Lymphoma – Hodgkin – Childhood

Overview

Types of Hodgkin lymphoma

There are four types of Hodgkin lymphoma. These are often treated in a similar manner, although research is emerging that will lead to new treatment approaches for some types.

Nodular sclerosis Hodgkin disease (NSHD). This is the most common type of Hodgkin lymphoma in the United States and other developed countries. It is most common in girls. Tumors are often very bulky, begin in the neck, chest, or abdomen, and may spread to the lungs.
Mixed cellularity Hodgkin disease (MCHD). This type is more common in people who have had the Epstein-Barr virus (the virus that causes mononucleosis) and is more common in boys. It is also the most common type of Hodgkin lymphoma seen in those with human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS). It usually begins in the lymph nodes in the abdomen or in the spleen.
Lymphocyte predominant Hodgkin disease (LPHD). In this type, cells under the microscope resemble normal lymphocytes. It usually begins in the lymph nodes of the underarm, neck, and groin, and less commonly involves the lymph nodes in the chest. In young children, LPHD is much more common in boys; in fact, the boy-to-girl ratio is approximately 10:1.
Lymphocyte depleted Hodgkin disease (LDHD). This is a very rare, aggressive type. It appears in the lymph nodes of the abdomen or pelvis, usually skipping the lymph nodes in the neck or underarms. LDHD is very uncommon in children.

There are three different forms of Hodgkin lymphoma:

• A childhood form (in children 14 years or younger)
• A young adult form (in people 15 to 34 years old)
• An older adult form (in people 55 to 74 years old)

Risk Factors

A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do.
The cause of Hodgkin lymphoma is unknown, although infection with the Epstein-Barr virus may trigger the development of the cancer in approximately 30% of children and teens. People with immune system problems also have a higher risk of developing Hodgkin lymphoma. This group includes:

• Children born with the hereditary condition of ataxia telangiectasia, which causes immune system problems
• Children with HIV/AIDS

Symptoms

Children with Hodgkin lymphoma may experience the following symptoms:

• Painless swelling of lymph nodes in the neck, underarm, or groin that doesn’t go away in a few weeks
• Unexplained fever (without other signs of infection) that doesn’t go away
• Itching
• Fatigue
• Unexplained weight loss
• Night sweats (usually drenching)

Treatment overview

Treatment of Hodgkin lymphoma consists of chemotherapy and/or radiation therapy. Surgery is not commonly used as a treatment, although it may sometimes be used for localized lymphocyte predominant Hodgkin disease (LPHD).
The amount and type of treatment used to treat Hodgkin lymphoma depends on how many lymph node areas are involved and how large the lymph nodes have grown. Children with more widespread (advanced) or “bulky” disease may have more cycles of chemotherapy and radiation therapy than children with early-stage disease. New studies of childhood Hodgkin lymphoma are trying to further reduce the amount of treatment to avoid long-term side effects.
Descriptions of the most common treatment options for childhood Hodgkin lymphoma are listed below.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy uses drugs to target cancer cells throughout the body. Chemotherapy for childhood Hodgkin lymphoma is given by a pediatric oncologist. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time.