What is non-Hodgkin lymphoma?

Lymphoma is a type of cancer that occurs in the lymphatic system. Non-Hodgkin lymphoma happens when a type of white blood cell, known as a lymphocyte, grows in an uncontrolled way.

Types of lymphocytes include B cells and T cells. These cells have different functions in your immune system.

A tumour can grow anywhere where there is lymph tissue. It can grow in the:

• lymph nodes (glands)
• spleen
• bone marrow
• thymus (a small organ in front of the heart)
• adenoids and tonsils
• stomach and intestines

Because normal lymphocytes travel through your body fighting infection, the cancerous cells can quickly spread to other organs.

The other type of lymphoma that children can get is called Hodgkin lymphoma (also known as Hodgkin disease).

What are the types of non-Hodgkin lymphoma?

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

1. 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.
2. Burkitt lymphoma — which grows in B cells and often starts as a tumour in the abdomen.
3. Large cell lymphoma — which can start in B cells or T cells anywhere in the body.

What are the symptoms of non-Hodgkin lymphoma?

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
• tiredness
• nausea or vomiting
• fever or night sweats
• not feeling hungry, or feeling full quickly
• swollen or painful tummy
• itchy red or purple lumps under the skin

Other symptoms depend on where the lymphoma is:

• coughing or trouble breathing (if the lymphoma is in the chest)
• problems using the toilet, such as finding it hard to do a wee or poo (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, take them to see a doctor.

What causes non-Hodgkin lymphoma?

We don't know why some children develop non-Hodgkin lymphoma. It's more common in adolescents than in younger children. It's rare in children less than 5 years old.

Non-Hodgkin lymphoma occurs more often in males than females.

It's more common in children who:

• have been exposed to radiation
• were born with certain genetic conditions
• have a weakened immune system
• have contracted certain viruses, like Epstein-Barr virus that causes glandular fever

When should I see my doctor?

See your doctor if your child has any of the signs and symptoms of non-Hodgkin lymphoma. Also, speak to your doctor if you notice any symptoms in your child that don't go away.

How is non-Hodgkin lymphoma diagnosed?

A range of 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 and tested in the laboratory.

Other tests may include:

• blood tests
• a CT scan
• an MRI scan
• a PET scan
• a lumbar puncture

If your child has non-Hodgkin lymphoma, their medical team will find out the stage of the tumour. This means how big it is and whether it has spread. The tumour can be at:

• Stage 1 — early disease and only involving one small group of lymph nodes either above or below the diaphragm.
• Stage 2 — still early disease but involving 2 or more groups of lymph nodes either above or below the diaphragm.
• Stage 3 — there are cancer cells in lymph nodes both above and below the diaphragm.
• Stage 4 — multiple lymph node areas are involved and cancer has spread to other body parts or organs such as the bone, liver or lungs.

Once doctors know the stage of disease they can work out how to treat the non-Hodgkin lymphoma. They will also know what your child's prognosis (outlook) is likely to be.

How is non-Hodgkin lymphoma treated?

If your child has non-Hodgkin lymphoma, a team of health professionals known as a multidisciplinary team will look after them. Each person in this team will be an expert in one area. Your child might see a:

• paediatric oncologist — doctor who specialises in treating children's cancer
• medical oncologist — doctor who specialises in medicines to treat cancer
• radiation oncologist — doctor who uses radiotherapy to treat cancer
• surgeon
• nurse
• social worker
• rehabilitation therapist
• psychologist

The best treatment for your child will depend on:

• the type of tumour
• where the tumour is in the body
• how quickly the tumour is growing
• how your child reacts to treatment

Most children will have a mix of treatments. Options include:

• Chemotherapy — anti-cancer medicines are used to destroy the cancer cells. Your child may need a combination of different medicines.
• Targeted therapy — medicines are used to target cancer cells, with fewer side effects than with chemotherapy.
• Radiotherapy — high-energy x-rays are used to destroy the cancer cells.
• Surgery — is used to remove the tumour, depending on where it is and whether it has spread. Your child may not need any further treatment.
• Bone marrow transplant — this is also called a stem cell transplant. It is usually used if the other treatments were not effective or if the cancer came back after chemotherapy.

Most treatment plans for children with non-Hodgkin lymphoma include chemotherapy and targeted therapy. Radiotherapy and surgery are less commonly used treatment options.

Living with non-Hodgkin lymphoma

A cancer diagnosis can be very distressing for you, your child and many people around your child.

For more information on coping with a cancer diagnosis and treatment in childhood, see:

• Support for children with cancer
• Support for parents of children with cancer

Complications of non-Hodgkin lymphoma

Some of the main complications of non-Hodgkin lymphoma are:

• a weakened immune system
• infertility (problems having children) after having cancer treatment
• getting another type of cancer
• heart disease
• lung disease

Can non-Hodgkin lymphoma be prevented?

Non-Hodgkin lymphoma can't be prevented. Some people who have a weakened immune system have a higher risk of getting it.

Resources and support

Information about lymphoma

The Cancer Council in your state or territory offers information and support for people with cancer. Call 131120.

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

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Family support

Canteen helps children aged 12 to 25 years affected by cancer. To talk to a health professional about information and support for young people, call 1800 226 833.

The Children's Cancer Foundation offers family support and information about the latest treatments.

Kids with Cancer Foundation Australia gives financial assistance to children with cancer and their families or call 1800 255 522.

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.

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