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What Is Hodgkin Lymphoma?

Lymphoma is cancer of the lymph system. There are two main types:

Both Hodgkin lymphoma and non-Hodgkin lymphoma start in the lymph system, but they are not the same in how they spread, affect the body and respond to treatment.

What is the lymph system?

The lymph system is part of your child's immune system. It is a network of small vessels that collect a watery fluid from all around the body. This fluid is called lymph.

White blood cells called lymphocytes travel in the lymph, fighting infection and disease. Along the network of lymph vessels are lymph nodes - bean-like structures that filter the lymph and serve as activity centers that resist disease.

Other structures also play a role in the lymph system:

  • Spleen: helps make white blood cells that fight germs
  • Thymus: where the white blood cells mature and multiply
  • Tonsils: resist germs that enter through the nose and mouth
  • Stomach and intestines: have patches of lymph tissue
  • Bone marrow: where the body makes blood cells

Where does Hodgkin lymphoma occur?

The lymph system goes throughout the body so lymphoma can begin in many places. It can also spread to organs outside the lymph system.

Subtypes of lymphoma

Doctors divide Hodgkin lymphoma and non-Hodgkin lymphoma into subtypes based on these factors:

  • The specific type of cell affected
  • How mature the cells are
  • How the cells appear under a microscope
  • The way the cells grow

Knowing the subtype sometimes helps doctors decide which treatments are most likely to work.

Hodgkin Lymphoma in Children

Any child or teenager may get Hodgkin lymphoma. Doctors do not know what causes the disease. There are several factors that may increase a child's risk, but most children who have Hodgkin lymphoma have none of these risk factors.

For example, children who were in contact with the Epstein-Barr virus or had mononucleosis are at greater risk for some forms of Hodgkin lymphoma. But most children with the disease don't have this risk factor. They developed the disease for unknown reasons.

About 13% of children with cancer have lymphoma. Of these, slightly less than half have non-Hodgkin lymphoma, and slightly more than half have Hodgkin lymphoma.

Hodgkin lymphoma is more common in teens than in children younger than age 10.

Other factors that relate to risk are less clear. Doctors hope that ongoing research will help us better understand the risk factors.

Here are links that doctors have noted, but none of them cause the disease:

  • Risk is higher in twins formed from the same egg (monozygotic) and siblings.
  • Risk for some forms of the disease is linked with coming in contact with the Epstein-Barr virus or having had mononucleosis.
  • For older teens and young adults, higher socioeconomic status is a risk factor. For children under age 10, lower socioeconomic status is a risk factor.
  • For older teens, having fewer siblings and childhood playmates is a risk factor.

Hodgkin Lymphoma Stages

Staging refers to the way doctors classify lymphoma based on a variety of factors. The staging system is different for each type of cancer. Some cancer is staged only after surgery.

Children who have Hodgkin lymphoma are considered to be at one of these stages:

Stage 1 Hodgkin lymphoma

Applies to children who have Hodgkin lymphoma in one group of lymph nodes. Doctors add the letter "E" after "stage I" if the disease has spread to a structure nearby that isn't part of the lymph system.

Stage 2 Hodgkin lymphoma

Applies to children who have Hodgkin lymphoma in two or more groups of lymph nodes either above or below the diaphragm (the muscle that controls breathing and separates the chest and abdomen). Doctors add the letter "E" after "stage II" if the disease has spread to a structure nearby that isn't part of the lymph system.

Stage 3 Hodgkin lymphoma

Applies to children who have Hodgkin lymphoma on both sides of the diaphragm. Doctors add the letter "E" after "stage III" if the disease has spread to a structure nearby that isn't part of the lymph system. They will add the letter "S" if the only area of disease below the diaphragm is the spleen. (The disease may be stage III, IIIE, IIIS or IIIE+S.)

Stage 4 Hodgkin lymphoma

Applies to children who have Hodgkin lymphoma either:

  • Throughout one non-lymph organ and in lymph nodes distant from that organ
  • Throughout one or more organs that aren't in the lymph system (In children it is rare not to have at least one structure affected in the lymph system.)

Doctors may further classify Hodgkin lymphoma based on whether your child has B symptoms - fever, weight loss or night sweats.

Hodgkin Lymphoma at Seattle Children's

Our doctors are leaders in lymphoma research. Many serve on the lymphoma committees of the Children's Oncology Group (COG). COG is an international organization of childhood cancer specialists who conduct studies on many forms of childhood cancer.

They aim to understand better how the disease works, develop new treatment programs and reduce later effects of the disease and treatments.

Most children – 80% to 95% – who have Hodgkin lymphoma are cured.

At Children's, we work with many families each year who have a child with Hodgkin lymphoma. Many of the children are able to return to their normal lives after treatment, and they never have cancer again.

Our multidisciplinary team provides care for children with Hodgkin lymphoma. The team includes cancer doctors (oncologists), a nurse practitioner and a social worker.

Dr. Rebecca Johnson oversees the care. She has a clinical focus on adolescents and young adults with cancer.

We offer families and children the option to take part in clinical trials investigating ways to improve how we treat Hodgkin Lymphoma.

The trials include studies of innovative treatments in which the amount of therapy a child receives depends on the way the Hodgkin lymphoma presents and how it responds to the first type of therapy that is used.

This is known as risk-adapted, response-driven therapy. It is designed both to cure the disease and to limit any long-term effects from the treatment.

Dr. Eric Chow leads a study to learn more about the long-term physical and psychological effects of therapy in survivors of childhood and adolescent Hodgkin lymphoma.

Some of our patients receive transplants by doctors who are part of our world-renowned Pediatric Blood and Marrow Transplant Program through our partnership with Fred Hutchinson Cancer Research Center, whose doctors pioneered these transplants.

Hodgkin lymphoma survival rates

Doctors who treat people with cancer use five-year survival rates as one way to measure treatment success. The five-year survival rate means the percentage of patients with the disease who are alive five years after their disease was diagnosed.

Our outcomes for Hodgkin lymphoma at Children's are among the best in the nation. Our five-year survival rate is higher than the national average. Our rate is 97.5%. The national average is 93.1%

Read more childhood cancer statistics.

Read more about cancer-related programs and services and research at Children's Hospital.

Who Treats This at Seattle Children's?

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Spring 2014: Good Growing Newsletter

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Download Spring 2014 (PDF)