's risk. Prior infection with the Epstein-Barr virus (the virus that causes infectious mononucleosis) is also associated with a greater risk for lymphoma. 

The term lymphoma refers to a group of cancers of the lymph system, which is made up of:

• Vessels throughout the body that carry lymph (the colorless fluid from body tissue)
• Organs such as lymph nodes, the spleen and the thymus which produce and store infection-fighting cells
• The tonsils, stomach, small intestine and skin

Signs and symptoms

Signs and symptoms of Hodgkin lymphoma can include:

• Painless swelling of the lymph nodes in the neck, groin or underarm area
• Persistent fever
• Night sweats
• Weight loss
• Itchy skin
• Cough
• Chest pain

Diagnosis

Your child's doctor will do a physical exam — including checking for signs of the disease such as lumps in lymph nodes — and take a thorough medical history. If Hodgkin lymphoma is suspected, your child will undergo several or all of the following diagnostic tests to establish the diagnosis:

• Surgical biopsy. Tissue must be removed to diagnose Hodgkin lymphoma. A sample of tissue is removed while your child is under general anesthesia, and the pathologist will examine the cells of the tissue under a microscope. 
• Bone marrow aspirate and biopsy. Bone marrow is removed from the bone (usually the hipbone) either by aspiration (suctioning a small amount through a hollow needle) or by biopsy (removing a small chip of bone).
• X-rays. X-ray of the chest to look for presence of the disease.
• Blood tests. Complete blood count (CBC), blood chemistries and tests for inflammation are done to look for evidence of disease and determine when a child is ready for therapy.
• Other imaging scans. CT (computerized tomography), MRI (magnetic resonance imaging) and PET (positron emission tomography) scans may be conducted. These scans produce pictures of the body to show the extent of the disease.

After the tests are completed, members of the oncology team will discuss the results with you at a family meeting. Your child's doctor will then discuss the treatment options for your child and make recommendations.

Treatment

The specific treatment options for Hodgkins lymphoma will depend on your child, the extent of the tumor and the results of studies on tumor tissue. The doctors may discuss a treatment plan with you that is a clinical trial run by the Children's Oncology Group. Treatment may consist of chemotherapy (drugs that destroy cancer cells) and radiation therapy.

Proton Therapy for Pediatric Lymphoma

There is a newer form of radiation available for CHOP patients called proton therapy. This is sometimes recommended depending upon the location of the disease. If your child needs radiation, your doctor will consult with one of the pediatric radiation oncologists to develop the plan of treatment. You will also meet this group in order to better understand what is recommended and ask questions.

Your child's chemotherapy may be given during an inpatient hospital stay or, more likely, in the oncology outpatient day hospital. Radiation treatments will be given on an outpatient basis, usually at the Perelman Center for Advanced Medicine (across the street from Children's Hospital). Follow-up studies and scans such as CT and PET will be repeated at intervals during treatment and for a specific period following treatment. We will try to schedule these as outpatient procedures along with your clinic appointments.

During your child's hospitalization and your visits to the Oncology Clinic, the doctors, nurses and social workers will be working with you and your child to understand the disease, its treatment and how to care for special needs at home.

Long-term outcomes

Although Hodgkin lymphoma is a serious disease, most newly diagnosed children and adolescents can be cured with modern treatment.

Some children treated for Hodgkin lymphoma develop complications years later. Our Cancer Survivorship Program provides information about the potential long-term effects of the specific treatment your child received, including ways of monitoring and treating these effects.