Lymphoma in Children

Cancer is still the leading cause of nonaccident-related mortality in children, although the survival rate for childhood cancers in general has improved greatly in the past two decades. Many types of childhood cancers exist, with leukemia being the most common. Another type, lymphomas, account for approximately 10 to 15 percent of childhood malignancies.

Types

• Lymphoma is cancer in the lymphatic (or lymph) system. The lymph system is part of the immune system, and it helps fight off disease and infection. The two most common types of lymphoma in children are Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL), and they are considered the most "curable" of the childhood cancers. 60 percent of childhood lymphomas are classified as NHL, and the rest, HL.

  HL has a bimodal age distribution, meaning there is a peak of incidence among 15 and 40 year olds, and another in individuals over the age of 55. It is more common in males than females, and the Epstein-Barr virus has been linked to HL. There are two main variants of HL--classical Hodgkin's lymphoma, and nodular lymphocyte (the predominant kind).

  NHL is more commonly diagnosed in male children than female. There are three main subtypes of NHL - lymphoblastic NHL, Burkitt's or non-Burkitt's lymphoma, and large cell or diffuse histiocytic NHL - but these are beyond the scope of this article. Almost all pediatric NHL cases are aggressive and high-grade.

Symptoms

• Many patients who are diagnosed with HL have painless, swollen lymph nodes, often in the neck. Approximately 25 percent of children have what are called "B" symptoms, such as severe itching, high fever, night sweats and weight loss. These "B" symptoms are linked to more aggressive disease.

  Symptoms of NHL often have a sudden onset. Common symptoms include night sweats, swollen lymph nodes, sore throat, bone and joint pain, recurring infections and fatigue. Some children have symptoms of an abdominal mass or a chest mass, and have difficulty breathing or constipation.

Diagnosis

• The diagnosis of lymphoma is made by a biopsy of the primary site, blood tests like a complete blood count, sedimentation rate, serum ferritin level, liver and renal profiles, and marrow biopsies. Imaging studies like CT scans may also be used. Lymphoma is staged from Stage I to Stage IV, with associated subtypes.

Treatment and Prognosis

• Surgery, chemotherapy, radiation and immunotherapy may be used in the treatment for HL and NHL. The combination of treatment depends on the type of lymphoma, the subtype, stage, and individual patient characteristics. For patients with HL under the age of 14 years old, the five year survival rate is 95.4 percent, and for those under 20 years of age, the five year survival rate is 95.5 percent. Children under the age of 19 with NHL have a five year survival rate of 84.4 percent.

Future Concerns

• Fertility may be affected by treatment for lymphoma. Depending on the child's age, fertility preservation may be a topic for discussion, or fertility-sparing treatments may be an option. Cancer-related fatigue can also be a long-term effect after treatment, and this should be discussed with one's doctor.