Childhood Hodgkin’s Lymphoma
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Description
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What is Hodgkin’s lymphoma?
Hodgkin’s lymphoma is a type of lymphoma. Lymphomas are cancers that develop in
the lymph system, part of the body’s immune system.
The lymph system is made up of thin tubes that branch, like blood vessels, into
all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid
that contains white blood cells called lymphocytes. Along the network of
vessels are groups of small, bean-shaped organs called lymph nodes. Clusters
of lymph nodes are found in the underarm, pelvis, neck, chest, and abdomen.
The lymph nodes make and store infection-fighting cells. The spleen (an organ
in the upper abdomen that makes lymphocytes and filters old blood cells from
the blood), the thymus (a small organ beneath the breastbone), and the tonsils
(lymph tissue in the throat) are also part of the lymph system.
Because there is lymph tissue in many parts of the body, Hodgkin’s lymphoma can
start in almost any part of the body. The cancer can spread to almost any
organ or tissue in the body, including the liver, bone marrow (the spongy
tissue inside the large bones of the body that makes blood cells), and the
spleen.
Lymphomas are divided into 2 general types: Hodgkin’s lymphomas and non-Hodgkin’s
lymphomas. (Refer to the PDQ summaries on Adult Non-Hodgkin’s Lymphoma
Treatment and Childhood Non-Hodgkin’s Lymphoma Treatment for more information.)
This summary covers only childhood Hodgkin’s lymphoma. Adult Hodgkin’s lymphoma
is often treated differently. (Refer to the PDQ summary on Adult Hodgkin’s Lymphoma Treatment for more information.)
Hodgkin’s lymphoma is rare in children under 5 years of age. In children under
age 10, it is more common in boys than girls. The symptoms of childhood
Hodgkin’s lymphoma may include any of the following: painless swelling of the
lymph nodes in the neck or underarm area that doesn’t go away within a few
weeks; fever that doesn’t go away; night sweats; and weight loss without
dieting. If the lymph nodes don’t feel normal when examined by a doctor, the
doctor may need to cut out a small piece of tissue and look at it under a
microscope to see if there are any cancer cells. This is called a biopsy.
Most children with Hodgkin’s lymphoma receive combination chemotherapy and
low-dose radiation therapy.
The chance of recovery (prognosis) and choice of treatment depend on the stage
of the cancer (whether it is just in one area or has spread throughout the
body), the type of symptoms that are present, and the age and overall condition
of the child.
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Stage Explanation
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Stages of Childhood Hodgkin’s lymphoma
Once childhood Hodgkin’s lymphoma is found, more tests will be done to find out
if the cancer has spread from where it started to other parts of the body.
This is called staging. It is important to know the stage of the disease to
plan treatment.
The stage of disease may be determined by physical examination, blood tests,
and different kinds of x-rays. This is called clinical staging. In some
cases, an operation called a laparotomy is performed to determine the stage of
the cancer. During this operation, the abdomen is opened to see if the organs
inside contain cancer. Small pieces of tissue are removed during the operation
and examined under a microscope to see whether they contain cancer. This type
of staging is called pathologic staging. Pathologic staging is usually done
only when it is needed to help plan treatment. During this operation, the
spleen may be removed and the child may receive medicine to prevent infection.
If an operation is not possible, a needle biopsy may be performed. This is a
procedure in which tissue is removed with a needle for examination under a
microscope.
Each stage of childhood Hodgkin’s lymphoma is further divided into A and B
categories based on whether the child has symptoms. Children with no symptoms
are in the A category, while those who have symptoms (such as fever, weight
loss, or night sweats) are in the B category. For example, a child with stage
I disease without any symptoms is said to have stage IA disease; a child with
stage I disease with symptoms is said to have stage IB disease.
The following stages are used for childhood Hodgkin’s lymphoma:
Stage I
Cancer is found in only 1 lymph node area or in only 1 area or organ outside of
the lymph nodes.
Stage II
Either of the following means the disease is stage II:
- Cancer is found in 2 or more lymph node areas on the same side of the
diaphragm (the thin muscle under the lungs that helps with breathing).
- Cancer is found in only 1 area or organ outside of the lymph nodes and in
the lymph nodes around it. Other lymph node areas on the same side of the
diaphragm may also have cancer.
Stage III
Cancer is found in lymph node areas on both sides of the diaphragm. The cancer
may also have spread to an area or organ near the lymph node areas and/or to
the spleen.
Stage IV
Either of the following means the disease is stage IV:
- Cancer has spread in more than 1 spot to an organ or organs outside of the
lymph system. Cancer cells may or may not be found in the lymph nodes near
these organs.
- Cancer has spread to only 1 organ outside of the lymph system, but lymph
nodes far away from that organ are involved.
Recurrent
Recurrent disease means that the cancer has come back after it has been
treated. It may come back in the area where it first started or in another
part of the body.
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Treatment Option Overview
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How childhood Hodgkin’s lymphoma is treated
There are treatments for all patients with childhood Hodgkin’s lymphoma. The
most common treatments are radiation therapy and/or chemotherapy, but treatment
may be different depending on the stage of the cancer and whether the child has
reached full growth. Bone marrow transplants are being studied in clinical
trials for certain patients.
Radiation therapy is the use of high-energy x-rays to kill cancer cells and
shrink tumors. Radiation for childhood Hodgkin’s lymphoma usually comes from a
machine outside the body (external beam radiation therapy). Radiation therapy
given to the neck, chest, and lymph nodes under the arms is called radiation
therapy to the mantle. Radiation therapy given to the mantle and to the lymph
nodes in the upper abdomen, the spleen, and the lymph nodes in the pelvis is
called total nodal irradiation. Radiation therapy may be used alone or in
addition to chemotherapy.
Chemotherapy is the use of drugs to kill cancer cells and shrink tumors.
Chemotherapy may be taken by pill, or it may be put into the body by inserting
a needle into a vein or muscle. Chemotherapy is called a systemic treatment
because the drugs enter the bloodstream, travel through the body, and can kill
cancer cells throughout the body.
Bone marrow transplantation is a newer type of treatment. Sometimes Hodgkin’s lymphoma becomes resistant to treatment with radiation therapy or chemotherapy.
Very high doses of chemotherapy may then be used to treat the cancer. Because
the high doses of chemotherapy can destroy the bone marrow, marrow is taken
from the patient’s bones before treatment. The marrow is then frozen and
high-dose chemotherapy with or without radiation therapy is given to the
patient to treat the cancer. The marrow that was taken from the patient is
then thawed and given back through a needle into a vein to replace the marrow
that was destroyed. This type of transplant is called an autologous
transplant. If the patient is given marrow taken from another person, the
transplant is called an allogeneic transplant.
Some patients develop another form of cancer as a result of their treatment for
Hodgkin’s lymphoma; therefore, regular follow-up evaluations may be made. Female
patients who received radiation therapy between the ages of 10 and 16 have an
increased risk of breast cancer.
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Treatment by stage
Patients may be given vaccination shots against flu, pneumonia, and meningitis
both before and every few years after treatment in order to guard against these
infections.
Treatment for childhood Hodgkin’s lymphoma depends on the type and stage of
disease and how the stage was determined, as well as the child’s age, symptoms,
and general health.
Patients may receive treatment that is considered standard based on its
effectiveness in a number of patients in past studies, or parents may choose to
have their child treated in the context of a clinical trial. Not all patients
are cured with standard therapy and some standard treatments may have more side
effects than are desired. For these reasons, clinical trials are designed to
test new treatments and to find better ways to treat cancer patients. Clinical
trials are ongoing in most parts of the country for most stages of childhood
Hodgkin’s lymphoma. For more information, call the Cancer Information Service
at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
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Stage I Childhood Hodgkin’s Lymphoma
Treatment depends on whether the disease is stage IA or stage IB and where the
cancer is found.
If the cancer is above the diaphragm and does not involve a large part of the
chest, treatment may be one of the following
- Chemotherapy with low-dose radiation therapy to areas that contain
cancer
- A clinical trial of chemotherapy with or without radiation therapy.
- A clinical trial of chemotherapy alone
If the cancer is above the diaphragm and involves a large part of the chest,
treatment may be one of the following
- Chemotherapy followed by radiation therapy to the chest or the mantle
- A clinical trial of chemotherapy plus low-dose radiation therapy
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Stage II Childhood Hodgkin’s Lymphoma
Treatment depends on whether the disease is stage IIA or stage IIB and where
the cancer is found.
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Stage IIA
If the cancer is above the diaphragm and does not involve a large part of the
chest, treatment may be one of the following:
- Chemotherapy plus low-dose radiation therapy to areas that contain cancer
- A clinical trial of low-dose chemotherapy with or without radiation
therapy
- A clinical trial of chemotherapy alone
If the cancer is above the diaphragm and involves a large part of the chest,
treatment may be one of the following:
- Chemotherapy followed by radiation therapy to the chest or the mantle
- A clinical trial of chemotherapy plus low-dose radiation therapy
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Stage IIB
If the cancer is above the diaphragm and does not involve a large part of the
chest, treatment may be one of the following:
- Chemotherapy followed by low-dose radiation therapy to areas that contain
cancer
- Treatment in a clinical trial
If the cancer is above the diaphragm and involves a large part of the chest,
treatment may be one of the following:
- Chemotherapy plus radiation therapy to the chest or the mantle
- A clinical trial of chemotherapy followed by low-dose radiation therapy
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Stage III Childhood Hodgkin’s Lymphoma
Treatment depends on whether the disease is stage IIIA or stage IIIB.
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Stage IIIA
Treatment may be one of the following:
- Chemotherapy alone
- Chemotherapy plus radiation therapy
- A clinical trial of chemotherapy with or without radiation therapy
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Stage IIIB
Treatment may be one of the following:
- Chemotherapy alone
- Chemotherapy plus radiation therapy
- Treatment in a clinical trial
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Stage IV Childhood Hodgkin’s Lymphoma
Treatment may be one of the following:
- Chemotherapy alone
- Chemotherapy plus radiation therapy
- A clinical trial of chemotherapy with or without radiation therapy to the
lymph nodes
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Recurrent Childhood Hodgkin’s Lymphoma
Hodgkin’s lymphoma in children and adolescents that does not respond to
treatment can be divided into 3 groups: refractory disease (that which does not
respond to treatment), disease that recurs within 1 year of complete remission,
and disease that recurs more than 1 year after complete remission. Most
children with recurrent disease have received previous chemotherapy and
different regimens of radiation therapy. Treatment for recurrent/refractory
disease may include different chemotherapy regimens, peripheral stem cell
transplantation, and/or radiation therapy.
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Changes to This Summary (01/21/2004)
The PDQ cancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Editorial changes were made to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
