What is Non-Hodgkin Lymphoma (NHL)?

Lymph nodes, bone marrow, the spleen and the thymus gland are all parts of the lymphatic system. This system works to help the body fight infection.

NHL is cancer of the lymphatic system. The lymphatic system is part of the immune system, which helps the body fight infection. The lymphatic system includes:

• Lymph: Infection-fighting fluid made mostly of a certain type of white blood cell called lymphocytes.
• Lymph nodes: Small bean-shaped organs that filter lymph and store white blood cells. Lymph nodes are grouped together throughout the body. Some areas where they are found include the neck, armpit, and groin.
• Bone marrow: Soft tissue found in the center of bones. Blood cells are made in the bone marrow.
• Thymus gland: The thymus gland helps build the immune system in children. It produces a type of white blood cell called T-lymphocytes, which fight infection. The thymus gland is located underneath the breastbone.
• Spleen: Organ that stores certain lymphocytes and filters the blood. It’s located under the ribs on the left side of the body.

With NHL, cancer cells form in the lymphatic system. When the cancer cells group together, they form a tumor. The tumor can spread (metastasize) to another part of the body, such as the lungs. The presence of cancer cells makes it hard for the body to fight infection and can cause other health problems.

Who Gets NHL?

Children at any age can get NHL, but kids ages seven to 11 are affected most often. NHL is not contagious, meaning your child can’t pass it to another person.

What Causes NHL?

NHL occurs when white blood cells grow abnormally (mutate). What causes this to happen is not fully known. If the cells crowd lymph nodes or other areas of the body, they can cause tumors to form. Mutations in certain genes may affect the way your child’s cells grow. This gene mutation is random and couldn’t have been prevented. In rare cases, other factors, such as exposure to certain viruses, chemicals or radiation, play a role. But most often, the cause of cancer in children is unknown.

What Are the Symptoms of NHL?

Some common symptoms of non-Hodgkin lymphoma include fever, night sweats and swollen lymph nodes in the neck, chest, armpits or groin. Your child may have experienced some of these symptoms, or other symptoms.

How Is NHL Diagnosed?

Your child’s healthcare provider examines your child. You will be asked about your child’s health history. Your child may also have one or more of the following:

• Blood tests to take a sample of the blood and test it
• Imaging tests to take detailed images of areas inside the body. These may include a chest x-ray, MRI, CT scan, and PET scan.
• Bone marrow aspirations and biopsies to take samples of bone marrow from the hipbones
• Lumbar puncture, also called spinal tap, to take a sample of the fluid that surrounds the spinal cord from the child’s lower back

Staging and Grading of NHL

Staging is the process that determines the size of the cancer and how much it has spread. Most cancers have their own staging system. Grading is used to describe how abnormal the cancer cells look when seen through a microscope. The more abnormal the cells are, the faster they grow. Staging and grading help the healthcare team plan treatment for your child. They also help determine the likelihood of cure (prognosis). The process used for NHL takes into consideration the following:

The presence of symptoms related to NHL

• Location of the primary tumor
• Tumor size and number of tumors
• If the cancer has spread to other areas of the body
• How abnormal the cancer cells look under a microscope

The cancer is also broken down into stages one through four (often written as I through IV). The different stage numbers refer to the tumor’s size and if it has spread. For instance, stage I is a very early stage of cancer. Stage IV means the cancer is widespread. NHL is also broken down into further classifications. Your child’s healthcare provider can tell you more if needed. Talk to the healthcare provider if you have any questions about the stage of your child’s cancer.

How Is NHL Treated?

There are many different types of NHL. Your child’s healthcare provider will talk to you about the type your child has. The treatment your child receives depends on the type of NHL he or she has. Treatments may be combined. Your child may require one or more of the following treatments:

• Surgery to remove all or part of a tumor
• Chemotherapy (“chemo”) to destroy cancer cells with powerful cancer-fighting medications. Multiple chemo medications may be used. They are given through a tube (IV) that’s usually put into a vein in the arm or chest. Or, they may be given by mouth or injection.
• Radiation therapy to destroy cancer cells and shrink a tumor using high-energy x-rays. Radiation may be used before or after other treatments.

Supportive Treatments

The goal of supportive treatments is to protect the child from infection, prevent discomfort and bring the body’s blood counts to a healthy range. During your child’s treatment, he or she may be given antibiotics. These are medications that help prevent and fight infection. Anti-nausea and other medications may also be given. These help ease side effects caused by treatment. Your child may receive a blood transfusion to restore the blood cells destroyed by treatment. Blood is taken from a donor and stored until the child is ready to receive it.

What Are the Long-Term Concerns?

With early treatment, NHL is often curable. But chemotherapy and radiation may cause some problems, such as damage to certain organs. So your child’s health will need to be monitored for life. This may include clinic visits, blood tests, imaging tests and ultrasounds of the heart.

Coping

Receiving a cancer diagnosis for your child is scary and confusing. It’s important to remember that you are not alone. Your child’s healthcare team will work with you and your child throughout your child’s illness and care. You may also wish to seek information and support for yourself. Doing so can help you cope with the changes cancer brings. Learning about and talking with others who also have a child with cancer may help you and your family cope.