Lymphoma is a cancer of the lymphatic system that can affect children of any age but is more common in teens and adolescents. The lymphatic system is a crucial part of our immune system. It is composed of a network of lymph vessels, nodes and ducts as well as organs such as the spleen and tonsils. Lymphoma begins in primitive lymphocytes and can occur in different parts of the body.
The primary symptom of lymphoma is swollen lymph nodes under the arms or in the neck, chest or abdomen. Sometimes the spleen or liver is enlarged, which your child’s doctor will be able to feel. Your child may have other symptoms of lymphoma that include:
- Night sweats
- Weight loss
- Unexplained asthma
- Shortness of breath
The lymphatic system’s normal function is to recognize and defend the body against microorganisms and infection. Lymphoma develops when normal cells mutate and grow rapidly. Lymphoma is not contagious or inherited from generation to generation.
Not all lymph node enlargements are caused by lymphoma. Most causes include infection and inflammation. If your child has an enlarged lymph node, his or her doctor can evaluate and observe it for several weeks to see if it decreases in size. If the lymph node does not get smaller, your child may be referred to a cancer specialist for more thorough testing.
The main types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma. Each type affects different blood cells in the lymphatic system, and each requires different treatment.
One of the most curable forms of cancer, Hodgkin lymphoma is named after the doctor who first described the disease. The two main types of childhood Hodgkin lymphoma are:
- Classical Hodgkin lymphoma. This type makes up about 95 percent of Hodgkin lymphoma cases. It is characterized by larger lymphocytes called Reed-Sternberg cells, named after the doctors who discovered them.
- Nodular lymphocyte-predominant Hodgkin lymphoma. This type accounts for about 5 percent of Hodgkin lymphoma cases. The cancerous cells are a large variant of Reed-Sternberg cells, called popcorn cells because they look like popcorn.
Non-Hodgkin lymphoma is a general term for a group of cancers that includes:
- Burkitt's lymphoma. This type of cancer develops from B cells and is one of the fastest-growing cancers.
- Lymphoblastic lymphoma. This type of cancer mainly affects children and teenagers and may consist of B cells or T cells.
- Diffuse large B cell lymphoma (DLBCL). This is the most common type of non-Hodgkin lymphoma in the United States. It typically occurs in older people but can also occur in children. It is fast-growing but usually responds well to treatment.
- Primary mediastinal B cell lymphoma. This is a subtype of DLBCL in which the lymphoma cells are large but with lots of scar-like tissue. It affects about 2 percent of all people with lymphomas and originates in the chest.
Diagnosis of Lymphoma
Doctors at Riley at IU Health will perform a biopsy of the enlarged lymph node to make a definite diagnosis of lymphoma. Other tests and exams include:
- Physical examination. Your child's doctor will perform a thorough physical exam that includes reviewing your family medical history.
- Blood tests. The doctor will perform a blood test to count the red cells, white cells and platelets (small, colorless blood cells), detect cancer activity and evaluate body function.
- Blood chemistry. The doctor will also request a blood chemistry (serum) test to measure factors such as electrolyte, blood sugar, cholesterol and iron, calcium and potassium levels.
- Bone marrow biopsy. A hematopathologist examines bone marrow tissue to confirm a cancer or bone marrow disorder diagnosis or evaluate response to therapy.
- Computed tomography (CT scan). This fast, painless imaging procedure creates multiple detailed or three-dimensional images of bone, tissue and blood vessels to detect enlarged lymph nodes.
- Magnetic resonance imaging (MRI). This is an imaging procedure that detects tumors or bone changes. It uses a magnetic field instead of radiation to make detailed pictures of the body’s internal organs and bones.
- Positron emission tomography (PET) scan. This uses small amounts of radioactive material to help measure body functions such as blood flow and metabolism in order to diagnose and determine the advancement of diseases.
- X-ray. The doctor may perform an X-ray of the chest, lungs, heart, ribs, diaphragm or large arteries to look for tumors, fluid buildup or enlarged lymph nodes.
These tests are important to determine the type or subtype and stage (advancement) of lymphoma, which determines the treatment and prognosis (prospects for survival).
The goals of treatment are to achieve remission and total disappearance of lymphoma. Any of these treatments may be provided alone or in combination:
- Chemotherapy. Medicines are provided by mouth or intravenously to destroy cancer cells.
- Radiation therapy. High-energy radiation is directed on the tumor to shrink or destroy it or to kill cancer cells that have spread beyond the lymph system.
- Surgery. Surgery is not usually required, but part of a swollen lymph node may be removed for biopsy or removed entirely if necessary.
- Stem cell transplant (blood and marrow transplant). Blood or bone marrow cells from the patient’s own body or from a donor are transplanted to the patient to rebuild a healthy blood supply.
- Chimeric Antigen Receptor (CAR) T-Cell Therapy. CAR T-cell therapy is an emerging form of cancer immunotherapy. Riley at IU Health is the only pediatric healthcare system in Indiana to offer CAR T-cell therapy to treat pediatric patients and young adults with acute lymphoblastic leukemia (ALL) and young adults with non-Hodgkin lymphoma.
- What is CAR T-Cell Therapy? This CAR T-cell therapy involves supercharging a patient’s T cells to recognize and attack cancer cells. T-cells are a kind of white blood cell that has the job of targeting and destroying bacteria, viruses, and cancer cells. However, with certain types of blood cancers, your T-cells may not be able to do their job properly. That’s where CAR T-cell therapy may help. It is used after failure of two other kinds of treatment. For this treatment, your child’s blood will be collected over the course of a few hours and passed through a machine that separates out some their T-cells. After your child’s T-cells are collected, they will be sent to a laboratory and modified to become CAR T-cells. Your child will undergo several days of low-dose conditioning chemotherapy to prepare their body for treatment. Your child’s CAR T-cells will then be infused back into your body to help recognize and attack your cancer cells. After the CAR-T cells are infused, your child will need to remain in the hospital for 2-4 weeks and will need to stay within 2 hours of Riley at IU Health for 4-8 weeks to monitor for side effects of treatment.
Doctors at Riley at IU Health use the minimum treatment necessary to reduce long-term side effects.
Key Points to Remember
Key Points to Remember
- Lymphoma is a cancer of the lymphatic system that can affect children of any age but is more common in adolescents and young adults.
- The primary symptom of lymphoma is swollen lymph nodes under the arms or in the neck, chest or abdomen.
- The main types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma. Each type affects different blood cells in the lymphatic system, and each requires different treatment.
- Your child's doctor will perform a biopsy of the enlarged lymph node to make a definite diagnosis of lymphoma.
- Treatment of lymphoma may include chemotherapy, radiation therapy, stem cell transplant and surgery.
Support Services & Resources
Support Services & Resources
Visit the trusted websites below to learn more about lymphoma.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The Cancer & Blood Diseases Department at Riley at IU Health conducts research to find better ways to diagnose and treat lymphoma. Research includes collecting data on treatment outcomes and clinical trials for new medicines. Ask your child's doctor for more information about current research studies and eligibility for clinical trials.
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