Overview

Non-Hodgkin lymphoma is a disease in which cancer cells form in the lymphatic system and start to grow uncontrollably.
There are several different types of lymphomas. Some involve lymphoid cells (called Reed-Sternberg cells) and are grouped under the heading Hodgkin disease or Hodgkin lymphoma.
All other forms of lymphoma fall into the non-Hodgkin grouping. The different forms of non-Hodgkin lymphoma are characterized by the malignant growth of white blood cells that live in the lymph nodes, called lymphocytes.

The exact cause of non-Hodgkin lymphoma is unclear, but doctors have identified some risk factors, such as:

• having conditions that weaken the immune system, like AIDS (acquired immunodeficiency syndrome)
• taking immune-suppressing medications after organ transplants
• exposure to certain viruses, such as Epstein-Barr virus (the virus that usually causes mono)
• having a sibling with the disease
• being white and male

Although no lifestyle factors have been definitively linked to childhood lymphomas, kids who have received either radiation treatments or chemotherapy for other types of cancer seem to have a higher risk of developing lymphoma later in life.
Regular pediatric checkups may spot early symptoms of lymphoma in cases where this cancer is linked to the treatments or conditions mentioned above.

Symptoms of non-Hodgkin lymphoma vary depending on the type of lymphoma and where a tumor is located. Some kids may feel stomach pain, constipation, and decreased appetite. Others may have trouble breathing, difficulty swallowing, coughing, wheezing, or chest pain.
Other symptoms may include:

• painless swollen lymph nodes
• fever, chills, or night sweats
• itchy skin
• weight loss despite eating normally
• tiredness
• bone or joint pain
• recurring infections

The symptom that some kids first experience is swollen lymph nodes — usually in the neck, armpits, and groin. Of course, swollen lymph nodes do not usually mean cancer — they're most often a sign of a common illness, like an infection. In fact, all of the symptoms of non-Hodgkin lymphoma can also be caused by other conditions, which is why only a doctor can determine what's really wrong with a child.

After performing a thorough evaluation, which includes a medical history and physical examination, a doctor who suspects that a child has non-Hodgkin lymphoma will refer the child to an oncologist, or cancer doctor.
The doctor may perform a biopsy, or tissue sample, of lymph nodes. During a biopsy, a tiny bit of tissue is removed from the body and sent out to a laboratory for analysis. Depending on the type of biopsy ordered, the doctor may use local anesthesia (where only a part of the body is numbed) or general anesthesia (which puts a child to sleep) to ensure that the child doesn't feel any pain.

Biopsies used to test for non-Hodgkin lymphoma include excisional biopsy (where the doctor opens the skin to remove an entire lymph node) or incisional biopsy (where the doctor removes only a part of the lymph node).
Another type of biopsy, fine needle aspiration (where a doctor uses a very thin needle to suction out a small amount of tissue from the lymph node), is used on some rare occasions to diagnose non-Hodgkin lymphoma.
Doctors also may perform a bone marrow biopsy, where a needle is used to take samples of the soft tissue found inside a bone.
Other tests used to diagnose non-Hodgkin lymphoma include:

• blood tests
• a chest X-ray, a simple procedure in which the person lies on a table while an X-ray machine takes an image of the chest
• a computerized tomography (CT or CAT) scan, which rotates around the patient and creates an X-ray picture of the inside of the body from different angles
• an ultrasound, which uses high-frequency sound waves to create pictures of the inside of the body
• a magnetic resonance imaging (or MRI) scan, which uses magnets and radio waves to allow doctors to see inside the body.
• a gallium scan, which uses the injection of a material known as gallium to help show tumors and inflammation
• a bone scan to detect bone changes