This information is about non-Hodgkin lymphoma (NHL) 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.

About 80 children, of all ages, develop non-Hodgkin lymphoma in the UK each year. It is more common in boys than girls.

Non-Hodgkin lymphoma is cancer of the lymphatic system.

The lymphatic system is part of the immune system, which is the body’s natural defence against infection and disease. This 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 lymphatic 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: Hodgkin's disease and non-Hodgkin lymphoma. Although these are both types of lymphoma, there are significant differences between them, which means that the treatment is also different.

There are two main types of non-Hodgkin lymphoma: B-cell NHL usually involves the lymph nodes in the abdomen and intestines, but may involve nodes in the head and neck. The other type is T-cell NHL, which usually affects lymph nodes in the chest.

Occasionally, non-Hodgkin lymphoma can develop in unusual places outside the lymph nodes, such as the stomach. This is called extranodal lymphoma.

The causes of NHL are largely unknown. However, children who have deficiencies of the immune system, or who have used immune suppressing drugs for a long time, are at increased risk of NHL.

The first sign of NHL is usually a swelling of a group of lymph nodes somewhere in the body. The swelling is usually painless. If the glands in the chest become very large, your child may have some problems with breathing, can have a cough, and could develop a puffy face and neck.

If glands in the abdomen are affected, this may cause some blockage of the bowel, in which case an operation to relieve it may need to be needed. Other symptoms include, a high temperature (fever), tiredness, weight loss and loss of appetite. In a few children with NHL, lymphoma cells may be found in the bone marrow, or the fluid around the spinal cord (cerebrospinal fluid).

A variety of tests and investigations may be needed to diagnose non-Hodgkin lymphoma. Part, or all, of a swollen lymph gland may be removed so that the cells can be examined in the laboratory (biopsy). This involves a small operation that is usually done under a general anaesthetic. Tests such as x-rays, ultrasound scans, CT scans and blood tests are carried out to find the extent of the disease. This is known as staging.

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

The 'stage' of a cancer is a term used to describe its size and whether it has spread beyond its original site. The type of treatment your child receives depends on the stage of the disease. A simplified version of the stages of non-Hodgkin lymphoma is as follows:

• Stage 1 One group of lymph nodes is affected, or there is a single extranodal tumour.
• Stage 2 Two or more groups of nodes are affected, or there is a single extranodal tumour which has spread to nearby lymph nodes, or there are two single extranodal tumours, but only on one side of the diaphragm (the sheet of muscle under the lungs that plays a large part in our breathing).
• Stage 3 There is lymphoma on both sides of the diaphragm (either in two or more groups of nodes) or there are two single extranodal tumours; or the lymphoma is affecting the chest.
• Stage 4 The lymphoma has spread beyond the lymph nodes to other organs of the body, such as the bone marrow or nervous system.

Chemotherapy is the most important treatment for children with NHL. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is common for a combination of drugs to be used, and treatment may last for a number of months or years. The treatment will be planned according to your child’s particular type of NHL and the stage of the disease. T-cell NHL is treated for around two years, and treatment for B-cell is usually shorter. Your child’s doctor will discuss the treatment options with you.

Non-Hodgkin lymphoma may sometimes affect the brain and spinal cord. To stop this, chemotherapy may be injected directly into the fluid around the spinal cord (intrathecal chemotherapy).

Occasionally, radiotherapy is also necessary. Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.

High-dose chemotherapy with a bone marrow transplant is sometimes used if the NHL comes back (recurs) after initial treatment.

Treatment for NHL often causes side effects, and your child’s doctor will discuss this with you before 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 vomiting, temporary hair loss, an increased risk of infection, bruising and bleeding, tiredness and diarrhoea.

A small number of children may develop late side effects, sometimes many years later, that are caused by their treatment for non-Hodgkin lymphoma. These include possible reduction in bone growth, a change in the way the heart and lungs work, and a slightly increased risk of developing another cancer in later life.

After treatment with chemotherapy, some children – particularly boys – may become infertile, although this is uncommon. Parents of teenage boys should be aware of the option of sperm banking. 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. There is more detailed information about these late side effects in our general information on children's cancers.

Many children have their treatment as part of a clinical research trial. Trials aim 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'll be given plenty of time to decide if it is right for your child.

Once treatment has ended, the doctors will monitor your child closely, with regular scans and blood tests in the hospital outpatients department.

Over 80% of the children who get NHL recover completely. The chances of successful treatment depend on the specific type, stage and grade of lymphoma. Your child’s doctor will be able to discuss these details with you.

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 in detail.

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.