Treatment and care of children with cancer is usually provided by a team of health professionals called a multidisciplinary team. Members of this team are specialists in children’s cancers – they understand the differences between children’s cancer and adult cancer, and each team member brings different skills in managing care to meet the needs of both you and your child.
The team will be led by a childhood cancer specialist (paediatric oncologist). Other members of the team depend on the age of your child and their type of disease, and may change over time as your child’s needs change. A list of team members who might make up the multidisciplinary team can be found in The treatment team.
Treatment for non-Hodgkin lymphoma depends on the age of your child, the stage of the disease, the biological features of the cancer and other factors identified during diagnosis. Treatment will be tailored to your child’s particular situation, and may involve one or more of the following (see How is cancer treated for more detail).
Surgery has a limited role in the treatment of non-Hodgkin lymphoma, but your child may have surgery to remove all or part of the tumour. If the entire tumour can be removed and it has not spread to other parts of the body, your child may not need any other treatment.
Your child might have surgery to insert a venous access device (also called a central venous catheter, portacath or central venous line) into a large blood vessel, usually in their chest or upper arm. This is a small plastic tube that either sticks out of the body or sits just under the skin. It allows medicines, including chemotherapy, to be given intravenously, and can also be used to take blood samples for testing.
Chemotherapy uses anti-cancer medicines to destroy cancer cells. It is often given as a combination of medicines to try to prevent the cancer cells from becoming resistant to just one or two medicines.
Chemotherapy medicines are given together in courses, often over a few days. Once the body has recovered from the side effects, the next course is given. Most children receive multiple courses of chemotherapy.
Non-Hodgkin lymphoma is usually treated with combination chemotherapy . If your child's doctor thinks that the lymphoma may have spread to the brain or spinal cord, chemotherapy can also be given directly into the cerebrospinal fluid through a device called a ventricular access catheter, which is inserted during an operation. This device has a small tube that passes into the area of the brain where the cerebrospinal fluid flows. The treatment team can inject chemotherapy medicines directly into it, and also take samples of fluid out of it to run tests.
Radiation therapy (also called radiotherapy) uses high-energy X-rays or other types of radiation to destroy cancer cells or stop them from growing. Radiation therapy may be used:
- to treat lymphomas that have spread to the brain or spinal cord, in combination with chemotherapy
- as urgent therapy to treat large tumours in the chest
- along with high-dose chemotherapy and stem cell transplant
- to relieve symptoms caused by some tumours.
Radiation therapy can have long-term side effects in children. If radiation therapy is included in your child’s treatment, special care will be taken to reduce these risks.
Some medicines can target the specific changes in cancer cells that make them different from normal cells. This means that they work differently from standard chemotherapy, and they usually have fewer side effects, or the side effects are not as severe.
Medicines called rituximab and brentuximab vedotin are monoclonal antibodies that may be used to treat non-Hodgkin lymphoma. These medicines find the abnormal cells and attach to them. They can then deliver chemotherapy that either directly destroys the cells or stops the cells from dividing.
Targeted therapies are usually given in combination with other types of treatment.
Stem cell transplant
Some children may be treated using a stem cell transplant (also known as a bone marrow transplant), in combination with high-dose chemotherapy or radiation therapy.