Non-Hodgkin Lymphoma (pediatric)

What is non-Hodgkin lymphoma?
Lymphoma is cancer that begins in the cells of the immune system, specifically in the white blood cells that are designed to fight infection and protect the body from disease. There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma.

There are many different sub-types of non-Hodgkin lymphoma. They are usually characterized by how fast-growing or slow-growing they are, and in which type of white blood cell the cancer starts (T-cell or B-cell).

There are four main types of non-Hodgkin lymphoma in children:
• B-cell non-Hodgkin lymphoma (also known as Burkitt lymphoma)
• Diffuse large B-cell lymphoma
• Lymphoblastic lymphoma
• Anaplastic large cell lymphoma

What causes non-Hodgkin lymphoma?
Non-Hodgkin lymphoma starts when a white blood cell (a T-cell or a B-cell) becomes abnormal. This abnormal cells starts to grow and divide, creating more abnormal cells. As these abnormal cells increase in number, they start to crowd out the normal white blood cells and prevent them from doing their job, which is to protect the body against infection and disease.

The exact cause of lymphoma is unknown, but there are several factors that might increase the risk of developing non-Hodgkin lymphoma:
• Being infected with Epstein-Barr virus (EBV), a common viral infection which causes a disease named mononucleosis
• Being infected with HIV (the virus that causes AIDS)
• Being infected with Hepatitis C virus
• Weakened immune system

Having one or more risk factors does not mean that a person will definitely develop non-Hodgkin lymphoma. Alternatively, people who have no risk factors might develop non-Hodgkin lymphoma.

What are the symptoms of non-Hodgkin lymphoma?
Children who have non-Hodgkin lymphoma might experience some of the following symptoms (although these symptoms could be indicative of another condition):
• Painless masses (enlarged lymph nodes) under the skin are the most common symptom. These masses commonly fluctuate in size
• Swelling in the head, neck, upper body or arms
• Trouble breathing
• Fever
• Night sweats
• Coughing

How is non-Hodgkin lymphoma diagnosed?
At KHCC, physicians use different procedures and tests to properly diagnose and stage lymphoma:
• A biopsy is necessary to make a correct diagnosis and to determine subtype of the disease
•  X-ray of the chest
• CT scan of the involved areas and internal organs to screen for spread especially in the chest and abdomen
• PET scan (a machine is available at KHCC that works on combining images of CT and PET scans for more accuracy)
• Bone marrow biopsy
• Complete blood count (CBC) to detect anemia and low white cell or platelet count in cases of bone marrow involvement
• Other blood tests: including ESR, kidney and liver function tests

How is non-Hodgkin lymphoma treated at KHCC?
No two patients are alike even if they have the same type of lymphoma. Each case is potentially approached differently.

The treating physician will present the case to the MDC panel. The patient’s pathology samples and radiology results are carefully reviewed and relevant questions will be asked about the case, upon which a comprehensive treatment plan is decided. Observation, chemotherapy, radiation therapy, referral to BMT or a combination of these may be included in the treatment plan, depending on the patient’s specific diagnosis. Surgery is usually not an option for lymphoma patients.

Pediatric patients receive top quality care from a multidisciplinary team of pediatric oncology specialists that is entirely devoted to diagnosing and treating brain tumors and other childhood tumors.

Supportive Care
The pediatric multidisciplinary clinic works in close cooperation with other departments at KHCC so that pediatric cancer patients receive the most comprehensive care possible. Supportive care services at KHCC include: