National Cancer Institute


Posted Date: Sep 10, 2002

TABLE OF CONTENTS


Description

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Childhood non-Hodgkin's lymphoma is a disease in which cancer (malignant) cellsare found in the lymphatic system. The lymphatic system is made up of thintubes that branch, like blood vessels, into all parts of the body. Lymphvessels carry lymph, a colorless, watery fluid that contains white blood cellscalled lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in theunderarm, pelvis, neck, and abdomen. The lymph nodes make and store infection-fighting cells. These cells become the cancer (malignant) cells in non-Hodgkin's lymphoma. The spleen (an organ in the upper abdomen that makeslymphocytes and filters old blood cells from the blood), the thymus (a smallorgan beneath the breastbone), and the tonsils (an organ in the throat) arealso part of the lymphatic system.

Because there is lymph tissue in many parts of the body, non-Hodgkin's lymphomacan start in almost any part of the body. The cancer can spread to almost anyorgan or tissue in the body, including the liver, bone marrow (the spongytissue inside the large bones of the body that makes blood cells), and thespleen.

Lymphomas are divided into two general types: Hodgkin's disease and non-Hodgkin's lymphomas. Both of these diseases are treated differently andoccur in both children and adults. (Refer to the PDQ summaries on AdultHodgkin's Disease Treatment; Childhood Hodgkin's Disease Treatment; and AdultNon-Hodgkin's Lymphoma Treatment for more information.)

There are three major types of childhood non-Hodgkin's lymphomas: lymphoblastic lymphoma, small noncleaved cell lymphoma (either Burkitt'slymphoma or non-Burkitt's lymphoma), and large cell lymphoma. The type isdetermined mainly by what the cancer cells look like under a microscope. Theway the cells look under a microscope is called the "histology" of the cancer.

If your child has symptoms, your doctor will examine your child carefully andcheck for swelling or lumps in the neck, underarms, groin, and abdomen. Achest x-ray will usually be done to check for swellings in the chest. If thelymph nodes don't feel normal, or a lump is found in the chest or abdomen, yourchild's doctor may need to cut out a small piece of tissue and look at it underthe microscope to see if there are any cancer cells. This is called a biopsy.

Your child's chance of recovery (prognosis) and choice of treatment depend onthe stage of your child's cancer (whether it is just in one area or has spreadthroughout the body), the type of lymphoma, and your child's age and overallcondition.


Stage Explanation

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Stages of childhood non-Hodgkin's lymphoma

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Once childhood non-Hodgkin's lymphoma is found, more tests will be done to findout if the cancer has spread from where it started to other parts of the body. This is called staging. Your child's doctor needs to know the stage of thedisease to plan treatment.

The following stages are used for childhood non-Hodgkin's lymphoma:


Stage I

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Cancer is found in only one area outside of the abdomen or chest.


Stage II

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    Any of the following mean the disease is stage II:

  • Cancer is found in only one area and in the lymph nodes around it.
  • Cancer is found in two or more lymph nodes or other areas on the same sideof the diaphragm (the thin muscle under the lungs that helps you breathe).
  • Cancer is found to have started in the digestive tract. The lymph nodes inthe area may or may not have cancer.


Stage III

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    Any of the following mean the disease is stage III:

  • Cancer is found in tumors or lymph nodes on both sides of the diaphragm.
  • Cancer is found to have started in the chest.
  • Cancer is found in many places in the abdomen.
  • Cancer is found in the area around the spine, around the outermost coveringof the brain, or on the outermost covering of the brain (these tumors arecalled epidural tumors).


Stage IV

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Cancer has spread to the bone marrow or to the brain and/or the spinal cord.


Recurrent

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Recurrent disease means that the cancer has come back after it has beentreated. It may come back in the area where it first started or in anotherpart of the body.


Treatment Option Overview

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There are treatments for all patients with childhood non-Hodgkin's lymphoma andpatients can be cured. The main treatment used is chemotherapy (using drugs tokill cancer cells and shrink tumors). Radiation therapy (using high-dosex-rays or other high-energy rays to kill cancer cells and shrink tumors) issometimes used in special situations. Bone marrow transplantation is beingtested in clinical trials for certain patients.

Chemotherapy uses drugs to kill cancer cells and shrink tumors. Chemotherapymay be taken by pill, or it may be put into the body by a needle in a vein ormuscle. Chemotherapy is called a systemic treatment because the drugs enterthe bloodstream, travel through the body, and can kill cancer cells throughoutthe body. Chemotherapy may also be put into the fluid that surrounds the brainthrough a needle in the brain or back (intrathecal chemotherapy) to treatcertain types of non-Hodgkin's lymphoma that spread to the brain.

Bone marrow transplantation is a newer type of treatment. Sometimes lymphomacells become resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Becausethe high doses of chemotherapy can destroy the bone marrow, marrow is takenfrom the bones before treatment. The marrow is then frozen and high-dosechemotherapy with or without radiation therapy is given to treat the cancer. The marrow that was taken out is then thawed and given back through a needle ina vein to replace the marrow that was destroyed. This type of transplant iscalled an autologous transplant. If the marrow given is taken from anotherperson, the transplant is called an allogeneic transplant.


Treatment by stage

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Treatment for childhood non-Hodgkin's lymphoma depends on the stage of yourchild's disease, how the cancer cells look under a microscope (the histology),and your child's age and general health.

Your child may receive treatment that is considered standard based on itseffectiveness in a number of patients in past studies, or you may choose tohave your child go into a clinical trial. Not all patients are cured withstandard therapy and some standard treatments may have more side effects thanare desired. For these reasons, clinical trials are designed to test newtreatments and to find better ways to treat cancer patients. Clinical trialsare ongoing in most parts of the country for advanced stages of childhood non-Hodgkin's lymphoma. If you want more information, call the CancerInformation Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


Stage I and II Childhood Lymphoblastic Lymphoma

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Your child's treatment will probably be systemic chemotherapy plus intrathecalchemotherapy.


Stage III and IV Childhood Lymphoblastic Lymphoma

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Your child's treatment will probably be systemic chemotherapy plus intrathecalchemotherapy. Radiation therapy is sometimes given if there is a large mass inthe chest.


Recurrent Childhood Lymphoblastic Lymphoma

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Your child's treatment will depend on where the cancer comes back, the type oftreatment that was given before, and your child's overall condition. Yourchild's treatment may be one of the following:

  1. Allogeneic bone marrow transplantation
  2. Systemic chemotherapy with different drugs than were used before
  3. A clinical trial of new methods of treatment


Stage I and II Childhood Small Noncleaved Cell Lymphoma (includes Burkitt's and non-Burkitt's)

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Your child's treatment will probably be systemic chemotherapy with or withoutintrathecal chemotherapy.


Stage III and IV Childhood Small Noncleaved Cell Lymphoma (includes Burkitt's and non-Burkitt's)

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Your child's treatment will probably be systemic chemotherapy plus intrathecalchemotherapy. Clinical trials are testing new combinations and doses of drugs.


Recurrent Childhood Small Noncleaved Cell Lymphoma (includes Burkitt's and non-Burkitt's)

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Your child's treatment will depend on where the cancer comes back, the type oftreatment that was given before, and your child's overall condition. Yourchild's treatment may be one of the following:

  1. Systemic chemotherapy
  2. Allogeneic or autologous bone marrow transplantation
  3. Systemic chemotherapy plus intrathecal chemotherapy
  4. A clinical trial of new methods of treatment


Stage I and II Childhood Large Cell Lymphoma

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Your child's treatment will probably be systemic chemotherapy with or withoutintrathecal chemotherapy.


Stage III and IV Childhood Large Cell Lymphoma

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Your child's treatment will probably be systemic chemotherapy with or withoutintrathecal chemotherapy. Clinical trials are testing new combinations ofdrugs.


Recurrent Childhood Large Cell Lymphoma

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Your child's treatment will depend on where the cancer comes back, the type oftreatment that was given before, and your child's overall condition. Yourchild's treatment may be one of the following:

  1. Allogeneic or autologous bone marrow transplantation
  2. Systemic chemotherapy with or without intrathecal chemotherapy
  3. A clinical trial of new methods of treatment


To Learn More

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Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

  • NCI Public Inquiries Office
  • Suite 3036A
  • 6116 Executive Boulevard, MSC8322
  • Bethesda, MD 20892-8322


About PDQ

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PDQ is a comprehensive cancer database available on Cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

The PDQ database contains listings of groups specializing in clinical trials.

The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on Cancer.gov or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

The PDQ database contains listings of cancer health professionals and hospitals with cancer programs.

Because cancer in children and adolescents is rare, the majority of children with cancer are treated by health professionals specializing in childhood cancers, at hospitals or cancer centers with special facilities to treat them. The PDQ database contains listings of health professionals who specialize in childhood cancer and listings of hospitals with cancer programs. For help locating childhood cancer health professionals or a hospital with cancer programs, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.


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