T-cell childhood non Hodgkin lymphoma (NHL)
Although many children are successfully treated, it is devastating for everyone concerned. T-cell non Hodgkins lymphoma in children is very rare. As well as the doctors and nurses on the ward, you and your child will be supported by a number of professionals during and after treatment, including your GP, cancer nurse specialists, social workers, play specialists and a psychologist or psychotherapist.
There is a lot of support available to help you and your child. You can contact the Cancer Research UK information nurses on freephone 0808 800 4040, from 9am until 5pm, Monday to Friday.
Our page about children's cancer organisations gives details of organisations you can contact for information, help and support. The Children's Cancer and Leukaemia Group (CCLG) have a booklet called A Parent’s Guide to Children’s Cancers – For parents and carers. This gives general information about childhood cancer, treatments and where to get further information and support. It is helpful for parents and grandparents. The CCLG also has factsheets about individual types of children’s cancer and their treatment.
NHL is a complicated disease and there are many different types. In the UK each year, only 60 to 70 children are diagnosed with all types of NHL. But the most important thing is whether NHL is low grade or high grade. Low grade usually means slow growing and high grade is fast growing. Low grade tumours are common in adults but in children most NHLs are high grade.
Because there are so many different types of lymphomas doctors put them into different groups. They call this classification. Non Hodgkin lymphomas can be classified in several different ways according to
- The type of cell affected (B cell or T cell)
- How fast they tend to grow (their grade)
- How the cells look under a microscope
- How the lymphoma behaves clinically
- What genetic abnormailities the tumour has
There are three main types of NHL found in children. Like many illnesses, they have quite complicated names. These are
- Non cleaved cell (Burkitt's lymphoma)
- Lymphoblastic (usually T cell) lymphoma
- Large cell lymphoma
The lymphoblastic type is the most common type of childhood T cell NHL.
Childhood NHL has 4 stages, which look at how many lymph nodes are affected by the lymphoma and whether other organs in the body are also affected. Unlike adults with NHL, who mostly have disease in their lymph nodes, children typically have lymphoma in their chest, abdomen or head and neck area. NHL is more common in boys than in girls and the reasons for this are unclear.
Stage 1 means there is lymphoma in one part of the body or one group of lymph nodes outside the tummy (abdomen) or chest
Stage 2 means the cancer is in
- Only one part of the body and in the lymph nodes around it or
- In 2 or more areas or groups of lymph nodes on one side of the diaphragm (the muscle that divides the chest and abdominal cavity and helps with breathing) or
- In the stomach or bowel
Stage 3 means the lymphoma is in
- Parts of the body or lymph nodes on both sides of the diaphragm or
- Within the chest or
- In more than one place in the abdomen or
- Around the spine
Stage 4 means the lymphoma has spread to another part of the body such as the bone, liver or brain
Chemotherapy is the most important treatment for children with NHL. They usually have a combination of chemotherapy drugs. The drugs used may include
- Steroid drugs – prednisolone and dexamethasone
The links in the list above take you to more information about each of these drugs, including information about their side effects. Some children also have radiotherapy to the brain to try and prevent the lymphoma from spreading there.
The treatment may last from a few months to up to 2 years. Your child’s doctor will discuss the treatment options with you.
High dose chemotherapy with a bone marrow transplant is sometimes used if the NHL comes back (recurs) after initial treatment.
The side effects of the treatment will depend upon the particular treatment being used. Your child’s doctor will discuss this with you before treatment starts. The side effects can include feeling and being sick, temporary hair loss, an increased risk of infection, bruising and bleeding, tiredness, and diarrhoea.
For many years the chance of being cured for children with NHL has been getting higher. A study in 2008 reported that around 80% of children with stage 4 T cell lymphoma are likely to be cured. Your child's doctor can give you more information about the likely chance of cure in his case.
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