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Non-Hodgkin's Lymphoma

Lymphoma is the third most common childhood cancer. It is cancer of the lymphatic system, which is made up of thin tubes that branch like blood vessels into all parts of the body. These lymph vessels carry lymph, a colorless, watery fluid containing white blood cells called lymphocytes. Along the network of vessels are lymph nodes, groups of small bean-shaped organs that make and store infection-fighting cells.

There are clusters of lymph nodes in the underarm, groin, neck and abdomen. The lymph system also includes the spleen, the thymus, and the tonsils. Because the lymph system is so extensive, lymphoma can start in many locations and spread to almost any organ or tissue.

There are two types of lymphoma — Hodgkin's and non-Hodgkin's. The cause for both diseases is unknown and occurs in one child in 10,000.

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Non-Hodgkin's lymphoma occurs between the ages of 7 and 11. It affects boys almost three times more often than girls, and is more common among Caucasian children than among African-Americans and children of other races.

Types of Non-Hodgkin's Lymphoma

There are three major types of childhood non-Hodgkin's lymphomas:

  • Lymphoblastic — Lymphoblastic non-Hodgkin's lymphoma accounts for about 35 percent of lymphoma cases. This condition usually involves the T-cells, though it also can involve B-cells, and usually occurs with a mass in the chest and swollen lymph nodes with or without the involvement of bone marrow and the central nervous system.


  • Small Noncleaved Cell — Small noncleaved cell lymphoma, also referred to as Burkitt's lymphoma, is common in Africa and North America. Burkitt's lymphoma originating in Africa is almost always associated with the Epstein-Barr virus and often occurs with a jaw mass and central nervous system disease. Burkitt's lymphoma originating in North America is rarely associated with Epstein-Barr virus, arises in the abdomen and often spreads to bone marrow.


  • Large Cell or Diffuse Histiocytic — Large cell or diffuse histiocytic non-Hodgkin's involves either the B-cells or T-cells and accounts for about 15 to 20 percent of lymphoma cases. Large cell B cell lymphoma often originates in the abdomen and can spread to the bone marrow and central nervous system. Large cell T cell, also called anaplastic lymphoma, can involve the skin, lymph nodes, lungs, testicles, muscles and gastrointestinal tract.

In many children, non-Hodgkin's lymphoma is already extensive when first diagnosed. About a third of cases originate in the neck or chest, a third in the abdomen and another third elsewhere in the body.

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There is often pain and swelling at the site of the cancer. Other symptoms include:

  • Abdominal bloating
  • Change in bowel habits
  • Fever
  • Sweating, especially at night
  • Weight loss

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Many symptoms of non-Hodgkin's lymphoma could be caused by other conditions such as infections.

Your child's doctor may request a number of diagnostic tests, including:

  • Computed Tomography (CT or CAT) scans — This diagnostic imaging procedure provides detailed images of the body, including the bones, muscles, fat and organs.


  • Positron emission tomography (PET) scans — A PET scan is a nuclear medicine test in which a radioactive compound is injected and shows the areas of malignancy in the body.


  • Biopsy — Biopsy is the removal of a sample of tissue to see whether cancer cells are present, and it is necessary to confirm the diagnosis. There are several kinds of biopsies. Your child's doctor will choose the one best suited for your child. The goal is to get enough tissue to make an accurate diagnosis as quickly as possible with the fewest side effects.
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The primary treatment for non-Hodgkin's disease is chemotherapy, which uses drugs to kill cancer cells and shrink tumors. Radiation therapy, or the use of high-dose X-rays or other high-energy rays to kill cancer cells and shrink tumors, sometimes is used. Bone marrow transplantation is being tested in studies of patients with advanced disease. The prospect for curing children is now about 70 percent overall.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells and shrink tumors. It may be taken orally or may be administered into a vein or muscle by needle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream and can kill cancer cells throughout the body. Chemotherapy also may be injected by needle into the fluid that surrounds the brain or back to treat certain types of lymphoma that spread to the brain.

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Reviewed by health care specialists at UCSF Benioff Children's Hospital.

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