Non-Hodgkin's Lymphoma

Non-Hodgkin's lymphoma (NHL) is a form of cancer that occurs in the lymph nodes or other lymphoid tissues such as tonsils, thymus or gastrointestinal tract. These lymph nodes and lymphoid tissues make up the lymph system. 

The lymph system plays an important role in the body's fight against infection. It is made up of hundreds of small, bean-sized lymph nodes that are connected by lymph vessels. A clear fluid, called lymph, circulates throughout the system. Lymph is mostly made up of white blood cells called lymphocytes. White blood cells are important in the body's ability to fight disease, since they kill foreign matter in the body.

In NHL, some of the cells that make up the lymphatic tissues become abnormal. They divide rapidly, crowding out the normal cells. As the disease advances, it may spread to the bone marrow, central nervous system, liver, spleen and reproductive organs. The cause of NHL is unknown and may occur at any age from infancy through adulthood. In children, this disease is slightly more common among 4- to 8-year-olds, and in teenagers. However, the disease is much different in children than in adults.

The symptoms of NHL depend on where the disease begins and how far it has spread. Since NHL arises from lymphoid tissues which are present throughout the body; the disease may occur in any part of the body.

The most common symptom of NHL is a painless swelling of lymph nodes in the neck, groin, or armpit.

An enlarged lymph node in the chest or abdomen may not be noticed until it is large enough to cause problems.

If lymph nodes in the chest are affected, symptoms may include fever, cough, difficulty breathing, fatigue and shortness of breath.

If lymph nodes in the abdomen are involved, symptoms may include pain, development of a mass or swelling, vomiting, diarrhea or constipation and weight loss.

The diagnosis of NHL is made by biopsy of an involved lymph node. This procedure is done in surgery under general anesthesia so that your child is not conscious and will not feel any pain. A suspicious lymph node is removed and looked at under the microscope. Thin slices of the tissue are studied for the presence, type, and arrangement of cancer cells characteristic of the disease. If the bone marrow is involved, diagnosis may be made by bone marrow aspirate and biopsy.

Once the diagnosis of NHL is made, a number of tests are performed to see if the disease has spread through the lymph system to other parts of the body. These tests usually include blood tests, a spinal tap or lumbar puncture, bone marrow aspirate and biopsy, and X-rays. A CT scan may be done to check lymph nodes deep in the chest and abdomen.  Radioisotope scanning (PET scan and bone scan) is useful for detecting the spread of NHL to the liver, bones or spleen.

The treatment of NHL is related to the location of the tumor and how far the disease has spread.

The primary treatment is chemotherapy. In select cases, radiation therapy is also used. If the disease is in one place of the body or localized, treatment may consist of surgery and a short, less intensive course of chemotherapy.

If the disease is more advanced involving the thymus, chest or abdominal lymph nodes, liver or central nervous system, then the treatment usually includes many high-dose chemotherapy drugs and possibly bone marrow or stem cell transplantation.

In many children with advanced disease, there is a large tumor mass when the diagnosis is made. The first treatment with chemotherapy may cause kidney damage from the breakdown of so many tumor cells. Giving fluids and certain medications can help to protect the kidneys from damage.

Currently, the overall cure rate for NHL is approximately 70 percent. Children with localized disease have a better prognosis than those with advanced disease.

Cincinnati Children's is an international referral center for the treatment of children and young adults with high-risk and relapsed NHL. Our faculty leads national efforts in the development of new targeted therapies, immunological approaches, and stem cell transplantation. Learn more about active treatment regimens for relapsed NHL.

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Last Updated 12/2013