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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is about Hodgkin lymphoma| in children. You may find it helpful to read it alongside the Macmillan/CCLG booklet A parent’s guide to children’s cancer|, which contains more information about children's cancers, diagnosis, treatment and support services.
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 equally affected.
Hodgkin lymphoma was first described by Dr Thomas Hodgkin in 1832. It's 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.
The lymphatic system is made up of organs such as the bone marrow, thymus, spleen, and lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid.
The lymphatic system
View a large version of the diagram of the lymphatic system|
The lymph nodes you're most likely to notice are those in the neck, armpit and groin. Glands can swell in these areas as part of the body's response to infection. 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 20–50 nodes.
Cancers which start in the lymphatic system are called lymphomas. There are two main types of lymphoma: non-Hodgkin lymphoma (NHL)| and Hodgkin lymphoma (HL)|. Although these are both types of lymphoma, the differences between them mean their treatment is different.
The exact cause of Hodgkin lymphoma is unknown. However, there's increasing evidence that infections, such as the virus that causes glandular fever, may play a part in the development of Hodgkin lymphoma, especially in childhood. Very rarely, more than one member of a family may develop 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. However, it's important to remember that children's glands can be swollen when they have a sore throat or a cold. The first glands to be affected are usually in the neck, most often on one side only and 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|. This is caused by the pressure the glands exert on the airways.
Sometimes, a child with Hodgkin lymphoma may have a high temperature (fever), night sweats, severe itching or weight loss.
To diagnose Hodgkin lymphoma, a swollen lymph gland will be removed so that the cells can be examined in the laboratory. This is called a biopsy. It's a small operation that is usually done under a general anaesthetic.
Further tests are carried out to find the exact size and position of the lymphoma and to see whether it has spread beyond the original area. These tests| include x-rays, blood tests, and CT, MRI and PET scans.
Very often, a bone marrow sample will be taken. This is because the lymphoma cells can spread to the bone marrow as well as to other lymph glands.
Any tests and investigations that your child needs will be explained to you. The booklet A parent’s guide to children’s cancer gives details of what the tests and scans involve.
The stage of Hodgkin lymphoma describes the size and position of the cancer and whether it has spread. Staging is very important to because the type of treatment your child receives depends on the stage of the disease. The staging system for Hodgkin lymphoma is as follows:
Only one group of lymph nodes is affected and the lymphoma is only either above or below the diaphragm. The diaphragm is the sheet of muscle under the lungs that controls breathing.
Two or more groups of lymph nodes are affected and they are all either above or below the diaphragm.
The lymphoma is in lymph nodes both above and below the diaphragm. The spleen may also be enlarged, which may show up on CT, MRI or PET scans.
The lymphoma has spread beyond the lymph nodes to other organs such as 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: persistent 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, with more advanced lymphoma, and may need more intensive treatment.
Children with Hodgkin lymphoma are usually treated with chemotherapy|, but sometimes radiotherapy| is also needed. When the cancer has not spread beyond its original site (known as localised disease), your child may have surgery to remove the affected nodes, followed by radiotherapy. The type and amount of treatment given depends on the stage of the disease when it is diagnosed. Your child’s doctor will discuss the treatment options with you.
A rare type of Hodgkin lymphoma, called lymphocyte predominant lymphoma, may be treated with surgery alone.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It's usual for a combination of drugs| to be used, often given every few weeks over a number of months. It is common for a combination of drugs to be used, which will often be given every few weeks over a number of months.
A combination of drugs is used because each chemotherapy drug works in a different way. Using several drugs together increases the effectiveness of treatment. It also means lower doses of individual drugs can be used, which may reduce the possibility of long-term side effects.
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–Friday, over 2–4 weeks.
Treatment often causes side effects. 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's being treated.
Side effects during treatment can include feeling sick (nausea) and being sick (vomiting)|, hair loss|, an increased risk of infection| or bruising and bleeding, tiredness|, and diarrhoea|.
A small number of children may develop side effects many years later, depending on where the original tumour was, how far it spread and the type of treatment.
These late effects include a possible reduction in 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 after puberty, 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 these long-term side effects can be found in the booklet A parent’s guide to children’s cancer.
Many children have their treatment as part of a clinical research trial|. The aim of treatment for Hodgkin lymphoma is to cure the cancer with the fewest short- and long-term side effects.
This is particularly important in childhood Hodgkin lymphoma where cure rates are generally high. It's important to get the balance right between curing the cancer and having the lowest risk of 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 it's appropriate, and will answer any questions you 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's right for your child.
About 9 out of every 10 children who develop Hodgkin lymphoma are cured. If the cancer comes back|, different treatment can be given.
After the treatment is completed, your child will be checked regularly with scans in the hospital.
If you have specific concerns about your child’s condition and treatment, it's 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 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.
It's not possible to address here all of the feelings you may have. However, the Macmillan/CCLG booklet A parent’s guide to children’s cancer talks about the emotional impact of caring for a child with cancer, and suggests sources of help and support.
Your child may have a variety of powerful emotions| throughout their experience of cancer. The parent's guide discusses this further and talks about how you can support your child|.
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.
The Lymphoma Association| provides information and emotional support to people with lymphoma and their families, carers and friends.
This section has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.