Pediatric lymphoma is the third most common group of cancers found in young Americans. Approximately 2,200 people under the age of 20 receive the diagnosis each year, according to the National Cancer Institute. While those numbers sound staggering, pediatric lymphoma is actually rare, and only 8 percent of cancers that affect children and teens are lymphomas. Lymphomas are cancers that develop in lymphocytes, which are a type of white blood cell made in the bone marrow and concentrated in the blood and lymph tissue.

According to the Dana-Farber Cancer Institute, lymphoma can occur in both children and adults. However, the most common types, recommended treatments, and treatment outcomes are different for children.

In Childhood Cancer Survivorship, the authors report, “The therapeutic outcomes of microscopically identical cancers in adults and children are often different. … The fact that childhood cancer occurs in the context of rapid and dramatic growth and development also distinguishes it from adult cancers.”

The prognosis for children with lymphoma is generally positive, and it varies depending upon the type and stage of their lymphoma. The American Cancer Society cites survival rates between 80 percent and 90 percent for the most common types of pediatric lymphomas.

Understanding Lymphoma

Your body is a complex network of systems, each playing a supporting role to help you function and thrive. The lymphatic system maintains the balance of fluids in the body and helps fight infections. It consists of the bone marrow, thymus, lymph nodes, specialized patches of lymph tissue, and a network of lymphatic vessels and ducts. Lymphocytes develop in the bone marrow and thymus and then circulate throughout your body in clear lymph fluid and blood. Lymphoma is a cancer that originates in your lymphatic system.

Symptoms of Pediatric Lymphoma

Because of the position of the lymph nodes, swelling in your child’s neck, underarm, or groin areas are common signs of lymphoma. Other, less obvious signs can include:

• Swollen stomach.
• Diminished appetite or weight loss.
• Night sweats.
• Fever.
• Trouble swallowing.
• Difficulty coughing or breathing.
• Painless swelling of the testicle.
• Itchy skin.

When your child is sick, you’d do anything to help them feel better. It is important, when speaking with your doctor, to share any changes in your child’s physical well-being or behavior — regardless of whether you feel they’re relevant. Your pediatrician needs to see the holistic picture of your child’s health to make an accurate diagnosis. Should your doctor suspect lymphoma, you can request a referral to a pediatric oncologist to ensure your child receives diagnosis and treatment in an environment that is appropriate and supportive for children and families.

Types of Pediatric Lymphoma

Lymphomas are generally classified in two categories: non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). HL includes the presence of Reed-Sternberg cells, abnormally large cells that may contain more than one nucleus. In NHL, Reed-Sternberg cells are not present.

NHL is the most common among the pediatric lymphomas diagnosed in children up to age 14. The three most common subtypes are:

• T-cell lymphoma, generally found in preadolescent or adolescent males.
• Large cell lymphoma, generally found in children over 5.
• Small cell lymphoma, further classified as Burkitt's or non-Burkitt’s.

There is no single diagnostic tool or treatment protocol for pediatric lymphoma. Your clinical team will recommend the best approach to meet your child’s specific medical needs.

Non-Hodgkin Pediatric Lymphoma

The American Cancer Society reports that non-Hodgkin pediatric lymphoma is two to three times more common in boys than girls. It appears more frequently in children with European heritage than in those with African heritage, and it is uncommon in children younger than 3. The risk rises with a child’s age.

Other risk factors include:

• Inherited, congenital immune deficiencies.
• Organ transplants.
• HIV or AIDS.
• Exposure to radiation because of atomic bombs or nuclear reactor accidents.
• Infection with the Epstein-Barr virus, which causes mononucleosis.

Diagnosis and Treatment

To determine whether a child has NHL, a bone marrow biopsy must be performed to check for signs of cancer. Other tests may be conducted — including total body imaging, lumbar puncture, blood tests, and tests of heart, lung, or liver function — to determine if the cancer has spread within the lymphatic system or other parts of the body. If confirmed, the course of treatment will vary depending on the location and progress of the disease. Treatment may include surgery, chemotherapy, immunotherapy, radiation, or targeted therapy.

Hodgkin Pediatric Lymphoma

According to the American Cancer Society, Hodgkin lymphoma is the most common cancer diagnosed in teenagers ages 15 to 19. People in their 20s are at greater risk for developing HL, and the risk rises again after age 55. HL is rare in children under 5. It is more common in males than in females.

There are other known risk factors for developing Hodgkin lymphoma:

• A sibling, especially a twin, with the disease.
• A weakened immune system due to medications after an organ transplant, autoimmune disease, or HIV.
• Epstein-Barr virus infection, the cause of mononucleosis.

It’s not well understood why these factors increase risk, and having them does not guarantee your child will be diagnosed with the disease.

Diagnosis and Treatment

After a thorough examination and a health history, your child will undergo tests to properly diagnose Hodgkin lymphoma. A biopsy, blood tests, a chest X-ray, scans, bone marrow aspiration and biopsy, ultrasounds, blood tests, and tests of heart, lung, or liver function may be performed. These can help determine if cancer has spread within the lymph system or to other parts of the body. If confirmed, the course of treatment for most Hodgkin lymphoma is chemotherapy. Doctors will prescribe the most appropriate type and dosage for the stage and type of your child’s lymphoma. Radiation treatments, along with proton therapy, may be prescribed.

After the Diagnosis

If your child is diagnosed with lymphoma, take heart and remember that survival rates for lymphoma are favorable. Know that strides are being made each day on treatment protocols and outcomes through clinical studies. A parent’s positive attitude can help your child face the next steps with strength and resiliency.

Take a deep breath and implement some actionable steps to prepare you and your child. These might include:

• Bring a trusted neighbor or friend with you to doctors’ appointments to take notes while you talk with the doctor. This is an overwhelming time for any parent, and it may help you focus on the conversation without worrying about forgetting what is said. You could also ask the doctor whether it’s OK to record the meeting.
• Choose specialists who have experience working with children. You will want a physician who looks at your child holistically. This will be a journey. You need to have confidence in the team that will be leading your child’s treatment.
• Get a second opinion if you need it, but keep moving forward. Your child’s health depends upon it.
• Lean on your support system. Accept help from family, friends, work colleagues, your church, or other social groups. If they offer to mow your lawn, collect your mail, or pick a child up from sports practice or dance class, allow them to assist you. You need to focus on your child’s health.
• Finally, don’t forget to take care of your own health as much as you can by eating right, getting physical exercise, and managing stress with prayer, meditation, catching up with friends — whatever works for you. You need to be in good health to help your child return to good health.

The pediatric lymphoma journey may be a difficult one, but know that this path has been travelled before. On MyLymphomaTeam, you gain a community of more than 150 parents caring for a child with lymphoma.

Do you care for a child living with lymphoma? What advice would you offer other parents facing a recent diagnosis for their child? Comment below or post on MyLymphomaTeam.