This information is about Hodgkin lymphoma in children. It is helpful to read it alongside our general information on children's cancer, which contains more information about cancers in children, their diagnosis and treatment, and the support services available.

Fewer than 60 children in the UK develop Hodgkin lymphoma each year. It can affect children at any age, but is more common in teenagers and young adults. During childhood, boys are more often affected, but in the teenage years boys and girls are affected equally.

Hodgkin lymphoma was first described by Dr Thomas Hodgkin in 1832. It is a cancer that affects the lymphatic system. The lymphatic system is part of the immune system; the body’s natural defence against infection and disease. It is a complex system made up of the bone marrow, thymus, spleen, and lymph nodes throughout the body. These are connected by a network of tiny vessels called lymphatics or lymph vessels.

Lymph nodes are also known as lymph glands, and the ones you are most likely to notice are those in the neck, armpit and groin. The number of lymph nodes varies from one part of the body to another – in some parts there are very few, whereas under your arm there may be between 20 and 50 nodes.

Cancers which start in the lymphatic system are called lymphomas. There are two main types of lymphoma: non-Hodgkin lymphoma and Hodgkin lymphoma. Although these are both types of lymphoma, there are differences between them, which means that the treatment is also different.

The exact cause of Hodgkin lymphoma is unknown. However, there is increasing evidence that infections (such as the virus that causes glandular fever) may play a part in the development of Hodgkin lymphoma.

The first sign of Hodgkin lymphoma is usually a painless swelling of one gland, or a group of lymph glands, which continues for some weeks. The first glands to be affected are usually in the neck, most often on one side only, in a small area above the collarbone.

Sometimes, enlarged glands can be felt in the armpit or groin.

If glands in the chest are affected, this can cause a troublesome cough or breathlessness.

Occasionally, a child with Hodgkin lymphoma may have a high temperature (fever), night sweats, severe itching or weight loss.

In order to diagnose Hodgkin lymphoma, part, or all, of a swollen lymph gland has to be removed so that the cells can be examined in the laboratory. This is known as a biopsy and is a small operation that is usually done under a general anaesthetic. Further tests, such as x-rays, CT and MRI scans and blood tests, are carried out to find the exact size and position of the lymphoma and whether it has spread. Very often, a bone marrow sample will be taken.

Any tests and investigations that your child needs will be explained to you. Our general information on children’s cancers, gives details of what the tests and scans involve.

'Staging' is the term used to describe the size and position of the cancer and whether it has spread. It is very important, because the type of treatment your child receives depends on the stage of the disease. The staging system for Hodgkin lymphoma is as follows:

• Stage 1 Only one group of lymph nodes is affected and the lymphoma is only on one side of the diaphragm (the sheet of muscle under the lungs that controls breathing).
• Stage 2 Two or more groups of lymph nodes are affected but the lymphoma is still only on one side of the diaphragm.
• Stage 3 There are lymphoma cells in the lymph nodes above and below the diaphragm. The spleen may also be affected.
• Stage 4 The lymphoma has spread beyond the lymph nodes – for example to the liver, lungs or bone marrow.

As well as giving each stage a number, doctors also use a letter code – either A or B – to show if your child has the following specific symptoms: fever, significant weight loss (more than a tenth of their body weight in the last six months) or night sweats. If your child has none of these symptoms the lymphoma will be classified as A, and if they do have these symptoms it is classified as B.

Children with B symptoms are usually more unwell and may need more intensive treatment.

Hodgkin lymphoma in children is treated with chemotherapy, but sometimes radiotherapy is also needed. When the cancer has not spread beyond its original site (localised disease) radiotherapy alone may be used, following surgery to remove the affected nodes. The type and amount of treatment given depends on the stage of the disease at diagnosis. Your child’s doctor will discuss the treatment options with you.

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usual for a combination of drugs to be used, often given every few weeks over a number of months.

Radiotherapy treats cancer by using high-energy rays that destroy the cancer cells while doing as little harm as possible to normal cells. Radiotherapy is usually given for a few minutes each day, from Monday to Friday, over 2–4 weeks.

Treatment often causes side effects, and your child’s doctor will discuss these with you before the treatment starts. Any possible side effects will depend upon the particular treatment being used and the part of the body that is being treated. Side effects can include feeling sick (nausea) and being sick (vomiting), hair loss, an increased risk of infection or bruising and bleeding, tiredness and diarrhoea.

Late side effects

A small number of children may develop side effects many years later. These include a possible reduction in bone growth, a change in the way the heart and lungs work, and a small increase in the risk of developing another cancer in later life.

After treatment with chemotherapy, some children (particularly boys) may become infertile. Teenage boys and their parents should be made aware of the option of banking sperm before treatment starts. In this situation, sperm can be stored for possible use in later years.

Your child’s doctor or nurse will explain more about any possible late side effects. More detailed information about the possible late side effects of treatment can be found in our general information on children's cancer.

Many children have their treatment as part of a clinical research trial. The aim of treatment for Hodgkin lymphoma is to achieve the best survival with the least short and long-term side effects. This forms the basis of any clinical trial. Research aims to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version of the standard treatment. Specialist doctors carry out trials for children's cancer.

Your child's medical team will talk to you about taking part in a clinical trial (if appropriate) and will answer any questions you may have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and you will be given plenty of time to decide if it is right for your child.

About nine out of every 10 children who develop Hodgkin lymphoma are cured. If the cancer comes back, further (different) treatment can be given.

After the treatment is completed, your child will be checked regularly with scans and blood tests in the hospital.

If you have specific concerns about your child’s condition and treatment, it is best to discuss them with your child’s doctor, who knows the situation.

As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many different emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions, and are part of the process that many parents go through at such a difficult time.

Your child may have a range of powerful emotions throughout their experience of cancer. Our booklet, Peppermint Ward is a storybook for younger children with cancer. It looks at the issues that they and their family may face, and helps them to explore their feelings. You can order the booklet online.

This section has been compiled using information from a number of reliable sources, including:

• Cancer in Children: Clinical Management (5th ed). Eds PA Voute et al. Oxford University Press, 2005.

For further references, please see the general bibliography.