Hodgkin Lymphoma

What Is Hodgkin Lymphoma?

Hodgkin lymphoma (lim-FOE-muh) is a type of cancer that develops in the white blood cells of the lymphatic system, which is part of the immune system. These systems work together to remove bacteria, viruses, and other harmful substances from the body. 

The lymphatic system includes:

• the lymph nodes (also called lymph glands)
• thymus (a gland in the chest)
• spleen
• tonsils
• adenoids
• bone marrow
• tubes called lymphatics or that connect the parts of the lymphatic system

Hodgkin lymphoma often begins in the and then spreads from one part of the lymphatic system to another. The cancerous tumors usually have large cells called Reed-Sternberg cells.

What Are the Signs & Symptoms of Hodgkin Lymphoma?

Some patients have no symptoms. Those who do may have enlarged lymph nodes (swollen glands) in the neck, above the collarbone, in the underarm area, or groin.

If cancer is in the chest, pressure from any swelling can cause a cough, trouble breathing or swallowing, or swelling of the face and neck.

Some kids can also have fatigue (tiredness), poor appetite, or itchy skin. Fever, night sweats, and weight loss are also common.

What Causes Hodgkin Lymphoma?

This type of cancer usually is caused by a change in the genes of growing white blood cells called B lymphocytes. Doctors aren’t sure why this happens.

Lymphoma is more common in kids who have:

• a sibling with Hodgkin lymphoma
• immune system problems
• HIV infection
• been given immunosuppressive drugs after organ transplants
• have had Epstein-Barr viral infection (mononucleosis)

How Is Hodgkin Lymphoma Diagnosed?

To check for Hodgkin lymphoma, doctors look for signs of infection; swollen lymph nodes; breathing problems; or swelling in the belly, face, hands, or feet.

Sometimes, when a child has an enlarged lymph node with no known cause, the doctor will watch the node closely to see if it shrinks or grows. If it stays enlarged or gets bigger, the next step is a biopsy to check in a lab for cancer cells. Doctors can do:

• Needle aspiration biopsy: Doctors numb part of the body with local anesthesia, then use a hollow needle to remove a tiny bit of tissue from the lymph node for testing.
• Incisional or excisional biopsy: This is done in an operating room. Kids get medicines (anesthesia) to sleep. Then, the doctor makes a small cut to remove a piece of the lymph node (incisional) or the whole lymph node (excisional).

Biopsies also can check for lymphomas that might involve the bone marrow, chest, or belly.

If lymphoma is found, other tests can tell the type of lymphoma and whether it has spread (metastasized). These tests may include:

• blood tests, including checking the number of blood cells and how well the kidneys and liver are working
• imaging tests like ultrasound, computed tomography (CT) , magnetic resonance imaging (MRI) and X-rays
• biopsy or aspiration of the bone marrow
• imaging tests like ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and X-rays
• bone scan and/or positron emisson tomography (PET) scan (when a radioactive material is put into the bloodstream to look for cancer cells throughout the body)

How Is Hodgkin Lymphoma Treated?

A pediatric oncologist (a doctor who specializes in childhood cancer) will lead the medical team caring for a child with Hodgkin lymphoma. The oncologist works with other specialists, including nurses, social workers, and psychologists.

Treatment is based on staging. Staging is a way to see if the disease has spread and, if it has, how much. This information helps the care team choose the best treatments.

Treatment may include:

• chemotherapy (chemo): medicines that kill cancer cells and stop their growth
• radiation therapy: high-energy X-rays that kill cancer cells
• targeted therapy: specific drugs that find and attack cancer cells without hurting normal cells
• immunotherapy: medicine that uses the child’s own immune system to get rid of cancer cells
• stem cell transplants: healthy stem cells are put into the body
• enrollment in a clinical trial: tests of new cancer treatments or comparing them with current treatments. Many clinical trials focus on reducing side effects of current treatments.
  

Remission is when doctors see no cancer cells in the body. Hodgkin lymphoma can have very high remission rates. Most kids and teens are cured of the disease. This means that they're in permanent remission and will have long-term cancer-free survival.

After treatment, anyone who has had Hodgkin lymphoma should have regular checkups throughout their life to make sure the lymphoma hasn't come back. Doctors also want to make sure that the cancer therapy doesn’t lead to longer-term problems.

What Else Should I Know?

Having a child being treated for cancer can feel overwhelming for any family. But you're not alone. To find support, talk to your child's doctor or a hospital social worker. Many resources are available to help you get through this difficult time.

You also can find more information and support online at:

• National Children’s Cancer Society (NCCS)
• American Childhood Cancer Organization
• Nemours Children's Health
• American Cancer Society