Childhood Non-Hodgkin's Lymphoma: Diagnosis

Lymphoma can be very difficult to detect - a parent, loved one, or the child themselves may notice something wrong. There are some symptoms for Non-Hodgkin's but they are not specific. Often a lymph node swells, especially in the upper body area. Other times the child may feel that they have a lack of energy. More serious symptoms can include weight loss, fever, night sweats, or unexplained itching. A percentage of diagnoses are made when receiving normal examinations such as annual check-ups. It often seems the diagnosis comes as a surprise and a shock to the whole family.

Making the Diagnosis:

NHL is medically diagnosed by taking a tissue sample (in a surgical procedure called a biopsy). The pathologist (a person trained in the biology of cells) searches for cancerous cells.

There are other tests your medical team may do including the following:

• A physical exam including examining the lymph nodes
• Collecting a medical history and history of symptoms
• A complete blood work-up including checks for abnormal blood cell count, blood chemistry, and abnormal sedimentation rate
• A chest x-ray to view lymph nodes and to see if other organs are involved
• A computerized tomography (CT or CAT) scan, positron emission tomography (PET) scan and/or magnetic resonance imaging (MRI) scan of the chest, pelvis, and abdomen to determine the possible spread of the disease
• A gallium scan to check for radioactive intake of gallium in the lymph system indicating swelling and ultimately disease
• A bone marrow aspiration and biopsy to determine if the bone marrow has been affected by lymphoma; in this procedure the hip is numbed (ask for EMLA cream or similar to numb the site beforehand at home) and a needle is inserted into the bone; liquid bone marrow and a bone chip are extracted and the tissue is examined under a microscope

Certain medical centers may perform additional tests, including

• Exploratory surgery to determine the extent of the disease. In some cases bulky or life threatening tumors may be removed.
• A lymphangiogram, a procedure during which a radio-opaque liquid is injected into the lymph system through the feet; the fluid travels throughout the lymph system and remains visible by x-rays for up to six months

Using modern techniques, surgery and lymphangiogram are often not required to know what is going on with the lymphoma.

Once a biopsy sample is taken, it is classified into one of several types of Non-Hodgkin's Lymphoma:

Types of Non-Hodgkin's Lymphoma:

The types of NHL found in children are:

• Lymphoblastic Lymphoma
• Burkitt's Lymphoma (small non-cleaved cell lymphoma)
• Large Cell Lymphoma
• Anaplastic Large Cell Lymphoma

The medical team will also stage the spread of the lymphoma. There are four stages which depend on how far the cancer has spread through the body:

Stages of Non-Hodgkin's Lymphoma

Once non-Hodgkin's lymphoma is found, more tests will be done to find out if the cancer has spread from where it started to other parts of the body. This testing is called staging. The doctors need to know the stage of your disease to plan treatment.

The following stages are used for Childhood non-Hodgkin's lymphoma:

• Stage I -Cancer is found in only one area outside of the abdomen or chest.
• Stage II - Any of the following mean the disease is stage II:
• 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.
• Stage III - Any of the following mean the disease is stage III:
• Cancer is found in lymph node areas 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 epidermal tumors).
• Stage IV - Cancer has spread to the bone marrow or to the brain, its inner coverings, or the spinal cord.
• Recurrent - Recurrent disease means that the cancer has come back after it has been treated. It may come back in the area where it first started or in another part of the body.

Once the doctor knows the type and stage of the disease he can plan treatment, often in consultation with other oncologists (cancer specialist doctors).

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Just For Kids and Teens

Resources

How Is Childhood Non-Hodgkin's Lymphoma Diagnosed? - ACS

Test Information

Blood Count and Sedimentation Rate Information
Blood Counts for Kids University of Iowa
The Bone Marrow Biopsy - MedlinePlus
Tissue Testing (Biopsy)
MRI Scans - detailed information
CT and PET Scan Information
Gallium Scans - detailed information

Personal Experiences

Bryce's Story - a preschooler with lymphoblastic lymphoma

For more information on other aspects of lymphoma:

The Adult Non-Hodgkin's Information Pages
Lymphoma Classification and Typing

The Home Page - gateway to support and more:

The Lymphoma Information Network

Books

Lymphoma: Methods and Protocols, Illidge & Johnson, 2005, more for professionals but cutting edge