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Childhood Lymphoma

Pediatric lymphoma is a rare type of cancer that affects the immune system in children. Lymphoma happens more often in adults, but is also the third most common form of childhood cancer. At Banner Children's, our caring pediatric cancer experts help your family through it all. Understand more about this disease, including the types, causes, treatments and long-term outlook.

What is childhood lymphoma?

Lymphoma is a type of blood cancer that develops in the lymphatic (lymph) system. 

The lymph system is a network of organs, glands and vessels, including the lymph nodes (lymph glands), spleen and bone marrow. The lymph system is an essential part of the immune system, removing bacteria, viruses and other harmful substances from the body.

The lymph system carries a watery fluid called lymph. Lymph contains white blood cells (lymphocytes) that help fight infections. 

In lymphoma, something goes wrong with your lymphocytes. They don’t work correctly and multiply out of control. These cells can then cause swelling of the glands or other body areas where they are usually found. 

Types of lymphoma

There are two main types of lymphoma: Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). 

While HL is more common in older children and teens, NHL occurs more frequently in younger children. Both types can be found in various parts of the body, including the lymph nodes, bone marrow, tonsils, thymus (a gland in the chest) and spleen. 

Hodgkin’s lymphoma: HL develops in white blood cells and usually contain Reed-Sternberg cells (a type of large-cell cancer). About half of children diagnosed with lymphoma have HL.

HL is divided into two main types:

  • Classical Hodgkin’s lymphoma (CHL) is the most common form of HL. There are four subtypes of CHL (nodular sclerosing, mixed cellularity, lymphocyte rich, and lymphocyte depleted).
  • Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL) is uncommon - only  5% of HL cases are NLPHL.

Non-Hodgkin’s lymphoma: NHL in children behaves differently than it does in adults. It tends to be more aggressive and fast-growing (high grade) and requires intensive therapy. But there is good news: most high grade lymphomas respond well to treatment and often go into remission.

There are a few different types of NHL. These include:

  • Mature B cell lymphoma (MBCL): This type of NHL develops from B cells (a main type of white blood cell). Two different forms of MBCL are Burkitt’s lymphoma and diffuse large B-cell lymphoma.
  • Anaplastic large cell lymphoma: A type of NHL that develops from T cells (the other main type of white blood cell).
  • Primary mediastinal large B-cell lymphoma: A type of NHL typically affecting young adults.

Other slow growing (low grade) lymphomas, such as follicular or marginal cell lymphoma, are rare in children.

What causes childhood lymphoma?

The exact causes of lymphoma in children remain unknown. 

Changes in genes (gene mutations) may be part of the reason. Research is looking into possible causes of this gene mutation and how the immune system may play a role.

Most children diagnosed with lymphoma do not have any known risk factors. However, several factors may increase a child’s risk, including:

  • A weak immune system due to virus infections, medicines that weaken the immune system (immunosuppressive medications) or HIV infection
  • DNA repair abnormalities like Louis-Bar syndrome
  • Having a sibling with lymphoma (although this is very rare)

What are the symptoms of lymphoma?

The symptoms of lymphoma in children can vary based on the disease's type, stage and location. It’s important to note that some symptoms may also be related to other childhood illnesses. 

One of the most common symptoms of lymphoma is swollen lymph nodes (glands). Your child may get painless swelling in their lymph nodes, especially in the neck, armpits and groin area. 

Some swollen glands can press on organs and cause chest pain, coughing, trouble breathing or swallowing or pain in your stomach.

Other symptoms may include:

  • Poor appetite and weight loss
  • Night sweats
  • Fevers with no other symptoms
  • Itchy skin and rashes
  • Feeling tired all the time

Because the disease is rare and symptoms vary, diagnosing lymphoma can sometimes take a while. If these signs continue or get worse, contact your child’s health care provider. If the provider suspects your child may have lymphoma, they’ll act quickly to arrange tests and treatment. 

How is lymphoma diagnosed in children?

Your child will have tests to see if they have lymphoma. If the tests show your child has lymphoma, your provider will complete more tests to figure out the exact type of cancer and the best course of treatment.

In addition to a complete medical history and exam, some of the tests your child may have include:

  • Lymph node biopsy: Your provider may recommend a needle aspiration or incisional or excision (surgical) biopsy. A needle aspiration (suctioning a small amount of tissue through a hollow needle) is performed with local anesthetic when a swollen lymph node is close to the surface. If it is deeper in the body, your child will be put under general anesthesia for a surgical biopsy.
  • Bone marrow biopsy: Bone marrow is removed from the bone by needle aspiration or surgically. 
  • Blood tests: These measure your child’s red blood cells, white blood cells, platelets and hemoglobin levels.
  • Medical imaging and scans: Imaging exams can show where the lymphoma cells are gathering in the body. These tests may include an X-ray, ultrasound, CT and/or PET scan.
  • Lumbar puncture (spinal tap): This test looks to see if the cancer has spread to the central nervous system (brain and spinal cord). A special hollow needle is used to draw out some cerebral spinal fluid, which is then checked for cancer cells.

What are the stages of lymphoma?

Staging is the process of working out which part of the body is affected by cancer and how advanced it is. 

Your child’s cancer team uses the results of tests and scans to determine the stage of your child’s lymphoma. Staging is necessary because it helps plan the most appropriate treatment for your child.

HL and NHL are staged differently in children, but both systems help identify if your child’s lymphoma is “early stage” or “advanced stage.” There are four main stages numbered 1 to 4 (sometimes written in Roman numerals as I, II, III or IV). Stages 1 and 2 are early stages, and stages 3 and 4 are advanced stages. 

How is lymphoma treated in children?

Your child will have a care team at the hospital to support them throughout treatment. The team will explain all treatment options to help you and your child get ready for each phase of treatment.

Treatments will be chosen based on the following:

  • Your child’s age, overall health and medical history
  • The type, stage and location of the lymphoma
  • How well your child tolerates treatments
  • Genetics
  • Your preference

A caring team of specialists, including pediatric oncologists (cancer doctors) and hematologists (blood doctors), radiation oncologists and surgeons will work together to create your child's tailored treatment plan.

Your child’s treatment may include one or more therapies, depending on their needs:

Chemotherapy: Dosages and drugs are chosen based on your child’s age and the type of lymphoma. The medicines can be given by mouth (orally) or through an IV. These drugs target and destroy cells that are growing too fast to stop the cancer from coming back.

Radiation therapy: This treatment uses a beam of intense energy (usually X-rays) to kill cancer cells. Other types of radiation therapy include proton radiation. 

Stem cell transplantation: This procedure replaces abnormal blood-forming cells and/or cells destroyed by chemotherapy with fresh, healthy new blood-forming cells. To do this, matched donor stem cells are given by IV. 

Targeted therapy: This type of therapy is a newer approach to cancer treatment and a major focus of research. These therapies use medications to attack the genes or proteins that help cancer cells grow and divide. Targeted therapy has easier side effects than traditional chemotherapy and may work if chemotherapy does not help.

Immunotherapy: This is a type of treatment that works with your child’s own immune system to fight the cancer. 

Supportive care: Pediatric supportive care helps manage the many physical, emotional, social or spiritual needs your child and family may have during the cancer journey. It helps ease symptoms and side effects and can also help improve treatment outcomes. 

Your child can have supportive care anytime, even during active cancer therapy. Services may include pain management, nutritional support, psychological counseling and educational help.

Learn more about pediatric supportive (palliative) care.

Clinical trials

Ongoing research in childhood lymphoma continues to discover new treatments like targeted therapies and immunotherapies that work better with less side effects.

Banner Children’s is proud to help with this research. Your health care provider can help you learn about lymphoma clinical trials. 

What is the long-term outlook for childhood lymphoma?

The long-term outlook for childhood lymphoma depends on several factors, including the type and stage of lymphoma, response to treatment and the child’s overall health. However, 98% to 99% of children and teens are cured of the disease, meaning they are in permanent remission.

Our expert cancer specialists

Having a child diagnosed or being treated for lymphoma can feel overwhelming for any parent. Our goal is to help your child beat cancer, and our team never forgets that your child is not only a patient, but a kid.

At Banner Children’s, our pediatric cancer specialists are here to bring hope and healing by offering expert care to children of all ages. We are ready to answer your questions and help guide your family toward health.

We offer pediatric oncology services at:

You’re not alone. In addition to our treatment and care options, Banner Health offers many support groups to help you, your child and the rest of your family.