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The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains white blood cells called lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, chest, and abdomen. The lymph nodes make and store infection-fighting cells. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (lymph tissue in the throat) are also part of the lymph system.
Because there is lymph tissue in many parts of the body, Hodgkin's disease 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 2 general types: Hodgkin's disease and non-Hodgkin's lymphomas. (Refer to the PDQ summaries on Adult Non-Hodgkin's Lymphoma Treatment and Childhood Non-Hodgkin's Lymphoma Treatment for more information.) This summary covers only childhood Hodgkin's disease. Adult Hodgkin's disease is often treated differently. (Refer to the PDQ summary on Adult Hodgkin's Disease Treatment for more information.)
Hodgkin's disease is rare in children under 5 years of age. In children under age 10, it is more common in boys than girls. The symptoms of childhood Hodgkin's disease may include any of the following: painless swelling of the lymph nodes in the neck or underarm area that doesn't go away within a few weeks; fever that doesn't go away; night sweats; and weight loss without dieting. If the lymph nodes don't feel normal when examined by a doctor, the doctor may need to cut out a small piece of tissue and look at it under a microscope to see if there are any cancer cells. This is called a biopsy.
Most children with Hodgkin's disease receive combination chemotherapy and low-dose radiation therapy.
The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread throughout the body), the type of symptoms that are present, and the age and overall condition of the child.
The stage of disease may be determined by physical examination, blood tests, and different kinds of x-rays. This is called clinical staging. In some cases, an operation called a laparotomy is performed to determine the stage of the cancer. During this operation, the abdomen is opened to see if the organs inside contain cancer. Small pieces of tissue are removed during the operation and examined under a microscope to see whether they contain cancer. This type of staging is called pathologic staging. Pathologic staging is usually done only when it is needed to help plan treatment. During this operation, the spleen may be removed and the child may receive medicine to prevent infection.
If an operation is not possible, a needle biopsy may be performed. This is a procedure in which tissue is removed with a needle for examination under a microscope.
Each stage of childhood Hodgkin's disease is further divided into A and B categories based on whether the child has symptoms. Children with no symptoms are in the A category, while those who have symptoms (such as fever, weight loss, or night sweats) are in the B category. For example, a child with stage I disease without any symptoms is said to have stage IA disease; a child with stage I disease with symptoms is said to have stage IB disease.
The following stages are used for childhood Hodgkin's disease:
Cancer is found in 2 or more lymph node areas on the same side of the diaphragm (the thin muscle under the lungs that helps with breathing).
Cancer is found in only 1 area or organ outside of the lymph nodes and in the lymph nodes around it. Other lymph node areas on the same side of the diaphragm may also have cancer.
Cancer has spread in more than 1 spot to an organ or organs outside of the lymph system. Cancer cells may or may not be found in the lymph nodes near these organs.
Cancer has spread to only 1 organ outside of the lymph system, but lymph nodes far away from that organ are involved.
Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for childhood Hodgkin's disease usually comes from a machine outside the body (external beam radiation therapy). Radiation therapy given to the neck, chest, and lymph nodes under the arms is called radiation therapy to the mantle. Radiation therapy given to the mantle and to the lymph nodes in the upper abdomen, the spleen, and the lymph nodes in the pelvis is called total nodal irradiation. Radiation therapy may be used alone or in addition to chemotherapy.
Chemotherapy is the use of drugs to kill cancer cells and shrink tumors. Chemotherapy may be taken by pill, or it may be put into the body by inserting a needle into 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.
Bone marrow transplantation is a newer type of treatment. Sometimes Hodgkin's disease becomes 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 patient's bones before treatment. The marrow is then frozen and high-dose chemotherapy with or without radiation therapy is given to the patient to treat the cancer. The marrow that was taken from the patient is then thawed and given back through a needle into a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the patient is given marrow taken from another person, the transplant is called an allogeneic transplant.
Some patients develop another form of cancer as a result of their treatment for Hodgkin's disease; therefore, regular follow-up evaluations may be made. Female patients who received radiation therapy between the ages of 10 and 16 have an increased risk of breast cancer.
Treatment for childhood Hodgkin's disease depends on the type and stage of disease and how the stage was determined, as well as the child's age, symptoms, and general health.
Patients may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or parents may choose to have their child treated in the context of 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 most stages of childhood Hodgkin's disease. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:
1. Chemotherapy with low-dose radiation therapy to areas that contain
cancer.
2. A clinical trial of chemotherapy with or without radiation therapy.
3. A clinical trial of chemotherapy alone.
If the cancer is above the diaphragm and involves a large part of the chest, treatment may be one of the following:
1. Chemotherapy followed by radiation therapy to the chest or the mantle.
2. A clinical trial of chemotherapy plus low-dose radiation therapy.
1. Chemotherapy plus low-dose radiation therapy to areas that contain cancer.
2. A clinical trial of low-dose chemotherapy with or without radiation
therapy.
3. A clinical trial of chemotherapy alone.
If the cancer is above the diaphragm and involves a large part of the chest, treatment may be one of the following:
1. Chemotherapy followed by radiation therapy to the chest or the mantle.
2. A clinical trial of chemotherapy plus low-dose radiation therapy.
1. Chemotherapy followed by low-dose radiation therapy to areas that contain
cancer.
2. Treatment in a clinical trial.
If the cancer is above the diaphragm and involves a large part of the chest, treatment may be one of the following:
1. Chemotherapy plus radiation therapy to the chest or the mantle.
2. A clinical trial of chemotherapy followed by low-dose radiation therapy.
1. Chemotherapy alone.
2. Chemotherapy plus radiation therapy.
3. A clinical trial of chemotherapy with or without radiation therapy.
1. Chemotherapy alone.
2. Chemotherapy plus radiation therapy.
3. Treatment in a clinical trial.
1. Chemotherapy alone.
2. Chemotherapy plus radiation therapy.
3. A clinical trial of chemotherapy with or without radiation therapy to the
lymph nodes.
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.
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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.
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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.
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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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