Newly Diagnosed Non-Hodgkin Lymphoma (NHL)

When a child is diagnosed with non-Hodgkin lymphoma, he or she may have been experiencing the following symptoms.
  • Enlarged lymph nodes, which may cause swelling in the neck, underarm or groin. Sometimes the lymph nodes involved are in the stomach or intestines so there may be swelling of the abdomen, abdominal pain or constipation.
  • Difficulty breathing, such as wheezing or shortness of breath, or high-pitched breathing sounds may occur due to enlarged or swollen lymph glands in the chest
  • Pain
  • Unexplained fever
  • Weight loss
  • Night sweats

A number of tests are performed to evaluate a child with the suspected diagnosis of cancer. The initial test is a physical exam and identification of abnormal findings. Other tests are performed based upon the findings and symptoms and may include some of the following:

If cancer cells are found during the surgical removal of a tumor, biopsy, or examination of abnormal fluids in the chest or abdomen, more tests will need to be performed. The additional tests will determine whether cancer cells have spread to other parts of the body. This process is called staging. Staging identifies the extent of the cancer and is an important factor in determining appropriate treatment.

Stage I
The cancer is found only in one lymph node or in one area of the body (except the chest or abdominal area).

Stage II
The cancer is found in:
  • One area and the lymph node near it on the same side of the diaphragm (a thin muscle separating the chest cavity from the abdominal cavity); or
  • In two areas or two lymph nodes on the same side of the diaphragm.
  • One lymph node or area in the abdomen.
Stage III
The cancer is found:
  • On both sides of the diaphragm (in lymph nodes or areas),
  • In the chest cavity,
  • Tumor in the abdomen
  • Near the spine

Stage IV
The cancer is found in any of the places listed in Stages I-III and has also spread to the brain, spinal cord or bone marrow.

Sometimes non-Hodgkin lymphoma is grouped according to the ABC system and treatment is determined based on that classification.
  • Group A:tumors that can be completely removed together with any accompanying lymph nodes.
  • Group B:any tumor(s) that cannot be surgically removed, do not occur in the brain, and tumor cells make up less than 25% of cells in the bone marrow.
  • Group C: Tumor cells are in the brain, spine or spinal fluid, and/or less than 25% of cells in the bone marrow are tumor cells.
Factors Affecting the Type of Treatment and Chance of Cure
Factors affecting the treatment type and cure rate include:
  • Tumor stage: Earlier stage tumors (I or II) usually have a better outcome than higher stage tumors (III or IV).
  • Extent or volume of the cancer: Size of the primary tumor, whether or not lymph nodes are involved and to what parts of the body the tumor has spread will determine the treatment needed and the response to therapy.
  • Lymphocyte biology: There are a number of different types of non-Hodgkin lymphoma. The lymphocytes of patients with different types of NHL have a different appearance under the microscope. Each of the specific types of NHL requires a specific treatment approach.

Last updated September, 2011

About Non-Hodgkin Lymphoma
In Treatment with Non-Hodgkin Lymphoma
After Treatment of Non-Hodgkin Lymphoma

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