Mariah
Osteosarcoma Survivor
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Josh
Brain Tumor Survivor
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Sydney
Leukemia Survivor
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Alijah
Leukemia Survivor
Read Alijah's Story

Rosie
Wilms Tumor Survivor
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Ryan
Leukemia Survivor
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Sydney
Retinoblastoma Survivor
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Non-Hodgkin’s Lymphoma

Research and clinical trials are providing hope

Non-Hodgkin’s lymphoma is a family of tumors that originates in the lymph system. The lymph system is a vast network of thin tubes that branch, like blood vessels, throughout the body. These tubes carry a colorless fluid called lymph, which is made up of disease-fighting white blood cells that are an essential part of the body’s immune system.

These lymph vessels are connected to bean-shaped organs called lymph nodes which are found through the body - pelvis, armpit, neck and abdomen. These structures store and produce white blood cells. Because lymph tissue is found throughout the body, non-Hodgkin’s lymphoma can start almost anywhere - and spread to almost any organ, including the liver, spleen and bone marrow.

Non-Hodgkin’s lymphoma can affect both children and adults. The majority of children with non-Hodgkin’s lymphoma are cured. Therapies are aggressive, and are tailored to the type of lymphoma and the stage of the disease. A child’s chances for a good recovery depend on his or her age and general health, the cell-type involved, and how quickly the cancer cells reproduce.

There are three major types of childhood non-Hodgkin’s lymphomas. The types are based on the cell type and size of the cancer, also referred to as histology, as seen under a microscope. They are:

Symptoms

Symptoms can be difficult to diagnose because they are not specific to non-Hodgkin’s lymphoma.

Symptoms include:

  • Painless swelling of the lymph nodes
  • Possible swelling of the abdomen
  • Fever
  • Chills
  • Weight loss; loss of appetite
  • Night sweats

Diagnosis

  • Physical exam: If a child complains of any of the symptoms listed above, a doctor will examine the child’s body carefully, looking for swellings or lumps in areas of the lymph nodes - the neck, underarms, pelvis and abdomen.
  • X-rays and/or CT scans may be ordered to check for large lymph nodes or masses.
  • A biopsy may be done if enlarged lymph nodes are found. This involves snipping out a small piece of tissue to be examined under the microscope.

Staging the disease

Once lymphoma is found, more tests will be done to determine the extent to which it has spread to other parts of the body. This is called staging. Treatments are available for all stages of non-Hodgkin’s lymphoma, but a doctor needs to know the stage to plan the most effective treatment. The stages are:

  • Stage I: A single tumor (extranodal) or single anatomic area (nodal) with the exclusion of the mediastinum or abdomen.
  • Stage II: A single tumor (extranodal) with regional node involvement; two or more nodal areas on the same side of the diaphragm; two single (extranodal) tumors with or without regional node involvement on the same side of the diaphragm; a primary gastrointestinal tumor, usually in the ileocecal area, with or without involvement of associated mesenteric nodes only, grossly completely resected.
  • Stage III: Two single tumors (extranodal) on opposite sides of the diaphragm; two or more nodal areas above and below the diaphragm; all primary intra-thoracic tumors; all extensive primary intra-abdominal tumors; all paraspinal or epidural tumors, regardless of other tumor sites.
  • Stage IV: any of the above with initial central nervous system and/or bone marrow involvement Recurrent: Recurrent means that the cancer has come back after being treated. It may come back in the same area it first started, or in another area.

Treatment

There are treatments for all patients and all stages of non-Hodgkin’s lymphoma, and patients can be cured. Treatment options include:

  • Chemotherapy: This is the most accepted and widely-used primary treatment for non-Hodgkin’s lymphoma. Chemotherapy consists of introducing cancer-fighting drugs into the blood stream by mouth, or through a needle into a vein or muscle. It is a “systemic” treatment — meaning it treats the whole body, or system, because the circulating blood carries the drugs throughout the entire body. In some cases, the drugs are injected into the fluid surrounding the spine and brain — usually in an area of the spine — in a procedure known as “intrathecal chemotherapy.”
  • Radiation: In some cases, radiation is used. This therapy relies on a beam of high-energy particles, such as X-rays, directed at the cancer by a machine outside the body. The assault from this concentrated energy kills cells and reduces tumor size.
  • Bone Marrow Transplantation: This technique is being tested in clinical trials for its effectiveness in treating some patients with recurrent non-Hodgkin’s lymphoma. In a bone marrow transplant, surgeons replace diseased bone marrow with healthy marrow through a technique pioneered at the University of Minnesota.

In 1968 the very first successful human blood and marrow transplant was performed here, and U of M physicians have since done more than 3,700. The first successful transplant for lymphoma was also performed at the University of Minnesota in 1975. Through this technique, diseased marrow is killed with high doses of chemotherapy and sometimes, with radiation as well. Healthy marrow is then taken from a donor whose tissues match the patient’s tissues. This donated marrow is transplanted through a needle in a vein. Marrow cells then seek the right places in the bones to replace diseased marrow.

An internationally recognized leader in bone marrow transplantation, the University of Minnesota BMT program is experiencing increasing success, and its cases are being studied in clinical trials.

Treatment by stage and cell type

Because each case is different, treatment may vary. What follows are the most generally used treatments for a given cancer stage and cell type.

Childhood lymphoblastic lymphoma

Treatment may be similar to how those with acute lymphoblastic leukemia are treated.

  • Stages I and II: Systemic chemotherapy and intrathecal chemotherapy.
  • Stage III and IV: Systemic chemotherapy, intrathecal chemotherapy, and possibly radiation.
  • Recurrent: Treatment depends on the site at which the cancer recurs, the type of treatment given before, and the child’s general health. A child’s treatment may be one of the following:
    • Allogeneic bone marrow transplant. This is a transplant that uses bone marrow from a donor.
    • Systemic chemotherapy with different drugs than those used before.
    • New therapies by participating in clinical trials.

Small cell lymphoma, including Burkitt’s and non-Burkitt’s lymphoma

Stages I and II

  • Systemic chemotherapy with or without intrathecal chemotherapy.

Stage III and IV

  • Systemic chemotherapy plus intrathecal chemotherapy. Clinical trials are testing new combinations and doses of drugs.

Recurrent:

Treatment will depend on the site at which the cancer comes back, the type of treatment given before, and your child’s health. Treatment may be one of the following:

  • Systemic chemotherapy.
  • Allogeneic (from a donor) bone marrow transplant, or autologous (from marrow previously taken from your child) bone marrow transplant.
  • Systemic chemotherapy plus intrathecal chemotherapy.
  • A clinical trial of new methods of treatment.

Large-cell lymphoma

Stage I and II

  • Systemic chemotherapy with or without intrathecal chemotherapy.

Stage III and IV

  • Systemic chemotherapy with or without intrathecal chemotherapy.
  • Clinical trials that are testing new combinations of drugs.

Recurrent

Treatment will depend on the site at which the cancer comes back, the type of treatment given before, and your child’s health. Treatment may be one of the following:

  • Allogeneic (donated) bone marrow transplant, or autologous (marrow previously taken from your child) bone marrow transplant.
  • Systemic chemotherapy, with or without intrathecal chemotherapy
  • A clinical trial of new methods of treatment

Back to Types of Childhood Cancer