Children's Cancer

Hodgkin lymphoma (also called Hodgkin disease) affects lymphocytes, which are a type of white blood cell. Lymphocytes are part of the immune system that help our bodies fight infection.

Hodgkin lymphoma can start anywhere in the lymphatic system. The lymphatic system — made up of a network of vessels, tissues and organs — makes white blood cells and moves lymph around the body.

Hodgkin lymphoma often starts in the lymph nodes in the upper body, such as in the chest, neck or underarms. It can spread to other lymph nodes and throughout the lymphatic system.

There are two main types of Hodgkin lymphoma:

• classic Hodgkin lymphoma
• nodular lymphocyte predominant Hodgkin lymphoma.

Hodgkin lymphoma is more common in older children and teenagers than in young children.

Non-Hodgkin lymphoma is a different type of lymphoma that children can get.

Chance of a cure

One of your biggest concerns on learning your child has cancer may be about their chance of being cured.

Due to major advances in treatment, many children treated for cancer now survive into adulthood. Children diagnosed with cancer between 2004 and 2012 have a 5-year survival rate of 85%. In the 1980s, the 5-year survival rate for all cancers was about 73%.¹

Talk to your child’s doctor about your child’s diagnosis, treatments and long-term survival. Long-term survival is also called the outlook or prognosis. It on depends several things, including:

• age of your child at diagnosis
• extent or stage of the cancer
• how the cancer cells look under a microscope (the shape, function and structure of the cells)
• how the cancer responds to treatment
• cancer or tumour biology, which includes
  • the patterns of the cancer cells
  • how different the cancer cells are from normal cells
  • how fast the cancer cells are growing.

To learn more about survival for Hodgkin disease in children, visit Australian Cancer Childhood Statistics Online

References

[1] https://cancerqld.blob.core.windows.net/content/docs/Childhood-Cancer-in-Australia-1983-2015.pdf

Clinical trials

It’s possible that your child may be able to be part of a clinical trial. Clinical trials are research investigations to test new treatments, interventions or tests, or as a way to prevent, detect, treat, or manage various diseases or medical conditions. The patients involved in clinical trials are volunteers.¹

With regard to cancer, researchers run clinical trials to test new ways to:

• treat cancer
• find and diagnose cancer
• manage cancer symptoms and treatment side effects.

If a trial is available, taking part in one will be entirely the family’s decision.

It’s important to note that any new treatments are strictly regulated, and must be approved before they can be used in a clinical trial. Your child’s doctor will explain everything about the trial and give you detailed written information. If you wish your child to be part of the trial, you will need to give permission.

Participating in a clinical trial may or may not directly benefit your child. However, the results of clinical trials today help children with cancer in the future. If you’re interested in participating in a clinical trial, ask your child’s doctor if there are any suitable for your child.

See Clinical trials and research for more information.

References

[1] https://www.australianclinicaltrials.gov.au/what-clinical-trial

Diagnosis

When your child is diagnosed with cancer, it can feel overwhelming. This phase involves finding out if your child has cancer and determining the type of cancer they have. Children’s cancer can be difficult to diagnose, as many symptoms are similar to those caused by less serious conditions, or injuries. This means that your child may need several tests and medical appointments before you receive confirmation that your child has cancer.

If your doctor thinks your child has Hodgkin lymphoma (or Hodgkin disease), your child may have the following tests:

• medical history and physical exam
• blood tests
• medical imaging, such as:
  • chest X-ray
  • computed tomography (CT) scan
  • magnetic resonance imaging (MRI)
  • positron emission tomography (PET) scan
• lymph node biopsy
• bone marrow aspiration and biopsy.

Our section, How is cancer diagnosed? explains these tests in more detail.

Staging

Doctors use staging to describe how much the cancer has grown. Some of the tests for Hodgkin lymphoma will also help to stage the tumour. Staging determines:

• where the tumour is
• how big the tumour is
• what nearby organs it affects
• if the tumour has spread to other parts of the body.

Your doctor will use this information to choose the best way to treat the disease. Staging will also give your doctor an idea of how well these treatments are likely to work (prognosis).

How doctors assess the stage or extent of disease varies. They often describe Hodgkin lymphoma in four stages:

• Stage I – the cancer occurs in one lymph node area or lymphoid organ (like the thymus). Or, in one organ outside the lymphatic system.
• Stage II – the cancer occurs in two or more lymph node areas on the same side of the body. These can be either both above or both below the diaphragm, which separates the chest and the abdomen. The cancer can also spread from one lymph node area into a nearby organ.
• Stage III – the cancer occurs in more than one lymph node area on both sides of the diaphragm (above and below). The cancer can also occur in lymph node areas both above and below the diaphragm, spreading to a nearby organ and/or the spleen.
• Stage IV – the cancer has spread to one or more organs outside the lymphatic system. Alternatively, it occurs in two organs in distant parts of the body, but not in the nearby lymph nodes. Or, it occurs in the liver, bone marrow, lungs or cerebrospinal fluid.

Risk factors

A risk factor is anything that increases a person’s chance of getting a certain condition or disease. Researchers know about some risk factors that increase the chance of developing cancer. However, for most children with cancer, the cause is unknown.

What we do know is that if a child develops cancer, it’s not because of something they, or their parents did to cause it. No one is to blame if a child develops cancer.

Even if your child has a risk factor, it doesn’t mean they will develop cancer. Many children with a risk factor will never develop cancer. Most children with cancer have no known risk factors. Even if a child with a risk factor develops cancer, the risk factor may not have had much to do with it.

Researchers don’t completely understand what causes Hodgkin lymphoma (also called Hodgkin disease). However, there are some things that are linked to a higher chance of getting Hodgkin lymphoma.

Family history

Children who have a brother or sister with Hodgkin lymphoma have a higher chance of developing the disease. This is especially true if a child has a twin.

Certain virus infections

People who have had an Epstein–Barr virus infection are more likely to get Hodgkin lymphoma. However, this risk is very small. Other names for Epstein–Barr virus are glandular fever, infectious mononucleosis or ‘mono’.

People with HIV also have a higher chance of getting Hodgkin lymphoma.

Support and more information

A diagnosis of cancer in a child is difficult for all involved. It is normal for you and your family to feel overwhelmed, scared, anxious or angry.

If or others around you are having trouble coping, make sure you speak to your child’s treatment team. It’s very likely they have helped and supported many other families who have been through what you’re currently going through. Sometimes just letting other people know how you’re feeling helps you feel less alone. If you feel supported, then you will feel more able to support your child.

Most children’s hospitals will allocate a social worker to each family to provide support throughout treatment. If you need support, contact your hospital-based social worker to let them know how you’re feeling and to see what support can be made available to you and your family, including music therapists, play therapists or education support staff.

The following webpages and organisations also offer support and/or extra information for children with cancer and their families:

• Living with children’s cancer has information about physical, emotional and practical issues during and after diagnosis and treatment.
• Organisations that can provide support and information.
• Redkite is a national organisation that provides emotional support, financial assistance, information and resources to families who have a child with cancer. You can reach them through their support line 1800 733 548 (1800 REDKITE), which is open (9am-7pm AEST), email support@redkite.org.au or live chat on www.redkite.org.au
• Canteen provides a service called Canteen Connect, an online community for young people aged 12-25 dealing with their own or a close family member’s cancer, and Parent Connect, an online community with resources, information and peer support on parenting through cancer. Online counselling is available seven days a week, including evenings. Visit https://canteenconnect.org or call 1800 835 932.
• Lymphoma Australia supports children with Hodgkin lymphoma as well as their families.
• The Cancer Council in your state or territory can give you:
  • general information about cancer
  • information on resources and support groups in your area.
• You can call the Cancer Council Helpline from anywhere in Australia on 13 11 20.
• Any of the major children’s hospitals and networks in your state or territory can provide information about childhood cancer.

For more information about Hodgkin lymphoma, see:

• Hodgkin disease, from the American Cancer Society
• Childhood Hodgkin lymphoma treatment (PDQ®), from the National Cancer Institute (United States)
• Childhood lymphoma, from the Leukaemia Foundation.

Note that information from international organisations may not always apply to children in Australia.

Symptoms

Many conditions can cause the symptoms below, not just cancer. If your child has any of these symptoms and you are worried, talk to your child’s doctor. The earlier cancer is found, the better.

Symptoms of Hodgkin lymphoma may include:

• enlarged lymph nodes, usually felt as painless lumps under the skin in the neck, underarm or groin
• fever
• night sweats
• unexplained weight loss
• itchy skin
• tiredness
• loss of appetite
• coughing or trouble breathing (swollen lymph nodes in the chest can press on the windpipe).

Treatment

Your team of doctors, called a multidisciplinary team (MDT), will care for and treat your child, and will ensure that all your child’s needs are considered while they have cancer treatment. The section called The treatment team has further information about this.

Treatment for Hodgkin lymphoma depends on:

• The age of your child
• The stage of the cancer
• Other factors

Your doctor will suggest treatments based on your child’s situation. Treatment may involve one or more of the following:

• Surgery
• Chemotherapy
• Radiation therapy
• Targeted therapy
• Stem cell transplant
• Other treatments

Surgery

Surgery is rarely used to treat Hodgkin lymphoma. Surgery may be used to remove tumours in certain types of Hodgkin lymphoma. Usually, no further therapy is needed after surgery, but your child will be carefully observed.

See How is cancer treated - surgery for more detail.