Childhood Hodgkin Lymphoma Treatment (PDQ®)
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General Information About Childhood Hodgkin LymphomaKey Points:
Childhood Hodgkin lymphoma is a disease in which malignant
(cancer) cells form in the lymph system.
Childhood Hodgkin lymphoma is a type of
cancer that develops in the lymph system, which is part of the body's immune system.
The lymph system 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 and return it to the bloodstream.
- Lymph nodes:
Small, bean-shaped structures that filter lymph and store white blood cells that help fight
infection and disease. Lymph nodes are located along the network of lymph vessels
found throughout the body. Clusters of lymph nodes are found in the underarm,
- Spleen: An organ
that makes lymphocytes, filters the blood, stores blood cells, and destroys
old blood cells. The spleen is on the left side of the abdomen near the
- Thymus: An organ
in which lymphocytes grow and multiply. The thymus is in the chest behind the
- Tonsils: Two small
masses of lymph tissue at the
back of the throat. The tonsils make lymphocytes.
- Bone marrow: The
soft, spongy tissue in the center of large bones. Bone marrow makes white
blood cells, red blood cells, and
Lymph system; drawing shows the lymph vessels and lymph organs including the lymph nodes, tonsils, thymus, spleen, and bone marrow. One inset shows the inside structure of a lymph node and the attached lymph vessels with arrows showing how the lymph (clear fluid) moves into and out of the lymph node. Another inset shows a close up of bone marrow with blood cells.
Because lymph tissue is found throughout the body, Hodgkin
lymphoma can start in almost any part of the body and spread to almost any
tissue or organ in the body.
Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin
lymphoma. (See the PDQ summary on Childhood Non-Hodgkin Lymphoma Treatment for more information.)
Hodgkin lymphoma often occurs in teenagers (age 15–19). The
treatment for children and teenagers may be different than treatment for adults. (See the
PDQ summary on Adult Hodgkin Lymphoma Treatment for more information.)
There are two types of childhood Hodgkin lymphoma.
The two types of childhood Hodgkin lymphoma are:
Classical Hodgkin lymphoma is divided into four subtypes, based on how the cancer cells look under a microscope:
- Lymphocyte-rich classical Hodgkin lymphoma.
- Nodular sclerosis Hodgkin lymphoma.
- Mixed cellularity Hodgkin lymphoma.
- Lymphocyte-depleted Hodgkin lymphoma.
Epstein-Barr virus infection can affect
the risk of childhood Hodgkin lymphoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk. Risk factors for childhood Hodgkin lymphoma include the following:
Being exposed to common infections before the age of 5 may decrease the risk of Hodgkin lymphoma in children because of the effect it has on the immune system.
Possible signs of childhood Hodgkin lymphoma include swollen
lymph nodes, fever, night sweats, and weight loss.
These and other symptoms may be caused by childhood Hodgkin lymphoma or by other conditions. Check with a doctor if your child has any of the following problems:
- Painless, swollen lymph nodes in the neck, chest, underarm, or groin.
- Fever for no known reason.
- Weight loss for no known reason.
- Night sweats.
- Itchy skin.
- Pain in the lymph nodes after drinking alcohol.
Fever, weight loss, and night sweats are called B symptoms.
Tests that examine the lymph system are used to detect (find) and diagnose
childhood Hodgkin 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.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, or pelvis, 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.
- PET scan (positron emission tomography scan): A procedure to find malignanttumor cells in the body. A small amount of radioactiveglucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- 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.
- Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the blood sample made up of red blood cells.
Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
- Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
- Lymph node biopsy:
The removal of all or part of a lymph node. The lymph node may be removed during a thoracoscopy, mediastinoscopy, or laparoscopy. One of the following types of
biopsies may be done:
A pathologist views the tissue under a microscope to look for cancer cells, especially Reed-Sternberg cells. Reed-Sternberg cells are common in classical Hodgkin lymphoma.
Reed-Sternberg cell; photograph shows normal lymphocytes compared with a Reed-Sternberg cell.
The following test may be done on tissue that was removed:
- Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out what type of malignant (cancerous) lymphocytes are causing the lymphoma.
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend
on the following:
- The stage of the cancer.
- The size of the tumor.
- The type of Hodgkin lymphoma.
- Whether there are B symptoms at diagnosis.
- Certain features of the cancer cells.
- Whether there are too many white blood cells or too few red blood cells at diagnosis.
- How well the tumor responds to initial treatment with chemotherapy.
- Whether the cancer is newly diagnosed or has recurred (come back).
The treatment options also depend
Most children and teenagers with newly diagnosed
Hodgkin lymphoma can be cured.[Back to top]
Stages of Childhood Hodgkin LymphomaKey Points:
After childhood Hodgkin lymphoma has been diagnosed,
tests are done to find out if cancer cells have spread within the lymph
system or to other parts of the body.
The process used to find out if cancer has spread within the lymph
system or to other parts of the body is called staging. The information gathered from the staging
process determines the stage of the
disease. Treatment is based on the stage and other factors that affect prognosis. The following tests and procedures may be used in the staging process:
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Stages of childhood Hodgkin lymphoma may include A, B, E, and S.
Childhood Hodgkin lymphoma may be described as follows:
- A: The patient does not have fever, weight loss, or night sweats.
- B: The patient has B symptoms (fever, weight loss, and night sweats).
- E: Cancer is found in an organ or tissue that is not part of the lymph
system but which may be next to an involved area of the lymph system.
- S: Cancer is found in the spleen.
The following stages are used for childhood Hodgkin lymphoma:
Stage I childhood Hodgkin lymphoma; drawing shows cancer in one lymph node group above the diaphragm. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node.
Stage I is divided into stage I and stage IE.
Stage II is divided
into stage II and stage IIE.
Stage II childhood Hodgkin lymphoma; drawing shows cancer in lymph node groups above and below the diaphragm. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node.
Stage II: Cancer is found in two or more lymph node groups either above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
Stage IIE childhood Hodgkin lymphoma; drawing shows cancer in one lymph node group above the diaphragm and in the left lung. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node.
Stage IIE: Cancer is found in one or more lymph node groups either above or below the diaphragm and outside the lymph nodes in a nearby organ or area.
Stage III childhood Hodgkin lymphoma; drawing shows cancer in lymph node groups above and below the diaphragm, in the left lung, and in the spleen. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node.
Stage III is divided
into stage III, stage IIIE, stage IIIS, and stage
Stage IV childhood Hodgkin lymphoma; drawing shows cancer in the liver, the left lung, and in one lymph node group below the diaphragm. The brain and pleura are also shown. One inset shows cancer spreading through lymph nodes and lymph vessels to other parts of the body. Lymphoma cells containing cancer are shown inside one lymph node. Another inset shows cancer cells in the bone marrow.
In stage IV, the cancer:
- is found outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
- is found outside the lymph nodes in one organ and has spread to areas far away from that organ; or
- is found in the lung, liver, bone marrow, or cerebrospinal fluid (CSF). The cancer has not spread to the lung, liver, bone marrow, or CSF from nearby areas.
Untreated Hodgkin lymphoma is divided into risk groups.
Untreated childhood Hodgkin lymphoma is divided into risk groups based on the stage, size of the tumor, and whether the patient has "B" symptoms (fever, weight loss, or night sweats). The risk group is used to plan treatment.
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- Low-risk childhood Hodgkin lymphoma.
- Intermediate-risk childhood Hodgkin lymphoma.
- High-risk childhood Hodgkin lymphoma.
Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents
PrimaryrefractoryHodgkin lymphoma is lymphoma that continues to grow or spread during treatment.
Recurrent Hodgkin lymphoma is cancer that has recurred
(come back) after it has been treated. The lymphoma may come back in the
lymph system or in other parts of the body, such as the lungs, liver, bones, or bone marrow. [Back to top]
Treatment Option OverviewKey Points:
There are different types of treatment for children with
Different types of treatment are available for children with
Hodgkin lymphoma. Some treatments are standard
and some are being tested in clinical
trials. A treatment clinical trial is a research study meant to
help improve current treatments or obtain information on new treatments for
patients with cancer. When clinical
trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial
should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with Hodgkin lymphoma should have their treatment
planned by a team of health care providers with expertise in treating childhood
Treatment will be overseen by a
oncologist, a doctor who specializes
in treating children with cancer. The pediatric oncologist works with
other pediatrichealth care providers who are experts in treating children
with Hodgkin lymphoma and who specialize in certain areas of medicine. These
may include the following specialists:
The treatment of Hodgkin lymphoma in teenagers and young adults may be different than the treatment for children. Some teenagers and young adults are treated with an adult regimen.
Five types of standard treatment are used:
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.
The way the chemotherapy is given depends on the risk group. For example, children with low-risk Hodgkin lymphoma receive fewer cycles of treatment, fewer anticancer drugs, and lower doses of anticancer drugs than children with high-risk lymphoma.
See Drugs Approved for Hodgkin Lymphoma for more information.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Radiation therapy may be given, based on the child’s risk group and chemotherapy regimen. External radiation therapy is used for childhood Hodgkin lymphoma. The radiation is given only to the lymph nodes or other areas with cancer.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. One type of targeted therapy being used in the treatment of childhood Hodgkin lymphoma is monoclonal antibodytherapy.
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
Surgery may be done to remove as much of the tumor as possible for localized nodular lymphocyte-predominant childhood Hodgkin lymphoma.
High-dose chemotherapy with stem cell
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web
Proton beam radiation therapy
Proton-beam therapy is a type of high-energy, external radiation therapy that uses streams of protons (small, positively-charged particles of matter) to make radiation. This type of radiation therapy is being studied for girls with Hodgkin lymphoma, to help reduce the risk of breast cancer from radiation to the chest.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
For patients who receive chemotherapy alone, a PET scan may be done 3 weeks or more after treatment ends. For patients who receive radiation therapy last, a PET scan should not be done until 8 to 12 weeks after treatment.[Back to top]
Treatment Options for Children and Adolescents with Hodgkin Lymphoma
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your child's doctor for clinical trials that are not listed here but may be right for your child.[Back to top]
Low-Risk Childhood Hodgkin Lymphoma
Treatment of low-risk childhood Hodgkin lymphoma is combination chemotherapy. Sometimes radiation therapy is also given to the areas with cancer. For localizednodular lymphocyte predominant childhood Hodgkin lymphoma, surgery may be the only treatment needed when the tumor can be completely removed.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I childhood Hodgkin lymphoma and stage II childhood Hodgkin lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
Intermediate-Risk Childhood Hodgkin Lymphoma
Treatment of intermediate-risk childhood Hodgkin lymphoma is combination chemotherapy. Radiation therapy may also be given to the areas with cancer.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I childhood Hodgkin lymphoma, stage II childhood Hodgkin lymphoma, stage III childhood Hodgkin lymphoma and stage IV childhood Hodgkin lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
High-Risk Childhood Hodgkin Lymphoma
Treatment of high-risk childhood Hodgkin lymphoma is higher dosecombination chemotherapy. Radiation therapy may also be given to the areas with cancer.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III childhood Hodgkin lymphoma and stage IV childhood Hodgkin lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
Treatment Options for Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents
Treatment of primaryrefractory or recurrent childhood Hodgkin lymphoma may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent/refractory childhood Hodgkin lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
Late Effects from Childhood and Adolescent Hodgkin Lymphoma Treatment
Children and teenagers may have treatment-related side effects that appear months or years after treatment for
Hodgkin lymphoma. Because of these late effects on health and development, regular follow-up
exams are important. Late effects may include problems with the following:
For female survivors of Hodgkin lymphoma, there is an increased risk of breast cancer. This risk depends on the amount of radiation therapy they received during treatment and the chemotherapyregimen used. The risk of breast cancer is decreased when female survivors receive radiation therapy to the ovaries. It is suggested that these patients have a mammogram once a year starting 8 years after treatment or at age 25 years, whichever is later. Female survivors of childhood Hodgkin lymphoma who have breast cancer have an increased risk of dying from the disease compared to patients with no history of Hodgkin lymphoma who have breast cancer.
The risk of these long-term side effects will be considered when
treatment decisions are made. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.)[Back to top]
To Learn More About Childhood Hodgkin Lymphoma
For more information from the National Cancer Institute about childhood Hodgkin lymphoma, see the following:
For more childhood cancer information and other general cancer resources, see the following:[Back to top]
Changes to This Summary (01/30/2013)
The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.