The Pediatric Leukemia and Lymphoma Program at the Cancer Center at The Children's Hospital of Philadelphia consists of a multidisciplinary team of experts in treating non-Hodgkin's lymphoma. Many of our oncologists are also on the forefront of researching new therapies and advances in the treatment of this type of cancer.
The term lymphoma refers to a group of cancers of the lymph system. The lymph system is made up of vessels throughout the body that carry lymph (the colorless fluid from body tissue) as well as organs such as lymph nodes, the spleen and the thymus. These tissues produce and store infection-fighting cells. Certain parts of other organs such as the tonsils, stomach, small intestine and skin are also part of the lymph system.
In children, non-Hodgkin's lymphoma is classified as one of the following:
Non-Hodgkin's lymphoma (NHL) may arise almost anywhere in the body. In NHL, immature lymphocytes grow out of control and fail to mature. They accumulate in lymph nodes, spleen and lymph tissues of the small intestines or the thymus gland (located in the middle of the upper chest). This is why, if diagnosed with lymphoma, your child may have swollen lymph glands or a swollen abdomen.
In addition, these lymphoma cells may be present in the spinal fluid (the fluid that surrounds the brain and the spinal cord). Cells here can be detected by examining the spinal fluid after doing a spinal tap. Also, in boys, lymphoma cells can hide in the patients testes, causing the testes to become swollen. The disease may also involve the bone marrow and behave like acute leukemia. We do not know what causes lymphoma. It is not inherited and nothing you have done or not done is responsible for your child's cancer.
Non-Hodgkin's lymphoma can occur at any time during life. Lymphomas, both NHL and Hodgkin's lymphoma, are the third most common cancer in children. Younger children are more likely to be diagnosed with NHL, while adolescents are more commonly diagnosed with Hodgkin's lymphoma.
Non-Hodgkin's lymphoma is usually a disease of rapid onset and progression. Symptoms vary depending on what group of lymph nodes is affected. The original site of disease is sometimes hard to determine. The most common original site is in the abdomen, and the next most common site is in the chest. Some children only have initial disease in the lymph glands of their neck or groin. The first symptoms in your child may be large swollen glands in the neck, chest, under the arms or in the groin. Swollen lymph glands in the neck and chest may cause a cough, shortness of breath, wheezing or a swelling in the face.
When NHL arises in the abdomen, early symptoms may include stomach pain, a change in bowel habits or a mass (tumor) in the abdomen. Rarely, lymphomas arise in the bone or in other areas of the body.
In some cases, NHL is found in a single node or a single patch of lymphoid tissue in an organ. But in some cases it has begun to spread before being detected. Since Non-Hodgkin's lymphoma can spread (metastasize) to other areas of the body, your child will need to undergo a number of tests to detect any spread of the disease so it can be treated.
Your child will undergo several or all of the following diagnostic tests to establish a diagnosis:
The treatment of Non-Hodgkin's lymphoma depends on the child, the extent of the tumor and the results of studies sent on tumor tissue.
After the diagnosis of NHL is made and all of the tests are complete, we will know how extensive the cancer is, or what stage it is in. Members of the oncology team will discuss the results with you at a family meeting and your child's doctor will discuss the treatment plan for your child.
Your child's treatment plan may come from a National Cooperative Study used around the country based on your child's diagnosis. Treatment may consist of chemotherapy (drugs that kill cancer cells) and sometimes radiation therapy. You will be given a roadmap (a treatment schedule for your child). We will help you learn about the different chemotherapy drugs that will be given to your child. If indicated, you will be given information about radiation therapy as well.
Your child's chemotherapy will be given during an inpatient hospital stay and sometimes in the Oncology Outpatient Clinic. Radiation treatments will be given on an outpatient basis, usually at the Hospital of the University of Pennsylvania (next door to Childrens Hospital). Follow-up studies on bone marrow, lumbar punctures and scans will be repeated at intervals during treatment and for a specific period following treatment. We will attempt 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 your child's disease, its treatment and how to care for his/her special needs at home.
Although Non-Hodgkin's lymphoma is a disease that is serious and potentially life threatening (as are all forms of cancer), much success has been seen with the treatment of your child's disease.
Some children treated for non-Hodgkin's lymphoma may 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.
Reviewed by: Leslie Kersun, MD, MSCE, The Children's Hospital of Philadelphia
Date: November 2009
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