About Childhood Non-Hodgkin Lymphoma (NHL)
Non-Hodgkin Lymphoma (NHL) is a specific type of cancer that begins in the body’s immune system, in cells known as lymphocytes. While there are a variety of different classifications of NHL—usually based on key features such as the size, shape, and growth pattern of the cancerous cells—most children are diagnosed with one of three distinct types of NHL (the other types are mainly diagnosed in adults). While all three types of childhood NHL are considered “high grade” (growing aggressively) and diffuse, they are all treated somewhat differently.
The three types of Non-Hodgkin Lymphoma in children are:
- Lymphoblastic lymphoma (LBL): LBL begins in very young lymphocytes known as lymphoblasts, similar to acute lymphoblastic leukemia (ALL). In most cases, LBL develops from T cells (precursor T-lymphoblastic lymphomas) in the thymus, but occasionally in the tonsils or lymph nodes. B-cell NHL (precursor B-lymphoblastic lymphomas) can develop in lymph nodes in the chest or neck. LBL is an aggressive, quickly growing cancer that can cause breathing problems.
- Burkitt lymphoma (small, non-cleaved cell lymphoma): Burkitt lymphoma accounts for about 40% of all childhood NHL diagnoses in the United States (primarily in boys between the ages of 5-10). In most cases, Burkitt lymphoma starts in the abdomen. In certain parts of Africa, Burkitt lymphoma accounts for nearly all NHL diagnoses and more than 50% of all childhood cancers, and usually forms in the jaw or face. Burkitt lymphoma is one of the fastest-growing cancers and must be treated quickly and aggressively.
- Large cell lymphomas: Large cell lymphomas grow from more mature T or B cells. While this type of lymphoma can develop almost anywhere, it grows more slowly than other lymphomas and is unlikely to spread into the bone marrow or the brain. It is more common in older children and teens. There are two main subtypes: anaplastic large cell lymphoma (ALCL) and diffuse large B-cell lymphoma (DLBCL).
Detection and Diagnosis of Non-Hodgkin Lymphoma
In most cases, diagnosis of non-Hodgkin lymphoma in children comes when a parent or guardian notices unusual symptoms of illness or concern. Although in most cases, these types of symptoms are caused by any number of common childhood illnesses or infections, if your child’s pediatrician believes that lymphoma or another type of cancer may be present, he or she will recommend that you visit an oncologist or other specialist for further diagnostic testing. In most cases, NHL will be diagnosed and classified with a biopsy, in which some or all of the cancerous cells are surgically removed and examined under a microscope.
Childhood NHL can cause a variety of signs and symptoms of illness, usually stemming from where in the body the cancer is growing. Some of the most common symptoms of NHL include:
- Enlarged lymph nodes (lumps under the skin that can be seen or felt) usually in the neck, underarm, collar bone, or groin. They are generally not painful (unlike enlarged lymph nodes resulting from infection).
- Swollen abdomen caused by a tumor in or near the belly or a build-up of fluid because of a tumor. Other signs that of a lymphoma in the abdomen include feeling full after consuming only a small amount of food, pain, nausea, and/or vomiting.
- Shortness of breath or cough caused by a lymphoma growing in the thymus or lymph nodes in the chest.
- Swelling in the face, neck, arms, and upper chest may be caused by a lymphoma pressing on artery and veins near the heart, such as the superior vena cava. Other symptoms of so-called SVC syndrome include trouble breathing, headaches, dizziness, and loss of consciousness.
In addition, NHL can cause so-called B symptoms, which are generalized symptoms but often indicate the presence of an aggressive and quickly-growing lymphoma. B symptoms include:
- Fever and/or chills
- Unexplained weight loss
- Night sweats
- Fatigue (feeling very tired)
Finally, NHL may create symptoms stemming from too few health blood cells (because the lymphoma has spread to the bone marrow and is forcing out healthy blood cells). These symptoms include severe and/or frequent infections, easy bruising and/or bleeding, and fatigue, pale skin, and anemia.
About American Childhood Cancer Organization
American Childhood Cancer Organization (ACCO) is a non-profit charity dedicated to helping kids with cancer and their families navigate the difficult journey from cancer diagnosis through survivorship. Internationally, ACCO is the sole U.S. member of Childhood Cancer International (CCI), the largest patient-support organization for childhood cancer in the world. Here in the United States, ACCO promotes the critical importance of ensuring continued funding into new and better treatment protocols for childhood cancer. And most importantly, ACCO is focused on the children: developing and providing educational tools for children fighting cancer and their families, empowering them in their understanding of childhood cancer and the medical decisions they must make during this difficult journey. All of ACCO’s resources are available free of charge for families coping with childhood cancer.
For additional information about childhood cancer or on ACCO, or to order resources for you or your child, please visit our website at www.acco.org.