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. White blood cells are an important part of the immune system that help the body fight infection. Lymphomas usually occur in areas of the body where lymphocytes typically live like the lymph nodes, spleen, thymus and bone marrow.

What is the difference between Hodgkin and non-Hodgkin lymphoma?

There are many different kinds of lymphoma. They are usually divided into two main categories: Hodgkin lymphoma (also called Hodgkin’s disease) and non-Hodgkin lymphoma, based on how the disease cells look under a microscope and how the disease progresses.

Fortunately, there are very good treatments for Hodgkin lymphoma and most patients with Hodgkin lymphoma are cured.

What causes Hodgkin lymphoma?

As with other cancers, Hodgkin lymphoma is caused by mutations of genes in the cancer cell. This causes the cancer cells to abnormally divide and grow, eventually leading to the development of a tumor.

In almost all cases, we don’t know what causes the lymphoma to develop. Sometimes it may be related to infection by a virus such as the Epstein-Barr virus (EBV causes infectious mononucleosis, commonly called “mono”), although most people who get EBV don’t get lymphoma.

People whose immune systems aren’t working properly, such as people with HIV or people who are taking medicines to suppress their immune systems, can be at higher risk for Hodgkin lymphoma. Very rarely, people in the same family may get Hodgkin lymphoma, indicating that inherited risk factors may play a minor role.

While Hodgkin lymphoma can develop at any age, it is very rare in young children and most commonly occurs in teenagers.

Helpful resources for Hodgkin lymphoma

What are the signs and symptoms of Hodgkin Lymphoma?

Children with Hodgkin lymphoma (also called Hodgkin’s disease) usually have painless swelling of the lymph nodes in their neck or under their arm, or less frequently in their groin area. Usually the swelling is more prominent and lasts longer than with an infection, continuing for weeks to months.

Often, a patient will have seen his or her doctor and been treated with antibiotics without getting any better, which may make the doctor suspicious of lymphoma. People with Hodgkin lymphoma can also have swelling of the lymph nodes inside the chest, around the blood vessels and airway passages. This can lead to symptoms like cough or shortness of breath.

Because the lymphoma cells can release chemicals that “rev up” the immune system, other symptoms that affect the whole body can occur, such as fevers without any obvious source. People can also lose weight for no reason and without trying. Sometimes, people with Hodgkin lymphoma will wake up in the middle of the night with the sheets soaking wet from sweating.

Fever, weight loss and night sweats are all called “B symptoms,” which are part of the staging system for Hodgkin lymphoma that helps doctors at Children’s Hospital Colorado determine the best type of treatment for your child. Children with Hodgkin lymphoma can also have very itchy skin, feel fatigued and have a poor appetite.

What tests are used to diagnose Hodgkin lymphoma?

Diagnosis of Hodgkin lymphoma (also called Hodgkin’s disease) requires a biopsy of one of the affected lymph nodes. A biopsy is a small sample of tissue obtained by a surgeon.

Biopsies are minor surgical procedures that are usually done in the operating room while the child is asleep so that they don’t experience any pain. Usually, patients are able to go home the same day that the biopsy is done and don’t need to stay in the hospital.

The tissue from the biopsy is looked at under the microscope by a pathologist, who makes the diagnosis. Usually, it takes a day or two to gather all the information needed to make a diagnosis once the biopsy has been done, although in some cases it may take longer.

How do doctors know if the lymphoma has spread?

Once a diagnosis is made, the next important step is to figure out how widespread the lymphoma is within the body. This process is called tumor staging and involves a series of imaging tests to look for disease throughout the body, a bone marrow test and blood tests.

A chest X-ray is used to check for any enlarged lymph nodes in the chest. 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. 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.

Because the lymphoma cells can also hide in the bone marrow, an additional test often done as part of the staging process is a bone marrow aspirate and biopsy. A small amount (around a teaspoon) of bone marrow is drawn out of the back hipbones through a needle. This procedure is painful, so it is almost always done while the patient is asleep in the operating room. It may be done at the same time as the biopsy of the lymph node if your doctor suspects the chance for lymphoma to be high.

In addition, basic blood tests will be done to check the function of the bone marrow, kidneys and liver and to check for signs of inflammation.

What to expect from testing for Hodgkin lymphoma

All of these scans and tests can be done as an outpatient and don’t require a child to stay in the hospital, but it takes a few days to get them done. Treatment isn’t started until the tests are complete so that your child’s doctors at Children’s Hospital Colorado can select the best treatment course.

How is Hodgkin lymphoma diagnosed?

With all of the information collected from testing, your child’s doctors will assign a stage (I to IV) that describes how far the cancer has spread. Staging is important, because it helps doctors plan the most effective treatment.

  • Stage I means that the lymphoma only involves one lymph node area.
  • Stage II 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. 
  • Stage III means that the lymphoma involves areas above the diaphragm and below the diaphragm. 
  • Stage IV means that the lymphoma involves organs outside of the lymph nodes and spleen, such as the bone marrow, bones, liver and lungs. If there are B symptoms like fever and night sweats, the stage is followed by a “B” (for example, stage II B). If there are no B symptoms, then the stage is followed by an “A.” 

Why choose Children’s Hospital Colorado for your child’s testing?

Whenever possible, we prefer that all tests for Hodgkin lymphoma be done at Children’s Colorado. This helps ensure that we are getting the best, most accurate information and that everything is done as kid-friendly as possible, with pediatric surgeons, radiologists, anesthesiologists and phlebotomists who are experienced in working with children and their families.

If these tests are done elsewhere, however, we will still be able to gather the information and use it to provide the best care possible.

How is Hodgkin lymphoma treated?

This planning involves a multidisciplinary team, led by a pediatric oncologist (cancer doctor) who is a member of our solid tumor team. 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 social workers, child life specialists, and a child psychologist on the team who are able to provide their advice and support to patients and their families who are coping with the stress of cancer. Once a diagnosis is made and the staging is complete, your child’s doctors at Children’s Hospital Colorado will begin to plan treatment, which almost always involves chemotherapy (drugs used to kill the rapidly dividing cancer cells or keep them from growing) and often radiation therapy (X-rays that kill the cancer cells or keeps them from growing).

Treatment is based on the specific type and stage of Hodgkin lymphoma. In some specific cases with low-stage disease, treatment may be surgery alone.

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. This special IV is placed by a pediatric surgeon in the operating room while the patient is asleep so that they don’t experience any discomfort. The central line can stay in for the duration of therapy, which is usually a few months, then is removed.

Different treatment protocols use different chemotherapy drugs, so once your child’s treatment plan is decided, your doctors and nurses will explain what to expect from each of the drugs.

Sometimes, doctors will need some extra tests like heart and lung function tests before chemotherapy to monitor potential side effects. In most cases, chemotherapy will be given 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 get to meet with our pediatric radiation oncologist early in the treatment course to find out what to expect. Radiation treatments are usually given after chemotherapy treatments are completed. They are given at the Anschutz Cancer Pavilion, across the street from Children’s Colorado.

The good news: Most children and adolescents are cured

With modern treatments, most children and adolescents with Hodgkin lymphoma will be cured. In the unusual case where lymphoma doesn’t respond to treatment or comes back after treatment, Children’s Colorado will be able to offer further treatment options, sometimes provided through our Experimental Therapeutics Program, which offers cutting-edge new therapies for more difficult to treat diseases. Treatment in this situation may also involve high-dose chemotherapy with stem cell transplant, provided through our bone marrow transplantation program.

The Center for Cancer and Blood Disorders at Children’s Colorado participates in the Children’s Oncology Group (COG), a National Cancer Institute-supported clinical trials group, which is the world’s largest organization devoted exclusively to childhood and adolescent cancer research. The 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 for your child to treat his or her Hodgkin lymphoma, we will likely discuss if you would like your child to participate. If a clinical trial is not available, if we do not feel that participation on a study is the best option for your child, or if you decide you would prefer not to participate, then we will provide you with the best up-to-date treatment available based on the results of the latest treatment studies.

Read more about our cancer research.

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