Non-Hodgkin lymphoma (paediatric)

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.

In this section

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.

Treatment of non-Hodgkin lymphoma

Treatment for non-Hodgkin lymphoma (NHL) in children mainly involves chemotherapy. The exact plan depends on the type, stage and response to treatment.

Chemotherapy

A combination of chemotherapy drugs is used to destroy the cancer cells. The treatment may last a few months or years. The exact combination and length of treatment depends on the type and stage of lymphoma. Chemotherapy may be given by injections or a drip into a vein (intravenous infusion).

NHL may sometimes affect the central nervous system. To stop this happening chemotherapy is injected into the spinal fluid during a lumbar puncture. This treatment is known as intrathecal chemotherapy and is given at regular time intervals during your child’s treatment.

High-dose chemotherapy with stem cell transplant is sometimes used if the lymphoma comes back after initial treatment.

Radiotherapy

Radiotherapy is rarely used to treat NHL. If your child needs radiotherapy your doctor will explain why. More information is available in the Children’s Unit booklet called Radiotherapy treatment.

Surgery

Occasionally, enlarged glands in the abdomen may cause a blockage of the bowel, which may need an operation to relieve it.

Clinical trials

If your child takes part in a clinical trial, the treatment will be 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’.

Effects of treatment

The prognosis for non-Hodgkin lymphoma is good and the majority of children are cured.

Long-term effects

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

Some children, particularly boys, may have reduced fertility after 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.