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Table of Contents General Information About Childhood Hodgkin Lymphoma
Stages of Childhood Hodgkin Lymphoma
Primary Progressive/Recurrent Hodgkin Lymphoma in Children and Adolescents
Treatment Option Overview
Treatment Options for Children and Adolescents with Hodgkin Lymphoma
Treatment Options for Primary Progressive/Recurrent Hodgkin Lymphoma in Children and Adolescents
Late Effects from Childhood and Adolescent Hodgkin Lymphoma Treatment
To Learn More About Childhood Hodgkin Lymphoma
Get More Information From NCI
Changes to This Summary (11/10/2008)
About PDQ
General Information About Childhood Hodgkin Lymphoma
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Childhood Hodgkin lymphoma is a disease in which malignant
(cancer) cells form in the lymph system.
Childhood Hodgkin lymphoma is a type of cancer that develops in the lymph system, part of the body's immune system.
The lymph system is made up of the following:
- Lymph: Colorless,
watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the
body against infections and the
growth of tumors.
- Lymph vessels: A network of thin tubes that collect lymph
from different parts of the body and return it to the bloodstream.
- Lymph nodes:
Small, bean-shaped structures that filter lymph and store white blood cells that help fight
infection and disease. Lymph nodes are located along the network of lymph vessels
found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
- Spleen: An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys
old blood cells. The spleen is on the left side of the abdomen near the stomach.
- Thymus: An organ
in which lymphocytes grow and multiply. The thymus is in the chest behind the
breastbone.
- Tonsils: Two small
masses of lymph tissue at the
back of the throat. The tonsils make lymphocytes.
- Bone marrow: The
soft, spongy tissue in the center of large bones. Bone marrow makes white
blood cells, red blood cells, and platelets.
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| Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart. |
Because lymph tissue is found throughout the body, Hodgkin
lymphoma can start in almost any part of the body and spread to almost any
tissue or organ in the body.
Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin
lymphoma. (See the PDQ summary on Childhood Non-Hodgkin Lymphoma Treatment for more information.)
Hodgkin lymphoma can occur in both children and adults; however,
treatment for children may be different than treatment for adults. (See the
PDQ summary on Adult Hodgkin Lymphoma Treatment for more information.)
There are two types of childhood Hodgkin lymphoma.
The two types of childhood Hodgkin lymphoma are:
Classical Hodgkin lymphoma is divided into four subtypes, based on how the cancer cells look under a microscope:
- Lymphocyte-rich classical Hodgkin lymphoma.
- Nodular sclerosis Hodgkin lymphoma.
- Mixed cellularity Hodgkin lymphoma.
- Lymphocyte-depleted Hodgkin lymphoma.
Age, gender, and Epstein-Barr virus infection can affect
the risk of developing childhood Hodgkin lymphoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for childhood Hodgkin lymphoma include the following:
- Being between the ages of 15 and 19. At these ages, Hodgkin lymphoma is slightly more common in girls than in boys. In
children younger than 5 years, it is more common in boys than in girls.
- Being infected with the Epstein-Barr virus.
- Having a brother or sister with Hodgkin lymphoma.
Possible signs of childhood Hodgkin lymphoma include swollen
lymph nodes, fever, night sweats, and weight loss.
These and other symptoms may be caused by childhood Hodgkin lymphoma or by other conditions. A doctor should be consulted if any of the
following problems occur:
- Painless, swollen lymph nodes in the neck, chest, underarm, or groin.
- Fever.
- Night sweats.
- Weight loss for no known reason.
- Itchy skin.
Tests that examine the lymph system are used to detect (find) and diagnose
childhood Hodgkin lymphoma.
The following tests and procedures may be used:
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend
on the following:
- The stage of the cancer.
- The size of the tumor and how quickly it shrinks after initial treatment.
- The patient's symptoms when diagnosed.
- Certain features of the cancer cells.
- Whether the cancer is newly diagnosed, does not respond to initial treatment, or has recurred (come back).
The treatment options also depend
on:
- The child's age and gender.
- The risk of long-term side effects.
Most children and adolescents with newly diagnosed
Hodgkin lymphoma can be cured.
 Back to Top Stages of Childhood Hodgkin Lymphoma
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After childhood Hodgkin lymphoma has been diagnosed,
tests are done to find out if cancer cells have spread within the lymph
system or to other parts of the body.
The process used to find out if cancer has spread within the lymph
system or to other parts of the body is called staging. The information gathered from the staging
process determines the stage of the
disease. Treatment is based on the stage and other factors that affect prognosis. The following tests and procedures may be used in the staging process:
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). An MRI of the abdomen and pelvis may be done.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.
| Enlarge | | | | Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope. |
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The letters "E" and "S" may be used to describe the stages of childhood Hodgkin lymphoma.
- E: Cancer is found in an organ or tissue that is not part of the lymph
system but which may be next to an involved area of the lymph system.
- S: Cancer is found in the spleen.
The following stages are used for childhood Hodgkin lymphoma:
Stage I
Stage I is divided
into stage I and stage IE.
Stage II
Stage II is divided
into stage II and stage IIE.
Stage III
Stage III is divided
into stage III, stage IIIE, stage IIIS, and stage
IIIE+S.
Stage IV
In stage IV, cancer is found throughout one or more organs or tissues that are not part of the lymph system and may be in lymph nodes that are near or far away from those organs.
Untreated, classical Hodgkin lymphoma is divided into risk groups.
Untreated, classical childhood Hodgkin lymphoma is divided into risk groups based on the bulk of the tumor (tumors that are 5 centimeters or larger are considered "bulky") and whether the patient has "b" symptoms (fever, weight loss, or night sweats). Treatment is based on the risk group.
- Low-risk disease:
- Patients with stage I or stage II disease; and
- No bulky tumors or "b" symptoms.
- Intermediate-risk disease:
- Patients with stage I or stage II disease, with bulky tumors, or with "b" symptoms; or
- Patients with stage III or stage IV disease without "b" symptoms.
- High-risk disease: Patients with stage III or stage IV disease with "b" symptoms.
After initial chemotherapy, a PET scan may be done.
A PET scan may be done after one or two cycles of chemotherapy and again after chemotherapy ends, to find out how well the chemotherapy worked.
Back to Top Primary Progressive/Recurrent Hodgkin Lymphoma in Children and Adolescents
Primary progressive Hodgkin lymphoma is lymphoma that continues to grow or spread during treatment. Recurrent Hodgkin lymphoma is cancer that has recurred
(come back) after it has been treated. The lymphoma may come back in the lymph system or in other parts of the body, such as the lungs, liver, bones, or bone marrow.
Back to Top Treatment Option Overview
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There are different types of treatment for children with
Hodgkin lymphoma.
Different types of treatment are available for children with Hodgkin lymphoma. Some treatments are standard and some are being tested in clinical
trials. A treatment clinical trial is a research study meant to
help improve current treatments or obtain information on new treatments for
patients with cancer. When clinical
trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial
should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with Hodgkin lymphoma should have their treatment
planned by a team of health care providers with expertise in treating childhood
cancer.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes
in treating children with cancer. The pediatric oncologist works with
other pediatric health care providers who are experts in treating children
with Hodgkin lymphoma and who specialize in certain areas of medicine. These
may include the following specialists:
Two types of standard treatment are used:
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web
site.
High-dose chemotherapy with stem cell
transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Surgery
Surgery may be done to remove as much of the tumor as possible.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
After one or two cycles of chemotherapy for childhood Hodgkin lymphoma, a PET scan may be done to see how well the lymphoma is responding to treatment. Re-staging is done after chemotherapy ends.
Back to Top Treatment Options for Children and Adolescents with Hodgkin Lymphoma
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Low-Risk Childhood Hodgkin Lymphoma
Treatment of low-risk childhood Hodgkin lymphoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I childhood Hodgkin lymphoma and stage II childhood Hodgkin lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Intermediate-Risk Childhood Hodgkin Lymphoma
Treatment of intermediate-risk childhood Hodgkin lymphoma may
include the following:
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