What Are the Symptoms of Childhood Lymphoma?

Swollen lymph nodes in neck, groin, armpit, or stomach; fever; night sweats and loss of appetite are the main symptoms of childhood lymphoma cancer, both Hodgkin’s and non-Hodgkins.

Lymphoma is a cancer of the lymphocytes, cells that are part of the body's immune system. In lymphoma, lymphocytes become abnormal and grow out of control. The abnormal cells can travel all over the body and often collect in the lymph nodes, causing them to swell. 

There two main types of lymphoma, and each type has several subtypes:

• Hodgkin lymphoma (Hodgkin disease) 
  • Commonly affects children age 15 and older
  • Results in abnormal cells called Reed-Sternberg cells in the cancerous lymph node
  • Subtypes include:
    • Nodular sclerosis: affects 70 percent of children who have Hodgkin lymphoma
    • Mixed cellularity: most commonly diagnosed in children younger than 10
    • Nodular lymphocyte predominant: more common in younger children
• Non-Hodgkin lymphoma (sometimes called NHL, or just lymphoma), which includes childhood Non-Hodgkin lymphoma
  • Behaves differently in children than in adults
  • Tends to be aggressive and fast-growing, and requires intensive therapy
  • Four main subtypes affect children:
    • Burkitt’s lymphoma 
    • Diffuse large B-cell lymphoma 
    • Anaplastic large-cell lymphoma 
    • Lymphoblastic lymphoma 

Symptoms of lymphoma in children include:

• One or more large, swollen lymph nodes
  • Felt under the skin
  • Usually are not painful
  • Often found in the neck, groin, armpit, or stomach
  • Cough or trouble breathing (from swollen lymph nodes around the lungs)
• Unexplained fever
• Night sweats that soak your clothes
• Weight loss without trying
• Loss of appetite
• Coughing 
• Difficulty breathing 
• Swollen abdomen

Other symptoms of lymphoma that tend to be more common in adults include: 

• Chills
• Itching skin
• Tiredness (fatigue)
• Chest pain
• Feeling full after only a small amount of food
• Chest pain or pressure
• Severe or frequent infections
• Easy bruising or bleeding

Causes of Hodgkin lymphoma and non-Hodgkin lymphoma include:

• Genetic mutations
• Changes in the immune system
• Immune deficiencies (due to inherited conditions, certain drugs treatments, organ transplants, or HIV infection) 
• Autoimmune diseases 
• Chronic infections 

Risk factors for developing Hodgkin lymphoma include:

• Epstein-Barr virus (EBV) 
• Age: most common in early adulthood (in a person’s 20s) and in late adulthood (after age 55)
• Gender: occurs slightly more often in males than in females
• Family history
• Weakened immune system: such as in people with HIV, those who take medicines to suppress the immune system after an organ transplant, and people with autoimmune diseases 

Risk factors for developing non-Hodgkin lymphoma include:

• Age over 60
• Gender: usually more common in men than in women, but there are some types that are more common in women
• Race, ethnicity, and geography: more common in Caucasians than African Americans and Asian Americans, and more common in developed countries, with the U.S. and Europe having some of the highest rates
• Family history
• Exposure to certain chemicals and drugs such as benzene, certain herbicides and insecticides, some chemotherapy drugs used to treat other cancers, and certain drugs used to treat rheumatoid arthritis, such as methotrexate and the tumor necrosis factor (TNF) inhibitors
• Radiation exposure: radiation treatment for other cancers and survivors of atomic bombs and nuclear reactor accidents
• Having a weakened immune system
• People who receive organ transplants and are treated with immunosuppressants
• Human immunodeficiency virus (HIV)
• Some genetic (inherited) syndromes, such as ataxia-telangiectasia (AT) and Wiskott-Aldrich syndrome
• Autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE or lupus), Sjogren (Sjögren) disease, and celiac disease
• Certain infections
• Being overweight or obese

Lymphoma is diagnosed with a physical exam and tests such as:

• Imaging tests
  • X-rays
  • Computerized tomography (CT) scan
  • Positron emission tomography (PET) scans
  • Magnetic resonance imaging (MRI)
  • Ultrasound
• Blood tests
  • Complete blood count (CBC) 
  • Erythrocyte sedimentation rate (ESR) 
  • Tests to check liver and kidney function 
  • HIV test
  • Hepatitis B and C virus test
• Biopsy
  • Lymph node
  • Bone marrow aspiration 
  • Lumbar puncture (spinal tap)
• Lung (pulmonary) function tests (PFTs) 
• Echocardiogram (an ultrasound of the heart) or a MUGA scan 

Treatments for lymphoma may include one or more of the following:

• Chemotherapy 
• Radiation therapy 
• Bone marrow transplant (also called "stem cell transplant") 
• Immunotherapy 
  • Chimeric antigen receptor (CAR) T cell therapy

Treatment of pediatric Hodgkin lymphoma in children who have not yet reached puberty and are not fully developed is slightly different from the treatment for adults. Chemotherapy is usually preferred over radiation therapy for children because radiation can affect bone and muscle growth and prevent children from reaching their normal size.