Hodgkin lymphoma - children
Lymphoma - Hodgkin - children; Hodgkin disease - children; Cancer - Hodgkin lymphoma - children; Childhood Hodgkin lymphoma
Hodgkin lymphoma is cancer of lymph tissue. Lymph tissue is found in the lymph nodes, spleen, tonsils, liver, bone marrow, and other organs of the immune system. The immune system protects us against diseases and infections.
This article is about classical Hodgkin lymphoma in children, the most common type.
Did you ever touch your neck and feel a bump on one or both sides? Usually, it's just a swollen gland or lymph node that's caused by a cold or other infection. But occasionally, swollen lymph nodes can be a sign of cancer, perhaps a cancer called Hodgkin's lymphoma. These are your lymph nodes. You'll find them not only on your neck, but in your armpits and groin too. They're a part of your body's normal defense system, which protects you against invading viruses and bacteria. Hodgkin's lymphoma is a type of cancer that starts inside the lymph nodes. What causes Hodgkin's lymphoma isn't known, but having the Epstein-Barr virus or HIV may increase your risk. So, what are the signs of Hodgkin's lymphoma? In addition to having swollen lymph nodes, you may feel tired and have no appetite. Some people wake up in the middle of the night soaked in sweat. That's called night sweats. Remember, though, that these symptoms can occur with many different conditions. So if you have them, don't panic. But do see your doctor, who can tell you for sure what's causing your symptoms. If your doctor suspects that you have Hodgkin's lymphoma, your doctor will probably cut and remove a small piece of tissue from your lymph node, called a biopsy, and the samples will be sent to a lab to look for cancer cells. If cancer is diagnosed, other tests are used to stage it, in other words, to see whether the disease has spread, and if so, how far it's spread. That helps your doctor find the right treatment. If you have Hodgkin's lymphoma, most often the treatment involves radiation therapy, chemotherapy, or a combination of both. People who don't respond to these treatments sometimes need a bone marrow transplant. While you're being treated for Hodgkin's lymphoma, you may need other therapies to help you feel better. That might include antibiotics to fight an infection or a blood transfusion to add red blood cells when they're low. Getting diagnosed with any type of cancer can be difficult to hear. But you should know that Hodgkin's lymphoma is one of the most curable types of cancer. Even if the disease has spread, your chances of survival are very high. You can improve your odds by following the entire treatment plan. Once your lymphoma has been treated, you'll need to see your doctor regularly for check-ups to make sure the cancer hasn't returned, and to monitor for any side effects your treatment may have caused.
In children, Hodgkin lymphoma is more likely to occur between ages 15 to 19 years. The cause of this type of cancer is unknown. But, certain factors may play a role in Hodgkin lymphoma in children. These factors include:
- Epstein-Barr virus, the virus that causes mononucleosis
- Some diseases where the immune system does not work well
- Family history of Hodgkin lymphoma
Common early childhood infections also may increase the risk.
Symptoms of Hodgkin lymphoma include:
- Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
- Unexplained fever
- Unexplained weight loss
- Night sweats
- Loss of appetite
- Itching all over the body
Exams and Tests
The health care provider will take your child's medical history. The provider will do a physical exam to check for swollen lymph nodes.
The provider may perform these lab tests when Hodgkin disease is suspected:
- Blood chemistry tests - including protein levels, liver function tests, kidney function tests, and uric acid level
- ESR ("Sed rate")
- Complete blood count (CBC)
- Chest x-ray, which often shows signs of a mass in the area between the lungs
A lymph node biopsy confirms the diagnosis of Hodgkin lymphoma.
If a biopsy shows that your child has lymphoma, more tests will be done to find out how far the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up.
Immunophenotyping is a laboratory test used to identify cells, based on the types of antigens or markers on the surface of the cell. This test is used to diagnose the specific type of lymphoma by comparing the cancer cells to normal cells of the immune system.
You may choose to seek care at a children's cancer center.
Treatment will depend on the risk group your child falls into. Other factors that will be considered include:
- Your child's age
- Treatment side effects
Your child's lymphoma will be grouped as low-risk, intermediate-risk, or high-risk based on:
- The type of Hodgkin lymphoma (there are different forms of Hodgkin lymphoma)
- The stage (where the disease has spread)
- Whether the main tumor is large and classified a "bulk disease"
- If this is the first cancer or if it has come back (recurred)
- The presence of fever, weight loss, and night sweats
Chemotherapy is most often the first treatment.
- Your child may need to stay in the hospital at first. But the chemotherapy drugs are typically given in a clinic, and your child will still live at home.
- Chemotherapy is given into the veins (IV) and sometimes by mouth.
Your child may also receive radiation therapy using high-powered x-rays at cancer-affected areas.
Other treatments may include:
- Targeted therapy that uses drugs or antibodies to kill cancer cells
- High-dose chemotherapy may be followed by stem cell transplant (using your child's own stem cells)
- Surgery is not commonly used to remove this type of cancer, but may be needed in rare cases
Having a child with cancer is one of the hardest things you will ever deal with as a parent. Explaining what it means to have cancer to your child will not be easy. You will also need to learn how to get help and support so you can cope more easily.
Having a child with cancer can be stressful. Joining a support group where other parents or families share common experiences may help ease your stress.
- Leukemia and Lymphoma Society --
- The National Children’s Cancer Society --
Hodgkin lymphoma is curable in most cases. Even if this form of cancer returns, chances of a cure are good.
Your child will need to have regular exams and imaging tests for years after treatment. This will help the provider check for signs of the cancer returning and for any long-term treatment effects.
Treatments for Hodgkin lymphoma may have complications. Side effects of chemotherapy or radiation therapy may appear months or years after treatment. These are called "late effects." It is important to talk about treatment effects with your health care team. What to expect in terms of late effects depends on the specific treatments your child receives. The concern of late effects must be balanced by the need to treat and cure the cancer.
Continue to follow up with your child's doctor to monitor and help prevent these complications.
When to Contact a Medical Professional
Contact your provider if your child has swollen lymph nodes with a fever that stays for a long time or has other symptoms of Hodgkin lymphoma. Call your child's provider if your child has Hodgkin lymphoma and has side effects from the treatment.
American Society of Clinical Oncology (ASCO) website. Lymphoma - Hodgkin - childhood.
Hochberg J, Goldman SC, Cairo MS. Lymphoma. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 523.
National Cancer Institute website. Childhood Hodgkin lymphoma treatment (PDQ) - health professional version.
Last reviewed on: 7/21/2020
Reviewed by: Adam S. Levy, MD, Division of Pediatric Hematology/Oncology, The Children's Hospital at Montefiore, Bronx, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 02/23/2021.