A guide to non-Hodgkin’s lymphoma in children

No parent wants to see their child sick, but it can and does happen. Although cancer is a diagnosis no one wants, we know that with early diagnosis – and the many effective therapies available – a cure can be possible.

If your child has recently been diagnosed with non-Hodgkin’s lymphoma (NHL), you may have questions not only about the disease, but also about the types of treatments usually prescribed and how effective they are.

Pediatric non-Hodgkin’s lymphoma (NHL) is a condition that affects your child’s lymph nodes. Although symptoms may appear gradually, the disease can also spread quickly. Keep in mind that symptoms can vary depending on where the cancer is starting to grow.

For example, if the cancer starts in the spine, you may also notice that your child has difficulty walking, weakness in their legs, or may even struggle with incontinence.

Symptoms in Babies

  • night sweats
  • unexplained fevers
  • appetite or weight loss
  • difficulty breathing and coughing
  • belly swelling

Symptoms in children and adolescents

  • swollen lymph nodes – usually starting in the neck, chest, armpits or groin
  • cough and shortness of breath – if swollen glands are found in the neck and chest
  • fevers
  • Rashes
  • decreased appetite
  • paler skin – this symptom may not be apparent depending on the child’s skin tone
  • stomach pain – if NHL starts in the abdomen
  • change in stool – also if NHL starts in the abdomen

One of the best ways to catch NHL early is to be aware of the symptoms and take action if you suspect something is wrong with your child. Since it is not a common childhood cancer, there are no widely recommended screening tests to detect NHL.

However, the diagnosis will usually begin with a medical history and physical exam. Sometimes NHL is diagnosed through a process of elimination. While swollen lymph nodes are the biggest contributing symptom of NHL, several curable diseases or illnesses like a simple infection can also cause this symptom to appear.

Biopsy

It’s not uncommon for doctors to start by trying to treat swollen glands with antibiotics. In fact, infection is usually the most common cause of swollen lymph nodes in children. But if the lymph nodes do not respond to treatment, further tests may be recommended, including a biopsy to determine the cause of the swollen nodes.

The speed of diagnosis will also depend on how quickly the nodes grow. Likewise, if a child’s health seems to be deteriorating, doctors will speed up the diagnostic process. Also, the type of biopsy performed will depend on the location of the swollen lymph nodes. But the most common methods are surgical biopsy and bone marrow biopsy.

Additional tests

While biopsies are an essential part of the diagnostic process, other tests may be performed. This may include several tests to find potential hidden areas of abnormal growth, such as:

In addition, your child may undergo an ECG-Echo (electrocardiogram and echocardiogram) and a pulmonary function test to determine heart and lung function before starting treatment.

Determining the right treatment depends on the type of NHL the child has. This is why biopsies are important so that the type can be accurately identified. The type of NHL depends on the type of lymphocyte (white blood cell) where the cancer starts to grow.

NHL in children is usually quite different from NHL in adults. However, childhood lymphoma is considered more aggressive due to how quickly the cancer can grow and spread.

There are four main types of NHL in children:

Steps

In the case of cancer, stage refers to the progress or amount of cancerous tumors detected when the disease was first diagnosed. The NHL is divided into four stages with one being the lowest and four being the most advanced. Stage one and two lymphomas are called limited stage while three and four are considered advanced stage.

  • Stage I: Lymphoma is only present in one place, such as a tumor, or located in one part of the body, and is not present in the chest or abdomen.
  • Stage 2: Lymphoma is in an area outside the lymph nodes and in nearby lymph nodes, or it can be in two or more areas above or below the diaphragm and spread to nearby lymph nodes. Also, there may be a tumor in the digestive tract that can be removed with surgery.
  • Stage III: The lymphoma may have started in the chest. The tumor may have started in the abdomen, but spread too far to be easily removed with surgery. The tumor may be near the spine or there may be more than one tumor present outside the lymph nodes. Additionally, the tumor may have spread widely to groups of lymph nodes above and below the diaphragm. Or, the tumor is present in the bone and potentially in a nearby area.
  • Stage IV: The lymphoma has spread to the central nervous system – either in the brain or the spinal cord – or the bone marrow.

Keep in mind that treatment may vary depending on the type and stage of NHL your child has.

However, chemotherapy is usually the main treatment. Some children may also be prescribed a combination of not only chemotherapy, but also drugs and steroids. If medications or steroids are recommended, the prescription will depend on the type and stage of cancer your child has.

Sometimes surgery can also be used to remove tumors, and in rare cases a child may have radiation therapy. Also, if a child has recurrent lymphoma, they may need more intensive chemotherapy and even a stem cell transplant.

Treatment delays vary considerably depending on on the type and stage of the cancer. Occasionally, clinical tests are also recommended in the treatment of relapsed NHL, to allow your child to benefit from the most advanced treatments available.

Although the thought of childhood cancer is frightening, know that NHL has a high prognosis rate for children. Oncologists don’t usually speak in terms of general success rates, but rather 5-year survival rates. This means that a child survived 5 years after completing treatment.

Although individual prognoses depend on the type and stage of your child’s cancer, treatment success rates are around 80-90% for all types. Stage I and II NHLs have the highest success rates, over 90%, while Stage III and IV NHLs range from 80-90%.

Cancer is a traumatic experience for both patient and family. But for parents, having a child with cancer can be particularly difficult, especially if they are young. In addition to trying to keep them informed in an age-appropriate way, parents should also deal with the emotional roller coaster associated with the whole process, from diagnosis to treatment.

In addition to remembering that children are inspired by their parents, it is important to have a strong support group. Check out some of these organizations for more resources:

Be prepared for your child to experience side effects from treatment. This can range from hair loss to weight loss, pain or discomfort from medications and loss of appetite. Take the time to talk with your child about these side effects before they happen, so you have a plan ready if they do occur.

Don’t forget to take the time to have fun, both for yourself and for your child(ren). Taking a moment to relax can help reset the mind and take the focus away from cancer treatment. And don’t be afraid to seek therapy for your child and yourself.

Cancer is a scary prospect, but even more so when diagnosed in a child. While non-Hodgkin’s lymphoma tends to be more aggressive in children than in adults, there are proven treatment options that, even in later stages, offer a promising prognosis with 5-year survival rates as high as 90%.

Taking a proactive approach to having your child diagnosed and establishing a personalized treatment plan is the best course of action. But remember to have a strong support group around you and your family as you navigate the process.

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