Key Points for This Section

Childhood non-Hodgkin’s lymphoma is a disease in which malignant (cancer) cells form in the lymph system. There are three major types of childhood non-Hodgkin’s lymphoma. Possible signs of childhood non-Hodgkin’s lymphoma include breathing problems and swollen lymph nodes. Tests that examine the body and lymph system are used to detect (find) and diagnose childhood non-Hodgkin’s lymphoma. Certain factors affect prognosis (chance of recovery) and treatment options.

Childhood non-Hodgkin’s lymphoma is a disease in which malignant (cancer) cells form in the lymph system.

The lymph system is part of the immune system and is made up of the following:

• Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.
• Lymph vessels: A network of thin tubes that collect lymph from different parts of the body.
• Lymph nodes: Small, bean-shaped structures that filter substances in lymph and help fight infection and disease. Lymph nodes grow along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen.
• Spleen: An organ that produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach.
• Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.
• Tonsils: Two small masses of lymph tissue in the throat. The tonsils produce lymphocytes.
• Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow produces white blood cells, red blood cells, and platelets.

Because lymph tissue is found throughout the body, childhood non-Hodgkin’s lymphoma can begin in almost any part of the body. Cancer can spread to the liver and many other organs and tissues.

Non-Hodgkin’s lymphoma can occur in both adults and children. Treatment for children is different than treatment for adults. (Refer to the PDQ summary on Adult Non-Hodgkin’s Lymphoma Treatment ¹ for more information.)

There are three major types of childhood non-Hodgkin’s lymphoma.

The specific type of lymphoma is determined by how the cells look under a microscope. The 3 major types of childhood non-Hodgkin’s lymphoma are:

• Lymphoblastic lymphoma.
• Small noncleaved cell lymphoma (either Burkitt’s lymphoma or non-Burkitt’s lymphoma).
• Large cell lymphoma.

Possible signs of childhood non-Hodgkin’s lymphoma include breathing problems and swollen lymph nodes.

These and other symptoms may be caused by childhood non-Hodgkin’s lymphoma or by other conditions. A doctor should be consulted if any of the following problems occur:

• Shortness of breath.
• Difficulty breathing.
• Wheezing.
• High-pitched breathing sounds.
• Swelling of the head or neck.
• Difficulty swallowing.
• Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin.
• Unexplained fever.
• Unexplained weight loss.
• Night sweats.

Tests that examine the body and lymph system are used to detect (find) and diagnose childhood non-Hodgkin’s lymphoma.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. One of the following types of biopsies may be done:
  • Excisional biopsy: The removal of an entire lump, lymph node, or suspicious tissue.
  • Incisional biopsy or core biopsy: The removal of part of a lump, lymph node, or suspicious tissue.
  • Needle biopsy or fine-needle aspiration: The removal of part of a lump, lymph node, or suspicious tissue with a needle.
  • Bone marrow aspiration and biopsy: The removal of a small piece of bone, and blood and tissue from the bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the sample under a microscope to look for cancer cells.
• Thoracentesis: The removal of fluid from the sac that surrounds the lung, using a needle inserted between the ribs. A pathologist views the fluid under a microscope to look for cancer cells.
• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on:

• The stage of the cancer.
• The number of places outside of the lymph nodes to which the cancer has spread.
• The type of lymphoma.
• The patient’s general health.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

The soft, sponge-like tissue in the center of most large bones. It produces white blood cells, red blood cells, and platelets.

The removal of a small sample of bone marrow (usually from the hip) through a needle for examination under a microscope.

An aggressive (rapidly progressing) type of B-cell non-Hodgkin's lymphoma that occurs most often in children and young adults. The disease may affect the jaw, central nervous system, bowel, kidneys, ovaries, or other organs. There are three main types of Burkitt’s lymphoma (sporadic, endemic, and immunodeficiency related). Sporadic Burkitt’s lymphoma occurs throughout the world, and endemic Burkitt’s lymphoma occurs in Africa. Immunodeficiency-related Burkitt’s lymphoma is most often seen in AIDS patients.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the bloodstream. Lymphoma is cancer that begins in the cells of the immune system.

The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells.

An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.

The removal of a tissue sample with a needle for examination under a microscope.

Computed tomography scan. A series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan.

A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.

The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy.

The area where the thigh meets the abdomen.

The complex group of organs and cells that defends the body against infections and other diseases.

A surgical procedure in which a portion of a lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body, and can be localized or systemic (spread throughout the body). The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on the site of the infection. When the body's natural defense system is strong, it can often fight the germs and prevent infection. Cancer treatment can weaken the natural defense system.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called a lymph gland.

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.

The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.

A type of white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases.

The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration.

A group of cancers of the lymphoid system, including B-cell lymphoma, Burkitt's lymphoma, diffuse cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, lymphoblastic lymphoma, mantle cell lymphoma, mycosis fungoides, post-transplantation lymphoproliferative disorder, small non-cleaved cell lymphoma, and T-cell lymphoma.

A part of the body that performs a specific function. For example, the heart is an organ.

A doctor who identifies diseases by studying cells and tissues under a microscope.

The lower part of the abdomen, located between the hip bones.

An exam of the body to check for general signs of disease.

A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called a thrombocyte.

The likely outcome or course of a disease; the chance of recovery or recurrence.

RBC. A cell that carries oxygen to all parts of the body. Also called an erythrocyte.

An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach.

The extent of a cancer within the body. If the cancer has spread, the stage describes how far it has spread from the original site to other parts of the body.

An organ that is part of the digestive system. It helps in the digestion of food by mixing it with digestive juices and churning it into a thin liquid.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Removal of fluid from the pleural cavity through a needle inserted between the ribs.

An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.

A group or layer of cells that are alike and that work together to perform a specific function.

One of two small masses of lymphoid tissue on either side of the throat.

A mass of excess tissue that results from abnormal cell division. Tumors perform no useful body function. They may be benign (not cancerous) or malignant (cancerous).

WBC. Refers to a blood cell that does not contain hemoglobin. White blood cells include lymphocytes, neutrophils, eosinophils, macrophages, and mast cells. These cells are made by bone marrow and help the body fight infection and other diseases.

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.