Non-Hodgkin lymphoma
Non-Hodgkin lymphoma (NHL) is a cancer of the lymph glands. The lymphatic system is made up of the lymph nodes (glands), thymus, spleen and bone marrow. Cancers that develop in the lymphatic system are called lymphomas.
There are three main types of non-Hodgkin lymphoma: lymphomblastic lymphoma, small non-cleaved lymphoma and large cell lymphoma. The type of NHL depends on what the cancer cells look like under a microscope.
Most NHLs in children are high-grade or fast growing and need intensive treatment.
Who gets non-Hodgkin lymphoma?
About 80 children develop NHL in the UK each year. It can develop at any age and is slightly more common in boys. It is more common in children with weak immune systems.
Signs and symptoms
The first sign is often painless swelling of a group of lymph glands. Other symptoms include:
- cough
- breathlessness
- swelling of the face
- abdominal (tummy) swelling
- tiredness or lethargy
- weight loss
- poor appetite
- fever.
Tests and investigations
Your doctors will need to carry out some tests to find out as much as possible about the type, position and size of the tumour. These tests will include:
- blood tests to show how well the kidneys are working as well as information about general health
- chest X-ray to show whether the glands in the chest are enlarged
- ultrasound scan to show whether the liver and spleen are enlarged
- CT scan to give more detailed information about which glands are enlarged and if the liver, spleen or lungs are affected
- biopsy, a small operation, usually carried out under general anaesthetic, to remove either part or all of a swollen lymph gland
- bone marrow aspirate and trephine to show whether the lymphoma has spread to the bone marrow
- lumbar puncture to show whether there are any lymphoma cells in the spinal fluid.
Staging
Staging refers to the size and position of the lymphoma and whether it has spread. Knowing the particular type and stage of the cancer helps the doctors decide on the most appropriate treatment. The following describes the staging system used for NHL:
- Stage I: one group of lymph glands is affected or there is a single tumour outside of the lymph glands (extra nodal)
- Stage II: two or more groups of lymph glands are affected or there are two extra nodal tumours, but only on one side of the diaphragm
- Stage III: lymphoma is present on both sides of the diaphragm, either in two or more groups of lymph glands or two single extra nodal tumours
- Stage IV: the lymphoma has spread beyond the lymph glands to other organs such as the bone marrow or nervous system.