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Because there is lymph tissue in many parts of the body, non-Hodgkin's lymphoma can start in almost any part of the body. The cancer can spread to almost any organ or tissue in the body, including the liver, bone marrow (the spongy tissue inside the large bones of the body that makes blood cells), and the spleen.
Lymphomas are divided into two general types: Hodgkin's disease and non-Hodgkin's lymphomas. Both of these diseases are treated differently and occur in both children and adults. (Refer to the PDQ summaries on Adult Hodgkin's Disease Treatment; Childhood Hodgkin's Disease Treatment; and Adult Non-Hodgkin's Lymphoma Treatment for more information.)
There are three major types of childhood non-Hodgkin's lymphomas:
lymphoblastic lymphoma, small noncleaved cell lymphoma (either Burkitt's lymphoma or non-Burkitt's lymphoma), and large cell lymphoma. The type is determined mainly by what the cancer cells look like under a microscope. The way the cells look under a microscope is called the "histology" of the cancer.
If your child has symptoms, your doctor will examine your child carefully and check for swelling or lumps in the neck, underarms, groin, and abdomen. A chest x-ray will usually be done to check for swellings in the chest. If the lymph nodes don't feel normal, or a lump is found in the chest or abdomen, your child's doctor may need to cut out a small piece of tissue and look at it under the microscope to see if there are any cancer cells. This is called a biopsy.
Your child's chance of recovery (prognosis) and choice of treatment depend on the stage of your child's cancer (whether it is just in one area or has spread throughout the body), the type of lymphoma, and your child's age and overall condition.
The following stages are used for childhood non-Hodgkin's lymphoma:
Cancer is found in only one area and in the lymph nodes around it.
Cancer is found in two or more lymph nodes or other areas on the same side of the diaphragm (the thin muscle under the lungs that helps you breathe).
Cancer is found to have started in the digestive tract. The lymph nodes in the area may or may not have cancer.
Cancer is found in tumors or lymph nodes on both sides of the diaphragm.
Cancer is found to have started in the chest.
Cancer is found in many places in the abdomen.
Cancer is found in the area around the spine, around the outermost covering of the brain, or on the outermost covering of the brain (these tumors are called epidural tumors).
Chemotherapy uses drugs to kill cancer cells and shrink tumors. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Chemotherapy may also be put into the fluid that surrounds the brain through a needle in the brain or back (intrathecal chemotherapy) to treat certain types of non-Hodgkin's lymphoma that spread to the brain.
Bone marrow transplantation is a newer type of treatment. Sometimes lymphoma cells become resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy the bone marrow, marrow is taken from the bones before treatment. The marrow is then frozen and high-dose chemotherapy with or without radiation therapy is given to treat the cancer. The marrow that was taken out is then thawed and given back through a needle in a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow given is taken from another person, the transplant is called an allogeneic transplant.
Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child go into a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients. Clinical trials are ongoing in most parts of the country for advanced stages of childhood non-Hodgkin's lymphoma. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
1. Allogeneic bone marrow transplantation.
2. Systemic chemotherapy with different drugs than were used before.
3. A clinical trial of new methods of treatment.
Your child's treatment will probably be systemic chemotherapy with or without intrathecal chemotherapy.
Your child's treatment will probably be systemic chemotherapy plus intrathecal chemotherapy. Clinical trials are testing new combinations and doses of drugs.
Your child's treatment will depend on where the cancer comes back, the type of treatment that was given before, and your child's overall condition. Your child's treatment may be one of the following:
1. Systemic chemotherapy.
2. Allogeneic or autologous bone marrow transplantation.
3. Systemic chemotherapy plus intrathecal chemotherapy.
4. A clinical trial of new methods of treatment.
1. Allogeneic or autologous bone marrow transplantation.
2. Systemic chemotherapy with or without intrathecal chemotherapy.
3. A clinical trial of new methods of treatment.
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site (Http: //cancer.gov) provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator (https://cissecure.nci.nih.gov/ncipubs). These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov (Http: //cancer.gov), the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, non-technical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at Cancer.gov (Http: //cancer.gov/clinical_trials). Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
The PDQ database contains listings of groups specializing in clinical trials.
The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on Cancer.gov (Http: //cancer.gov) or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
The PDQ database contains listings of cancer health professionals and hospitals with cancer programs.
Because cancer in children and adolescents is rare, the majority of children with cancer are treated by health professionals specializing in childhood cancers, at hospitals or cancer centers with special facilities to treat them. The PDQ database contains listings of health professionals who specialize in childhood cancer and listings of hospitals with cancer programs. For help locating childhood cancer health professionals or a hospital with cancer programs, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Date Last Modified: 09/2002
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