Childhood lymphoma in NZ: Symptoms, diagnosis, and treatment

What is lymphoma?

Lymphoma is a type of cancer that develops in the lymphatic system - an integral part of your body’s immune system. It occurs when white blood cells, specifically lymphocytes, begin to grow and multiply in an uncontrolled manner. This abnormal growth can form tumours in lymph nodes or other parts of the lymphatic system.

Data from the New Zealand Children’s Cancer Registry show that in 2023, lymphomas were the third most common cancer among those aged 0-14, next to leukaemias and CNS (central nervous system) tumours.

Types of childhood lymphoma

Lymphoma is divided into two major types: Hodgkin lymphoma and non-Hodgkin lymphoma. 

Hodgkin lymphoma

A key feature of Hodgkin lymphoma is the presence of abnormal cells known as Reed-Sternberg cells. It has two main types: classical Hodgkin lymphoma, which is more common, and nodular lymphocyte-predominant Hodgkin lymphoma.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is a group of cancers that start in the B-lymphocytes (B-cells), T-lymphocytes (T-cells), or natural killer (NK) cells. In children, NHLs are almost always high-grade, meaning they grow and spread quickly, but they also generally respond well to treatment.

What causes lymphoma in children?

In most cases, the causes of childhood lymphoma are unknown. You can’t catch it, and you can’t pass it on. 

However, some factors can increase a child’s risk of developing lymphoma. These could involve:

• A weakened immune system: Children with compromised immunity, such as those who have undergone organ transplant, take immunosuppressive medications, have inherited immunodeficiency syndromes, or have HIV or AIDS
• Epstein-Barr virus (EBV), which infects B cells
• Radiation exposure, such as due to the treatment of a different cancer
• Family history of the disease, although this is rare.

Note that children with lymphoma may have none of these risk factors. And having these risk factors does not mean your child will develop the disease.

Childhood lymphoma symptoms

Childhood lymphoma can present with a range of symptoms, although some kids may not have any, and their lymphoma is found by chance, such as during a test for a different health issue. 

The most common sign is a firm, painless swelling of the lymph node, usually in the neck, armpit, or groin. Lumps from infections are often sore and shrink within weeks, but lymphoma lumps tend to stay.

Other possible symptoms:

• Unexplained recurrent fevers
• Excessive night sweating
• Fatigue that doesn’t improve with rest
• Unintentional weight loss
• Itching or rash
• Chronic cough, wheezing, or breathlessness
• Abdominal symptoms, such as tummy pain, swelling, or changes in bowel habits. 

Having these symptoms doesn’t always mean your child has lymphoma, as they are often caused by less serious illnesses. But if they don’t go away, it’s important to see your GP.

Childhood lymphoma diagnosis and staging

If lymphoma is suspected, your child may be referred for a range of tests to find out for sure. 

The doctor may check for swollen glands in the neck, armpits, and groin, and look for signs of swelling in the chest or tummy. Blood tests can help check how well the organs are working.

The only way to confirm lymphoma is with a biopsy - this is when a tissue sample is taken from a swollen lymph node or lump. Depending on where the lump is, your child may have a scan or keyhole surgery to take the sample. In some cases, the entire lymph node may be removed. 

The tissue is then examined under a microscope to check for cancer cells. Other tests may be performed to diagnose and stage lymphoma. Staging helps determine the extent of the disease and guides treatment decisions. 

Some of these tests may include:

• CT scan: This imaging test helps doctors determine the spread of the lymphoma
• MRI: An MRI is especially useful for checking the brain and spinal cord
• PET scan: Involves injecting radioactive glucose so malignant cells show up more clearly on the scan
• Bone marrow biopsy: A sample of bone marrow is taken to check for the presence of lymphoma cells.

Childhood lymphoma treatments

Treating childhood lymphoma depends on several factors: the type of lymphoma, how far it has spread, your child’s age and overall health, and how your child responds to treatment. Most children need a combination of treatments. 

Treatment options:

• Chemotherapy: This is the most common treatment and may be combined with other therapy regimes. Chemotherapy uses powerful drugs to kill cancer cells or stop them from multiplying.
• Radiotherapy: A painless treatment that uses radiation to destroy cancer cells in a targeted area.
• Stem cell or bone marrow transplant: In cases where high-dose chemotherapy is used, a stem cell or bone marrow transplant may replace stem cells damaged during treatment. It is usually reserved for cases where the cancer has relapsed, has a high risk of coming back, or does not respond to other treatments.
• Targeted treatments use medicines designed to attack specific proteins or substances that lymphoma cells need to grow and survive. This approach can destroy cancer cells while causing less harm to healthy cells.

Possible side effects

Treatment for childhood lymphoma can come with side effects, both short-term and long-term. 

Potential short-term side effects:

• Low blood cell counts
• Tiredness or fatigue
• Easy bruising or bleeding
• Nausea 
• Vomiting
• Hair loss
• Mouth sores
• Increased risk of infection (low immunity).

Long-term or late side effects may include:

• Fertility issues
• A second cancer later in life
• Hormonal problems
• Organ damage.

Your child’s medical team will monitor their health closely during and after treatment to manage these effects early. Regular follow-ups help ensure your child stays well as they grow.

How insurance can help

If your child is covered by comprehensive medical insurance, your insurer may pay for the full or a portion of private medical costs and give you more options on where and by whom your child is treated. 

Health insurance can help you and your child:

• access consultations, diagnostic tests, and treatments faster through private facilities
• pay for private hospital expenses, including cancer treatments and hospital stays
• pay for non-Pharmac drugs and their administration, as well as other medical costs not funded in the public system.

If your critical illness cover includes a child’s trauma benefit, you may be able to access a lump sum payment if your child is diagnosed with a covered serious illness like cancer. You can use the funds however you need: for your child’s medical bills and travel costs, or to take time off work to be there for your child.

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Outlook and survival

In general, the outlook for children with lymphoma in New Zealand is encouraging. According to 2010-2019 data published by the National Child Cancer Network, the 5-year survival rate for childhood lymphomas was 94.8%. This means that nearly 95 out of every 100 children diagnosed with lymphoma were still alive after five years.

Your child’s outlook will also depend on factors such as the type and stage of lymphoma and how it responds to treatments. Early detection and timely treatment can help achieve the best possible outcomes for your child, so be aware of the symptoms and seek medical advice if anything seems unusual.

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