21st Century Pediatric Cancer Sourcebook: Childhood Hodgkin Lymphoma - Clinical Data and Practical Information for Patients, Families, and Physicians
Edition 1.0 - March 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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OncoLink * http://www.oncolink.upenn.edu/
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American Cancer Society (ACS) * http://www.cancer.org/
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PART ONE
Chapter 1A: Childhood Hodgkin Lymphoma
PART TWO
Chapter 1B Late Effects of Treatment for Childhood Cancer - Patient Version
Chapter 2B: Pediatric Supportive Care
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: When Someone You Love Is Being Treated For Cancer
Chapter 15B: Living Beyond Cancer: Finding a New Balance
Chapter 16B: Caring for the Caregiver
Chapter 17B: Young People With Cancer, A Handbook For Parents
Chapter 18B: When Cancer Returns
Chapter 19B: When Someone You Love Has Advanced Cancer / Support for Caregivers
Chapter 20B: Chemotherapy and You
Chapter 21B: Managing Chemotherapy Side Effects - Anemia
Chapter 22B: Managing Chemotherapy Side Effects - Appetite Changes
Chapter 23B: Managing Chemotherapy Side Effects - Bleeding Problems
Chapter 24B: Managing Chemotherapy Side Effects - Constipation
Chapter 25B: Managing Chemotherapy Side Effects - Memory Changes
Chapter 26B: Managing Chemotherapy Side Effects - Mouth and Throat Changes
Chapter 27B: Managing Chemotherapy Side Effects - Nerve Changes
Chapter 28B: Managing Chemotherapy Side Effects - Pain
Chapter 29B: Managing Chemotherapy Side Effects - Skin and Nail Changes
Chapter 30B: Managing Chemotherapy Side Effects - Swelling (Fluid retention)
Chapter 31B: Targeted Cancer Therapies
Chapter 33B : Follow-up Care After Cancer Treatment
Chapter 34B: Radiation Therapy and You
Chapter 36B: Understanding Radiation Therapy, What To Know About External Beam Radiation Therapy
Chapter 37B: Radiation Therapy for Cancer
Chapter 38B: Managing Radiation Therapy Side Effects - What To Do When Your Mouth or Throat Hurts
Chapter 39B: What To Do About Hair Loss (Alopecia)
Chapter 42B: Managing Radiation Therapy Side Effects - Changes When You Urinate
Chapter 43B: Managing Radiation Therapy Side Effects What To Do About Mild Skin Changes
Chapter 45B: General Cancer Information And Resources
Chapter 46B: Cancer And The Environment - What You Need to Know, What You Can Do
Chapter 48B: FDA Warning: Beware of Online Cancer Fraud
Chapter 49B: FDA Office of Oncology Drug Products
Chapter 50B: Understanding the HIPAA Privacy Rule
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Chapter 1A: Childhood Hodgkin Lymphoma
Last Modified: 08/09/2010
Childhood Hodgkin lymphoma is a disease in which malignant (cancer) cells form in the lymph system. There are two types of childhood Hodgkin lymphoma. Age, gender, and Epstein-Barr virus infection can affect the risk of developing childhood Hodgkin lymphoma. Possible signs of childhood Hodgkin lymphoma include swollen lymph nodes, fever, night sweats, and weight loss. Tests that examine the lymph system are used to detect (find) and diagnose childhood Hodgkin lymphoma. Certain factors affect prognosis (chance of recovery) and treatment options.
Childhood Hodgkin lymphoma is a type of cancer that develops in the lymph system, part of the body's immune system. The lymph system is made up of the following:
Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.
Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
Spleen: An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. The spleen is on the left side of the abdomen near the stomach.
Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.
Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils make lymphocytes.
Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow makes white blood cells, red blood cells, and platelets.
Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart.
Because lymph tissue is found throughout the body, Hodgkin lymphoma can start in almost any part of the body and spread to almost any tissue or organ in the body.
Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma.
Hodgkin lymphoma can occur in both children and adults; however, treatment for children may be different than treatment for adults.
There are two types of childhood Hodgkin lymphoma.
The two types of childhood Hodgkin lymphoma are:
Classical Hodgkin lymphoma.
Nodular lymphocyte-predominant Hodgkin lymphoma.
Classical Hodgkin lymphoma is divided into four subtypes, based on how the cancer cells look under a microscope:
Lymphocyte-rich classical Hodgkin lymphoma.
Nodular sclerosis Hodgkin lymphoma.
Mixed cellularity Hodgkin lymphoma.
Lymphocyte-depleted Hodgkin lymphoma.
Age, gender, and Epstein-Barr virus infection can affect the risk of developing childhood Hodgkin lymphoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for childhood Hodgkin lymphoma include the following:
Being between the ages of 15 and 19. At these ages, Hodgkin lymphoma is slightly more common in girls than in boys. In children younger than 5 years, it is more common in boys than in girls.
Being infected with the Epstein-Barr virus.
Having a brother or sister with Hodgkin lymphoma.
Possible signs of childhood Hodgkin lymphoma include swollen lymph nodes, fever, night sweats, and weight loss.
These and other symptoms may be caused by childhood Hodgkin lymphoma or by other conditions. A doctor should be consulted if any of the following problems occur:
Painless, swollen lymph nodes in the neck, chest, underarm, or groin.
Fever.
Night sweats.
Weight loss for no known reason.
Itchy skin.
Tests that examine the lymph system are used to detect (find) and diagnose childhood Hodgkin lymphoma.
The following tests and procedures may be used:
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
Lymph node biopsy: The removal of all or part of a lymph node. One of the following types of biopsies may be done:
Excisional biopsy: The removal of an entire lymph node.
Incisional biopsy: The removal of part of a lymph node.
Core biopsy: The removal of tissue from a lymph node using a wide needle.
Fine-needle aspiration (FNA) biopsy: The removal of tissue from a lymph node using a thin needle.
A pathologist views the tissue under a microscope to look for cancer cells, especially Reed-Sternberg cells. Reed-Sternberg cells are common in classical Hodgkin lymphoma.
Reed-Sternberg cell. Reed-Sternberg cells are large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma.
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
The number of red blood cells, white blood cells, and platelets.
The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
The portion of the blood sample made up of red blood cells.
Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.
Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out the type of malignant (cancerous) lymphocytes that are causing the lymphoma.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
The stage of the cancer.
The size of the tumor and how quickly it shrinks after initial treatment.
The patient's symptoms when diagnosed.
Certain features of the cancer cells.
Whether the cancer is newly diagnosed, does not respond to initial treatment, or has recurred (come back).
The treatment options also depend on:
The child's age and gender.
The risk of long-term side effects.
Most children and adolescents with newly diagnosed Hodgkin lymphoma can be cured.
Stages of Childhood Hodgkin Lymphoma
Key Points for This Section
After childhood Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.
There are three ways that cancer spreads in the body.
Stages of childhood Hodgkin lymphoma may include A, B, E, and S.
The following stages are used for childhood Hodgkin lymphoma:
Stage I
Stage II
Stage III
Stage IV
Untreated, classical Hodgkin lymphoma is divided into risk groups.
After initial chemotherapy, a PET scan may be done.
After childhood Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.
The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. Treatment is based on the stage and other factors that affect prognosis. The following tests and procedures may be used in the staging process:
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). An MRI of the abdomen and pelvis may be done.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.
Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
Through tissue. Cancer invades the surrounding normal tissue.
Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Stages of childhood Hodgkin lymphoma may include A, B, E, and S.
Childhood Hodgkin lymphoma may be described as follows:
A: The patient has no symptoms.
B: The patient has symptoms such as fever, weight loss, or night sweats.
E: Cancer is found in an organ or tissue that is not part of the lymph system but which may be next to an involved area of the lymph system.
S: Cancer is found in the spleen.
The following stages are used for childhood Hodgkin lymphoma:
Stage I
Stage I childhood Hodgkin lymphoma. Cancer is found in one or more lymph nodes in one lymph node group. In stage IE (not shown), cancer is found outside the lymph nodes in one organ or area.
Stage I is divided into stage I and stage IE.
Stage I: Cancer is found in one or more lymph nodes in one lymph node group.
Stage IE: Cancer is found outside the lymph nodes in one organ or area.
Stage II
Stage II is divided into stage II and stage IIE.
Stage II childhood Hodgkin lymphoma. Cancer is found in two or more lymph node groups, and both are either above (a) or below (b) the diaphragm.
Stage II: Cancer is found in two or more lymph node groups above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
Stage IIE childhood Hodgkin lymphoma. Cancer is found in one or more lymph node groups above or below the diaphragm and outside the lymph nodes in a nearby organ or area (a).
Stage IIE: Cancer is found in one or more lymph node groups above or below the diaphragm and outside the lymph nodes in a nearby organ or area.
Stage III
Stage III childhood Hodgkin lymphoma. Cancer is found in one or more lymph node groups above and below the diaphragm (a). In stage IIIE, cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area (b). In stage IIIS, cancer is found in lymph node groups above and below the diaphragm (a) and in the spleen (c). In stage IIIS plus E, cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area (b), and in the spleen (c).
Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIE+S.
Stage III: Cancer is found in one or more lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
Stage IIIE: Cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area.
Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm, and in the spleen.
Stage IIIE+S: Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.
Stage IV
Stage IV childhood Hodgkin lymphoma. Cancer is found outside the lymph nodes throughout one or more organs (a); or outside the lymph nodes in one organ and has spread to lymph nodes far away from that organ (b); or in the lung, liver, or bone marrow.
In stage IV, the cancer:
is found outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
is found outside the lymph nodes in one organ and has spread to lymph nodes far away from that organ; or
is found in the lung, liver, or bone marrow.
Untreated, classical Hodgkin lymphoma is divided into risk groups.
Untreated, classical childhood Hodgkin lymphoma is divided into risk groups based on the bulk of the tumor (tumors that are 5 centimeters or larger are considered "bulky") and whether the patient has "b" symptoms (fever, weight loss, or night sweats). Treatment is based on the risk group.
Low-risk disease:
Patients with stage I or stage II disease; and
No bulky tumors or "b" symptoms.
Intermediate-risk disease:
Patients with stage I or stage II disease, with bulky tumors, or with "b" symptoms; or
Patients with stage III or stage IV disease without "b" symptoms.
High-risk disease: Patients with stage III or stage IV disease with "b" symptoms.
After initial chemotherapy, a PET scan may be done.
A PET scan may be done after one or two cycles of chemotherapy and again after chemotherapy ends, to find out how well the chemotherapy worked.
Primary Progressive/Recurrent Hodgkin Lymphoma in Children and Adolescents
Primary progressive Hodgkin lymphoma is lymphoma that continues to grow or spread during treatment. Recurrent Hodgkin lymphoma is cancer that has recurred (come back) after it has been treated. The lymphoma may come back in the lymph system or in other parts of the body, such as the lungs, liver, bones, or bone marrow.
Treatment Option Overview
Key Points for This Section
There are different types of treatment for children with Hodgkin lymphoma.
Children with Hodgkin lymphoma should have their treatment planned by a team of health care providers with expertise in treating childhood cancer.
Three types of standard treatment are used:
Chemotherapy
Radiation therapy
Targeted therapy
New types of treatment are being tested in clinical trials.
High-dose chemotherapy with stem cell transplant
Surgery
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.
There are different types of treatment for children with Hodgkin lymphoma.
Different types of treatment are available for children with Hodgkin lymphoma. Some treatments are standard and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with Hodgkin lymphoma should have their treatment planned by a team of health care providers with expertise in treating childhood cancer.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health care providers who are experts in treating children with Hodgkin lymphoma and who specialize in certain areas of medicine. These may include the following specialists:
Medical oncologist /hematologist. * Pediatric surgeon. * Radiation oncologist. * Endocrinologist. * Pediatric nurse specialist. * Rehabilitation specialist. * Psychologist. * Social worker.
Three types of standard treatment are used:
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. One type of targeted therapy being used in the treatment of childhood Hodgkin lymphoma is monoclonal antibody therapy.
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Surgery
Surgery may be done to remove as much of the tumor as possible.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
After one or two cycles of chemotherapy for childhood Hodgkin lymphoma, a PET scan may be done to see how well the lymphoma is responding to treatment. Re-staging is done after chemotherapy ends.
Treatment Options for Children and Adolescents with Hodgkin Lymphoma
Low-Risk Childhood Hodgkin Lymphoma
Treatment of low-risk childhood Hodgkin lymphoma may include the following:
Combination chemotherapy with low- dose radiation therapy to involved areas.
A clinical trial of combination chemotherapy with or without low-dose radiation therapy to involved areas.
Intermediate-Risk Childhood Hodgkin Lymphoma
Treatment of intermediate-risk childhood Hodgkin lymphoma may include the following:
Combination chemotherapy with low- dose radiation therapy to involved areas.
A clinical trial of new combinations of chemotherapy before low-dose radiation therapy to involved areas.
High-Risk Childhood Hodgkin Lymphoma
Treatment of high-risk childhood Hodgkin lymphoma may include the following:
Intensive or high-dose combination chemotherapy with low- dose radiation therapy to involved areas.
A clinical trial of new combinations of chemotherapy before low-dose radiation therapy to involved areas.
Nodular Lymphocyte Predominant Childhood Hodgkin Lymphoma
Treatment of nodular lymphocyte predominant childhood Hodgkin lymphoma may include the following:
Combination chemotherapy with low- dose radiation therapy to involved areas.
Combination chemotherapy.
Surgery.
A clinical trial of surgery to remove a single lymph node.
A clinical trial of surgery followed by chemotherapy, with or without low-dose radiation therapy to involved areas.
Treatment Options for Primary Progressive/Recurrent Hodgkin Lymphoma in Children and Adolescents
Treatment of primary progressive or recurrent childhood Hodgkin lymphoma may include the following:
Chemotherapy with low- dose radiation therapy to involved areas for stage I or stage II non-bulky disease. Adolescent patients who have reached full growth may be treated with standard-dose radiation therapy.
High-dose chemotherapy with stem cell transplant with or without radiation therapy.
Monoclonal antibody therapy with or without chemotherapy.
Late Effects from Childhood and Adolescent Hodgkin Lymphoma Treatment
Children and adolescents may have treatment-related side effects that appear months or years after treatment for Hodgkin lymphoma. Because of these late effects on health and development, regular follow-up exams are important. Late effects may include problems with the following:
Development of sex organs in males.
Fertility (ability to have children).
Thyroid, heart, or lungs.
An increased risk of developing a second primary cancer.
Bone growth and development.
There is an increased risk of developing breast cancer for female survivors of Hodgkin lymphoma. This risk depends on the amount of radiation therapy they received during treatment. It is suggested that these patients have a mammogram once a year starting 8 years after treatment or at age 25 years, whichever is later.
Glossary Terms
abdomen (AB-doh-men)
The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
biopsy (BY-op-see)
The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood chemistry study (blud KEH-mih-stree STUH-dee)
A procedure in which a sample of blood is examined to measure the amounts of certain substances made in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.
bone marrow (bone MAYR-oh)
The soft, sponge-like tissue in the center of most bones. It produces white blood cells, red blood cells, and platelets.
cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chest x-ray
An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
classical Hodgkin lymphoma (KLA-sih-kul HOJ-kin lim-FOH-muh)
The most common type of Hodgkin lymphoma, which is a cancer of the immune system. Classical Hodgkin lymphoma is marked by the presence of a type of cell called the Reed-Sternberg cell.
complete blood count
A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called blood cell count and CBC.
contrast material
A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
core biopsy (... BY-op-see)
The removal of a tissue sample with a wide needle for examination under a microscope. Also called core needle biopsy.
CT scan
A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
Epstein-Barr virus (ep-stine-BAR VY-rus)
A common virus that remains dormant in most people. It causes infectious mononucleosis and has been associated with certain cancers, including Burkitt lymphoma, immunoblastic lymphoma, and nasopharyngeal carcinoma. Also called EBV.
excisional biopsy (ek-SIH-zhun-al BY-op-see)
A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.
fever (FEE-ver)
An increase in body temperature above normal (98.6 degrees F), usually caused by disease.
fine-needle aspiration biopsy (... NEE-dul AS-pih-RAY-shun BY-op-see)
The removal of tissue or fluid with a thin needle for examination under a microscope. Also called FNA biopsy.
glucose
A type of sugar; the chief source of energy for living organisms.
groin
The area where the thigh meets the abdomen.
hemoglobin (HEE-moh-GLOH-bin)
The substance inside red blood cells that binds to oxygen in the lungs and carries it to the tissues.
Hodgkin lymphoma (HOJ-kin lim-FOH-muh)
A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.
immune system (ih-MYOON SIS-tem)
The complex group of organs and cells that defends the body against infections and other diseases.
immunophenotyping (IM-yoo-no-FEE-no-tie-ping)
A process used to identify cells, based on the types of antigens or markers on the surface of the cell. This process is used to diagnose specific types of leukemia and lymphoma by comparing the cancer cells to normal cells of the immune system.
incisional biopsy (in-SIH-zhun-al BY-op-see)
A surgical procedure in which a portion of a lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope to check for signs of disease.
infection
Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
injection
Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
lymph (limf)
The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.
lymph node (limf node)
A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
lymph vessel (limf ...)
A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.
lymphatic system (lim-FA-tik SIS-tem)
The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
lymphocyte (LIM-foh-site)
A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. A lymphocyte is a type of white blood cell.
lymphoma (lim-FOH-muh)
Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One kind is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer.
malignant (muh-LIG-nunt)
Cancerous. Malignant cells can invade and destroy nearby tissue and spread to other parts of the body.