Lymphoma (continued)

Treatment

Treatment of childhood lymphoma is largely determined by staging. Staging is a way to categorize or classify patients according to how extensive the disease is at the time of diagnosis.

There are four stages of lymphoma, ranging from Stage I (cancer involving only one area of lymph nodes or only one organ outside the lymph nodes) to Stage IV (cancer has spread, or metastasized, to one or more tissues or organs outside the lymphatic system). The stage at diagnosis can guide medical professionals in the decision of therapy and helps doctors predict how someone with lymphoma will do in the long term.

Treatment may involve radiation (the use of high-energy rays to shrink tumors and keep cancer cells from growing), chemotherapy (the use of highly potent medical drugs to kill cancer cells), or both, depending on the type and stage of the cancer as well as the age and overall health of the child.

Chemotherapy is the primary form of treatment for NHL, and is generally important in treatment of Hodgkin disease, too. Children with Stage I Hodgkin disease or NHL may be treated with radiation alone, but for kids with more advanced stages of at the time of diagnosis, chemotherapy is used, sometimes together with radiation.

Short-Term and Long-Term Side Effects

Intensive lymphoma chemotherapy affects the bone marrow, causing anemia and bleeding problems, and increasing the risk for serious infections. Chemotherapy treatments have side effects — some short-term (such as hair loss, changes in skin color, increased infection risk, and nausea and vomiting) and some long-term (such heart and kidney damage, reproductive problems, or the development of another cancer later in life) — that parents should discuss with their doctor.

Side effects of radiation include fatigue, loss of appetite, and skin reactions. When total-body irradiation is used prior to bone marrow transplant, there is an increased risk that the child will have slowed growth, thyroid problems, abnormal function of the ovaries or testicles, or cataracts.

Chances for a Cure

The majority of kids with either Hodgkin disease or NHL are cured, meaning they will have cancer-free survival for more than 5 years.

About 90% of children with Hodgkin disease go into remission (where there is no longer evidence of cancer cells in the body) following initial chemotherapy. A long-term cure (5 years disease-free or longer) is achieved in almost all Stage I or Stage II patients, in up to 90% of Stage III patients, and more than 60% of those with Stage IV.

In children with NHL, 5-year survival is about 90% for those with Stage I or Stage II at the time of diagnosis, and close to 70% for those with more advanced Stage III or IV disease.

New Treatments

Although most kids do recover from lymphoma, some with severe disease will have a relapse (reoccurrence of the cancer) that doesn't respond to conventional treatments. For these children, bone marrow transplants and stem cell transplants are among the newest treatment options.