What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma develops when a type of white blood cell, known as a lymphocyte, grows in an uncontrolled way. Types of lymphocyte include B cells and T cells, which each have different functions within the immune system.

A tumour can grow anywhere where there is lymph tissue. It can develop in the lymph nodes (glands), spleen, bone marrow, thymus (a small organ in front of the heart), adenoids and tonsils or in the stomach and intestines. Because lymphocytes travel throughout the body to fight infection, the cancer can quickly spread to other organs.

We don’t know why some children develop non-Hodgkin lymphoma. It’s more common in older than in younger children and is seen more often in boys than girls. It’s also more common in children who have been exposed to radiation; who were born with certain genetic conditions; who have a weakened immune system; and who have contracted certain viruses, such as the Epstein-Barr virus that causes glandular fever.

The other type of lymphoma that children can get is called Hodgkin lymphoma.

Watch this video from Cancer Australia about what it can be like to have cancer as a child:

Types of non-Hodgkin lymphoma

There are 3 main types of non-Hodgkin lymphoma that occur in children:

Lymphoblastic lymphoma, which grows in cells called lymphoblasts, a type of lymphocyte. It can start in the thymus or glands in the neck and chest.

Burkitt lymphoma, which grows in B cells and often starts as a tumour in the abdomen.

Large cell lymphoma, which can start in B cells or T cells anywhere in the body.

Non-Hodgkin lymphoma symptoms

The symptoms of non-Hodgkin lymphoma depend on where the tumour is growing. They may include:

• swollen glands, usually in the neck, armpits or groin – these will be painless but won’t disappear
• fever
• night sweats
• unexplained weight loss
• swollen or painful tummy
• tiredness
• nausea or vomiting
• not feeling hungry, or feeling full quickly
• itchy red or purple lumps under the skin
• coughing or trouble breathing (if the lymphoma is in the chest)
• problems using the toilet (if the lymphoma is near the bladder or bowel)
• headaches, or problems with vision or speech (if the lymphoma presses on the brain)

Any of these symptoms can be due to other conditions and don’t necessarily mean your child has non-Hodgkin lymphoma. If you are worried about your child’s symptoms, however, you should see your doctor.

How is non-Hodgkin lymphoma diagnosed?

Different tests are used to diagnose non-Hodgkin lymphoma. The first step is usually to remove a lymph node or to take a biopsy from the affected area. In a biopsy, a small piece of tissue is removed to be tested in the laboratory.

Other tests may include blood tests, CT, MRI or PET scans, a lumbar puncture, or taking a sample of bone marrow or fluid.

If the test results show your child has non-Hodgkin lymphoma, a medical team will work out the stage the tumour is at. This means how big it is and whether it has spread. The tumour can be at:

Stage 1: small and unlikely to spread

Stage 2: likely to grow and spread

Stage 3: it has already spread to the lymph nodes, or is very likely to spread

Stage 4: it has already spread to distant parts of the body

Once doctors know the tumour’s stage, they can work out how to treat the non-Hodgkin lymphoma and what the outlook for your child is likely to be.

Non-Hodgkin lymphoma treatment

If your child has non-Hodgkin lymphoma, they will be looked after by a team of health professionals known as a multidisciplinary team. Together, this team will have a range of areas in which they specialise. Your child might see:

• paediatric oncologists — doctors who specialise in treating children's cancer
• medical oncologists — doctors who specialise in medicines to treat cancer
• radiation oncologists — doctors who specialise in using radiotherapy to treat cancer

Surgeons, nurses, social workers, rehabilitation therapists, psychologists, and other specialists may also be involved in your child’s care.

The best treatment for your child will depend on the type of tumour, where it is located, how quickly it is growing, and how your child reacts to treatment. Most children will have a mix of treatments. Options include:

Surgery: Surgery is sometimes used to remove the tumour, depending on where it is and whether it has spread. Your child may not need any further treatment.

Chemotherapy: Anti-cancer medicines are used to destroy the cancer cells. Your child may have a combination of different medicines.

Radiotherapy: High-energy x-rays are used to destroy the cancer cells.

Targeted therapy: Medicines are used to target cancer cells, with fewer side effects than with chemotherapy.

Bone marrow transplant: This is usually done along with chemotherapy or radiotherapy. It’s also called a stem cell transplant.

Where to look for information and support

The Cancer Council in your state or territory offers information and support for people with cancer. Call 13 11 20.

The Leukaemia Foundation provides information and free services to people with lymphoma.

Canteen helps children aged 12 to 25 affected by cancer. To talk to a health professional about information and support for young people, call 1800 835 932.

The Children’s Cancer Foundation provides family support and information about the latest treatments.

Kids with Cancer Foundation Australia provides financial assistance to children with cancer and their families.

Cancer Australia has links to support organisations for children with cancer and their families. It can also help you find clinical trials that your child could join and has a list of children’s hospitals in Australia.

Canteen's and Camp Quality's online community Parenting through cancer provides free expert advice, counselling and a chance to connect with other parents in similar situations.