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 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).

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

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
• unexplained weight loss
• swollen or painful tummy
• itchy red or purple lumps under the skin

Other symptoms depend on the location of the lymphoma:

• 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, you should see your 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, and it’s rarely seen in children less than 5 years old.

Non-Hodgkin lymphoma is also seen 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 you notice a change in your child or if your child has any of the signs and symptoms of non-Hodgkin lymphoma.

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

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: early disease and only involving one small group of lymph nodes on one side of the diaphragm.
• Stage 2: still early disease but involving 2 or more groups of lymph nodes on the same side of the diaphragm.
• Stage 3: cancer cells are seen in lymph nodes above and below the diaphragm.
• Stage 4: multiple lymph node areas are involved and other body parts or organs such as the bone, liver or lungs.

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

How is non-Hodgkin lymphoma treated?

If your child has non-Hodgkin lymphoma, they will be looked after by a team of health professionals known as a multidisciplinary team. Each person in this team will be an expert in one area. 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

The best treatment for your child will depend on:

• the type of tumour
• where it is located
• how quickly it is growing
• how your child reacts to treatment

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

• 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.

Can non-Hodgkin lymphoma be prevented?

There are no proven ways to prevent non-Hodgkin lymphoma. Some people who have a weakened immune system have a higher risk of getting it.

Complications of non-Hodgkin lymphoma

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

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

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 gives information and free services to people with lymphoma.

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 gives 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.

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.