Children's Hospital Colorado

Hodgkin Lymphoma in Children

What is Hodgkin lymphoma?

Lymphomas are cancers that involve a type of white blood cell called a lymphocyte.

Lymphocytes are part of the lymph system, which includes the lymph nodes, spleen, tonsils, liver, thymus and bone marrow. The lymph system is part of the immune system, which helps the body fight infection.

Lymphomas usually occur in areas of the body where lymphocytes typically live, such as the lymph nodes, spleen, thymus and bone marrow.

There are many types of lymphoma, but they are usually divided into two main categories: Hodgkin lymphoma (also called Hodgkin’s disease) and non-Hodgkin lymphoma. Lymphoma types are based on how the cancer cells look under a microscope and how the disease progresses. While Hodgkin's lymphoma can develop at any age, it is very rare in young children and most commonly occurs in teenagers between 15 to 19 years of age.

There are two main types of Hodgkin lympoma: classic Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Classic Hodgkin lymphoma is the most common type.

What causes Hodgkin lymphoma?

In almost all cases, we don’t know what causes the Hodgkin lymphoma to develop. The following may increase the risk:

  • Infection by a virus such as the Epstein-Barr virus, which causes infectious mononucleosis, commonly called “mono”
  • Weak immune system, which may be caused by HIV or medicines that suppress the immune system
  • Family history of Hodgkin lymphoma

What are the signs and symptoms of Hodgkin Lymphoma?

  • Painless swelling of the lymph nodes in the neck or under the arm, or less frequently in the groin area
  • Trouble breathing
  • Cough
  • Chest pain
  • Unexplained fever
  • Poor appetite
  • Unexplained weight loss
  • Night sweats
  • Itchy skin
  • Fatigue

What tests are used to diagnose Hodgkin lymphoma?

Your child’s doctor will do a physical exam to check for swollen lymph nodes in the abdomen, neck or under the arm. The doctor will also order tests to diagnose Hodgkin lymphoma and to see how widespread the lymphoma is within the body if your child does have Hodgkin lymhoma. This process is called tumor staging. Your child may need the following tests:

  • Blood tests are used to check the function of the bone marrow, kidneys and liver and to check for signs of inflammation.
  • Chest X-rays are used to check for any enlarged lymph nodes.
  • An ultrasound uses sound waves to produce pictures of the inside of the body.
  • A CT scan (or CAT scan) gives doctors even more detailed pictures of the inside of the neck, chest, abdomen and pelvis to look for any other sites of disease.
  • An MRI uses magnets to produce detailed images of the body’s organs and structures.
  • A PET scan is used to look for any areas in the body that are using up sugar faster than usual, indicating that they have increased metabolic activity. One characteristic of lymphoma cells is that they have increased metabolic activity, so PET scans are a sensitive way to find any areas in the body where the lymphoma may be hiding.
  • A lymph node biopsy is a minor surgical procedure that we do in the operating room while your child is asleep so that they don’t experience any pain. A pediatric surgeon will take a sample of tissue from the lymph node during the procedure. Usually, your child can go home the same day that the biopsy is done and doesn’t need to stay in the hospital. A pathologist (a doctor who specializes in looking at cells) will look at the tissue under the microscope. Usually, it takes a a couple of days after the biopsy to gather all the information needed to make a diagnosis. In some cases, it may take longer.
  • A bone marrow aspirate and biopsy is an additional test we often do as part of the staging process because the lymphoma cells can also hide in the bone marrow. A small amount (around a teaspoon) of bone marrow is drawn out of the back hipbones through a needle. This procedure is painful, so we almost always do it in the operating room while your child is asleep.
  • Echocardiograms (heart ultrasounds) or pulmonary function tests are sometimes done to know the normal function of the heart and lungs before therapy is initiated.

These scans and tests can be done as an outpatient and usually do not require that your child stay in the hospital. In some cases, your child may need to stay in the hospital for tests. It takes several days to complete all of the tests. We do not start treatment until after the tests are complete so we can select the best treatment course.

How do we diagnose Hodgkin lymphoma?

Once we make a diagnosis, the next important step is tumor staging. Using all the information we collect from testing, our doctors will assign a stage (I to IV) that describes how far the cancer has spread. Staging is important because it helps doctors to plan the most effective treatment. We evaluate if your child has B symptoms, which are symptoms including fever, weight loss, and night sweats. If your child has these symptoms, the stage is followed by a “B” (for example, stage II B). If your child does not have B symptoms, then the stage is followed by an “A.”

  • Stage I (one) means that the lymphoma only involves one lymph node area.
  • Stage II (two) means that the lymphoma involves more than one lymph node area, but all of the disease is either above or below the diaphragm, which is the thin muscle that helps us to breathe. It is located between the chest and the abdomen.
  • Stage III (three) means that the lymphoma involves areas above the diaphragm and below the diaphragm.
  • Stage IV (four) means that the lymphoma involves organs outside of the lymph nodes and spleen, such as the bone marrow, bones, liver and lungs.

How is Hodgkin lymphoma treated?

Once we make a diagnosis and the staging is complete, we will begin to plan treatment, which almost always involves chemotherapy. Chemotherapy is the use of drugs to kill the rapidly dividing cancer cells or keep them from growing. We may also use radiation therapy, which is the use of X-rays to kill the cancer cells or keep them from growing. Treatment is based on the specific type and stage of Hodgkin lymphoma.

Chemotherapy for Hodgkin lymphoma

Most children will require treatment with chemotherapy. Many of the chemotherapy drugs we give require placement of a special type of IV called a central line. A pediatric surgeon places this special IV in the operating room while the patient is asleep so they don’t experience any discomfort. The central line can stay in for the duration of therapy, which is usually a few months, and then we remove it.

Different treatment protocols use different chemotherapy drugs. Once we have decided on your child’s treatment plan, your child’s doctors and nurses will explain what to expect from each of the drugs.

In most cases, we will give chemotherapy in our clinic and your child will be able to go home the same day. However, some chemotherapy protocols require a stay in the hospital for a few days.

Radiation therapy for Hodgkin lymphoma

If treatment for your child includes radiation therapy, you will meet with our pediatric radiation oncologist (cancer doctor) early in the treatment course to find out what to expect. We usually give radiation treatments after chemotherapy treatments are complete. They are given at the Anschutz Cancer Pavilion, across the street from Children’s Colorado.

Why choose us for treatment of Hodgkin lymphoma

Our Center for Cancer and Blood Disorders has a specialized group of doctors who are national leaders in the treatment of lymphoma. We offer cutting-edge and proven treatment protocols for lymphoma with excellent outcomes. We often have clinical trials available to consider as treatment options. Treatment planning involves a multidisciplinary team, led by a pediatric oncologist. Other specialists who work as part of the team include pediatric surgeons, a pediatric radiation oncologist, pediatric pathologists, pediatric radiologists and pediatric oncology nurses and advance practice providers.

We also have a Wellness Program comprised of social workers, child life specialists, and a child psychologist on the team who provide advice and support to patients and their families who are coping with the stress of cancer.

In the unusual case where lymphoma doesn’t respond to treatment or comes back after treatment, further treatment options are available. In this situation, treatment may involve high-dose chemotherapy with stem cell transplant, which we provide through our bone marrow transplantation program.We sometimes provide treatment through our Experimental Therapeutics Program, which offers new, cutting-edge therapies for diseases that are more difficult to treat.

Our Center participates in the Children’s Oncology Group (COG). COG is a clinical trials group supported by the National Cancer Institute. COG is the world’s largest organization devoted exclusively to childhood and adolescent cancer research. COG brings together more than 8,000 experts in childhood cancer at more than 200 leading children’s hospitals, universities and cancer centers across North America, Australia, New Zealand and Europe.

If a clinical trial through COG is available to treat your child’s Hodgkin lymphoma, we will likely ask if you would like your child to participate. If a clinical trial is not available, if we do not feel that study participation is the best option for your child, or if you prefer not to participate, then we will provide you with the best available treatment based on the results of the latest treatment studies.

Read more about our cancer research.

  • The Wellness Program at Children’s Colorado identifies and address all the psychosocial needs of our patients and families.
  • The HOPE Survivorship Program helps childhood cancer and bone marrow transplantation survivors of all ages live fuller, healthier lives.
  • The Center for Cancer and Blood Disorders provides resources for families to help them cope and adapt to changes in their routines caused by a cancer diagnosis.
  • The Children’s Oncology Group supports research to cure all forms of childhood cancers.
  • The National Cancer Institute provides in-depth information about Hodgkin lymphoma.

The Leukemia and Lymphoma Society, Rocky Mountain Chapter offers support to patients and families affected by lymphoma and raises funds for research.

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