Cancers and Tumors

Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma?

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

  • Non-Hodgkin lymphoma
  • Hodgkin lymphoma, also called Hodgkin disease or Hodgkin's disease

Both types start in the lymph system, but they are not the same in how they spread, affect the body or 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 help our bodies resist disease.

Other structures play a role in the lymph system, too:

  • 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 non-Hodgkin lymphoma occur?

The lymph system goes throughout the body so lymphoma can begin in many places. They 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.

Non-Hodgkin Lymphoma in Children

Any child may get 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 lymphoma have none of these risk factors.

For example, children who were exposed to radiation such as from a nuclear reactor accident are at greater risk than children who were not exposed, but most children with the disease have never been exposed to this type of radiation. 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.

The risk of non-Hodgkin lymphoma increases throughout childhood into young adulthood. Non-Hodgkin lymphoma is more common in teens and young adults than in young children.

Children may be at higher risk for non-Hodgkin lymphoma if any one of these is true:

  • They have a genetic disorder that interferes with their immune system.
  • Their immune system was suppressed with medicines because they had an organ transplant.
  • They have human immunodeficiency virus (HIV), which has weakened their immune system.
  • They were exposed to radiation such as from a nuclear reactor accident or explosion of an atomic bomb.

Non-Hodgkin Lymphoma Stages

Staging refers to the way doctors classify lymphoma based on where it is in the body.

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

Stage 1 non-Hodgkin lymphoma

Applies to children who have non-Hodgkin lymphoma in only one area or lymph node, and that area or node is not in the abdomen or chest

Stage 2 non-Hodgkin lymphoma

Applies to children who have any one of these:

  • Disease in only one area, including the lymph nodes in the area
  • Disease in two or more areas or lymph nodes, with all the cancer either above or below the diaphragm (muscle that controls breathing and separates the chest and abdomen)
  • Disease that started in the stomach or intestines and that was completely removed through surgery

Stage 3 non-Hodgkin lymphoma

Applies to children who have any one of these:

  • Disease on both sides of the diaphragm
  • Disease that started in the chest
  • Disease in two or more areas in the abdomen
  • Disease around the spine

Stage 4 non-Hodgkin lymphoma

Applies to children who have non-Hodgkin lymphoma in their bone marrow, brain, spine or cerebrospinal fluid

Non-Hodgkin Lymphoma at Seattle Children's

The experts in our Leukemia and Lymphoma Program provide advanced therapies for children with all types of non-Hodgkin lymphoma, including lymphoma that recurs.

Our doctors are leaders in lymphoma research. Many serve on the non-Hodgkin lymphoma and Hodgkin 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 who have non-Hodgkin lymphoma are cured. At Children's Hospital, we work with many children each year with non-Hodgkin lymphoma. Many of them are able to return to their normal lives after treatment, and they never have cancer again.

We use a team approach to care for children with cancer. Our multidisciplinary team for lymphoma includes cancer doctors (oncologists), a nurse practitioner and a social worker.

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

Many of our patients with lymphoma take part in clinical trials. These research studies give children the chance to get the very latest treatment options being studied - options that are not offered at all treatment centers.

Non-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.

For non-Hodgkin lymphoma our rate is 6.5 points higher than the national average. More than two-thirds of children diagnosed with non-Hodgkin lymphoma survive more than five years after their diagnosis. Many live much longer.

The cure rate ranges from 65% to 100% of patients. This depends on the type of disease, the extent of disease when doctors diagnose it and how quickly the disease responds to the first round of treatment.

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