Hodgkin lymphoma (paediatric)

Hodgkin lymphoma is a cancer of the lymph glands. It is named after the man who first described it, Dr Thomas Hodgkin, in 1832. 

In this section

The lymphatic system is made up of the lymph nodes (glands), thymus, spleen and bone marrow.

Who gets Hodgkin lymphoma?

About 60 children develop Hodgkin lymphoma in the UK each year. It is rare in children under five years and is more common in teenagers and young adults. Boys and girls are equally affected. The exact cause of Hodgkin lymphoma is unknown. We see it more often in children with immune problems.

Signs and symptoms

The most common symptom is painless swelling of one gland or a group of glands, usually in the neck. Other glands may be enlarged, such as in the armpit or groin.

Other symptoms include:

  • fever
  • night sweats
  • weight loss
  • tiredness or lethargy
  • itching
  • cough or breathlessness.

Tests / investigations

We 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 – these will tell us how well the kidneys are working as well as some other information about general health.
  • Chest X-ray – this will tell us whether the glands in the chest are enlarged.
  • Ultrasound scan – this will tell us whether the liver and spleen are enlarged.
  • CT scan – a scan of your child’s neck, chest and abdomen will be carried out. This will give us more detailed information about which glands are enlarged and if the liver, spleen or lungs are affected.
  • Biopsy – this is a small operation, usually carried out under general anaesthetic, to remove either part, or all, of a swollen lymph gland.

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 of the most appropriate treatment. The following describes the staging system we use for Hodgkin lymphoma:

  • Stage I: One group of lymph glands is affected and the lymphoma is only on one side of the diaphragm (the breathing muscle that separates the lungs from the abdomen).
  • Stage II: Two or more groups of lymph glands are affected and the lymphoma is only on one side of the diaphragm.
  • Stage III: Lymph nodes are affected above and below the diaphragm. The spleen may also be affected.
  • Stage IV: The lymphoma has spread beyond the lymph glands, for example to the lungs, liver or bone marrow.

The stage is classified as A if your child does not have fever, night sweats or weight loss, or B if these symptoms are present.

Treatment of Hodgkin lymphoma

Treatment for Hodgkin lymphoma involves chemotherapy, radiotherapy or a combination of both. This depends on the type, stage and response to treatment.

Chemotherapy

A combination of chemotherapy (anti-cancer) drugs is used to destroy the cancer cells. The treatment is normally given every few weeks. The exact combination and number of courses depends on the type and stage of Hodgkin lymphoma.

If your child takes part in a ‘clinical trial’, the treatment is explained in more detail in the specific trial information sheet. An outline of the treatment will be provided in the form of a ‘road map’.

Radiotherapy

Your child may have radiotherapy if the lymphoma is confined to one area or if there is some tumour left after chemotherapy. See the Children’s Unit booklet Radiotherapy treatment for more details about this type of treatment.

Clinical trials

Clinical trials are medical research trials involving patients that are carried out to try and find new and better treatments. In cancer, clinical trials are most commonly used to try and improve different forms of treatment such as surgery, radiotherapy or chemotherapy.

The treatment being tested may be aimed at:

  • improving the number of people cured (for example, trying new types of surgery or chemotherapy)
  • improving survival
  • relieving symptoms of the cancer
  • relieving the side effects of treatment
  • improving the quality of life or sense of wellbeing for people with cancer.

Clinical trials may also involve research aimed at understanding more about the tumour’s biology. You may be asked to allow us to do research on the tumour sample removed at surgery, or on blood samples.

Well-run clinical trials have led to a significant improvement in the treatment of children with cancer. You can find more general information on clinical trials in the separate information sheet. If you are asked to consider entering your child into a clinical trial you will be given specific information about the trial before deciding whether to take part.

Effects of treatment

The prognosis is good and most children with Hodgkin lymphoma are cured.

General side effects of chemotherapy

Bone marrow suppression (myelosuppression)

Chemotherapy drugs decrease the production of blood cells by the bone marrow for a variable period of time. This results in low red blood cells (anaemia), low white blood cells (neutropenia) and platelets (thrombocytopenia). Your child may need blood or platelet transfusions and will be at increased risk of infections. The doctors and nurses caring for your child will tell you more about these side effects.

Nausea and vomiting

Some of the chemotherapy drugs used may make your child feel sick or vomit. We will give anti-sickness drugs at the same time to stop nausea and vomiting. These are usually very effective.

Hair loss

Temporary hair loss is common.

Specific drugs

For details of the side effects of individual drugs please see Macmillan specific drug information leaflets.

What are the possible long-term effects of treatment?

A small number of children develop side effects many years later because of the treatment they have received. These include growth problems, impaired heart and lung function and a small risk of developing a second cancer later in life.

Some children, particularly boys, may have impaired fertility after the treatment. Teenage boys can choose to store sperm for use in later years.

Your child will be followed up in the outpatient department and then transferred to the long-term follow-up clinic after about five years.