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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65781_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65781_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65781_"><span class="title" itemprop="name">Childhood Hodgkin Lymphoma Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><p class="small">Published online: May 31, 2018.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000257999__260">This PDQ cancer information summary has current information about the treatment of childhood Hodgkin lymphoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000257999__261">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board. </p></div><div id="CDR0000257999__1"><h2 id="_CDR0000257999__1_">General Information About Childhood Hodgkin Lymphoma</h2><div id="CDR0000257999__1.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000257999__2">Childhood Hodgkin lymphoma is a disease in which malignant
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(cancer) cells form in the lymph system.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__134">There are two types of childhood Hodgkin lymphoma. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__8">Epstein-Barr virus infection increases
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the risk of childhood Hodgkin lymphoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__12">Signs of childhood Hodgkin lymphoma include swollen
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lymph nodes, fever, night sweats, and weight loss.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__16">Tests that examine the lymph system are used to detect (find) and diagnose
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childhood Hodgkin lymphoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__20">Certain factors affect prognosis (chance
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of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000257999__2"><h3>Childhood Hodgkin lymphoma is a disease in which malignant
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(cancer) cells form in the lymph system.</h3><p id="CDR0000257999__4">Childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a> is a type of
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that develops in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, which is part of the body's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>.
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The immune system protects the body from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000698772/" class="def">foreign</a> substances, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>, and diseases. The lymph system is made up of the following:</p><ul id="CDR0000257999__6"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046305/" class="def">Lymph</a>: Colorless,
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watery <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> that carries
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a> called
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045765/" class="def">lymphocytes</a> through the lymph system. Lymphocytes protect the
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body against infections and the
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growth of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">Lymph vessels</a>: A network of thin tubes that collect lymph
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from different parts of the body and return it to the bloodstream. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">Lymph nodes</a>:
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Small, bean-shaped structures that filter lymph and store white blood cells that help fight
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infection and disease. Lymph nodes are located along the network of lymph vessels
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found throughout the body. Clusters of lymph nodes are found in the neck,
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underarm, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">Spleen</a>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>
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that makes lymphocytes, filters the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>, stores blood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>, and destroys
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old blood cells. The spleen is on the left side of the abdomen near the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046616/" class="def">Thymus</a>: An organ
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in which lymphocytes grow and multiply. The thymus is in the chest behind the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000549425/" class="def">breastbone</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046618/" class="def">Tonsils</a>: Two small
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masses of lymph <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> at the
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back of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a>. The tonsils make lymphocytes.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">Bone marrow</a>: The
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soft, spongy tissue in the center of large bones. Bone marrow makes white
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blood cells, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a>, and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a>.</div></li></ul><div id="CDR0000257999__237" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20lymph%20system%2C%20showing%20the%20lymph%20vessels%20and%20lymph%20organs%20including%20lymph%20nodes%2C%20tonsils%2C%20thymus%2C%20spleen%2C%20and%20bone%20marrow&p=BOOKS&id=506896_CDR0000653807.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000653807.jpg" alt="Lymph system; drawing shows the lymph vessels and lymph organs including the lymph nodes, tonsils, thymus, spleen, and bone marrow. One inset shows the inside structure of a lymph node and the attached lymph vessels with arrows showing how the lymph (clear fluid) moves into and out of the lymph node. Another inset shows a close up of bone marrow with blood cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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.</p></div></div><p id="CDR0000257999__5">Lymph tissue is also found in other parts of the body such as the stomach, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044751/" class="def">thyroid gland</a>, brain, and skin.</p><p id="CDR0000257999__125">There are two general types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">lymphoma</a>: Hodgkin lymphoma and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin
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lymphoma</a>. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000258002/">Childhood Non-Hodgkin Lymphoma Treatment</a> for more information.)
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</p><p id="CDR0000257999__7"> Hodgkin lymphoma often occurs in adolescents 15 to 19 years of age. The
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treatment for children and adolescents is different than treatment for adults. (See the
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PDQ summary on <a href="/books/n/pdqcis/CDR0000257991/">Adult Hodgkin Lymphoma Treatment</a> for more information.)</p></div><div id="CDR0000257999__134"><h3>There are two types of childhood Hodgkin lymphoma. </h3><p id="CDR0000257999__136">The two types of childhood Hodgkin lymphoma are:</p><ul id="CDR0000257999__157"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574284/" class="def">Classical Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574286/" class="def">Nodular lymphocyte-predominant Hodgkin lymphoma</a>.</div></li></ul><p id="CDR0000257999__158">Classical Hodgkin lymphoma is divided into four subtypes, based on how the cancer cells look under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>:</p><ul id="CDR0000257999__137"><li class="half_rhythm"><div>Lymphocyte-rich classical Hodgkin lymphoma.
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</div></li><li class="half_rhythm"><div>Nodular sclerosis Hodgkin lymphoma.
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</div></li><li class="half_rhythm"><div>Mixed cellularity Hodgkin lymphoma.
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</div></li><li class="half_rhythm"><div>Lymphocyte-depleted Hodgkin lymphoma.</div></li></ul></div><div id="CDR0000257999__8"><h3>Epstein-Barr virus infection increases
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the risk of childhood Hodgkin lymphoma.</h3><p id="CDR0000257999__10">Anything that increases your risk of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. 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. Talk with your child’s doctor if you think your child may be at risk. </p><p id="CDR0000257999__252">Risk factors for childhood Hodgkin lymphoma include the following: </p><ul id="CDR0000257999__121"><li class="half_rhythm"><div>Being infected with the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045684/" class="def">Epstein-Barr virus</a>.</div></li><li class="half_rhythm"><div>Being infected with the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044366/" class="def">human immunodeficiency virus</a> (HIV).</div></li><li class="half_rhythm"><div>Having certain diseases of the immune system.</div></li><li class="half_rhythm"><div>Having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642021/" class="def">personal history</a> of mononucleosis ("mono").</div></li><li class="half_rhythm"><div>Having a parent or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616710/" class="def">sibling</a> with a personal history of Hodgkin lymphoma.</div></li></ul><p id="CDR0000257999__220">Being exposed to common infections in early childhood may decrease the risk of Hodgkin lymphoma in children because of the effect it has on the immune system.</p></div><div id="CDR0000257999__12"><h3>Signs of childhood Hodgkin lymphoma include swollen
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lymph nodes, fever, night sweats, and weight loss.</h3><p id="CDR0000257999__14">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by childhood Hodgkin lymphoma or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>. Check with your child's doctor if your child has any of the following:</p><ul id="CDR0000257999__15"><li class="half_rhythm"><div>Painless, swollen lymph nodes near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000639993/" class="def">collarbone</a> or in the neck, chest, underarm, or groin.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a> for no known reason. </div></li><li class="half_rhythm"><div>Weight loss for no known reason.</div></li><li class="half_rhythm"><div>Night sweats.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000321374/" class="def">Fatigue</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044103/" class="def">Anorexia</a>.</div></li><li class="half_rhythm"><div>Itchy skin.</div></li><li class="half_rhythm"><div>Pain in the lymph nodes after drinking <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463134/" class="def">alcohol</a>.</div></li></ul><p id="CDR0000257999__221">Fever, weight loss, and night sweats are called B symptoms.</p></div><div id="CDR0000257999__16"><h3>Tests that examine the lymph system are used to detect (find) and diagnose
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childhood Hodgkin lymphoma.</h3><p id="CDR0000257999__18">The following tests and procedures may be used:</p><ul id="CDR0000257999__19"><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: 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.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, or pelvis, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> 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. <div id="CDR0000257999__262" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Computed%20tomography%20(CT)%20scan%20of%20the%20abdomen&p=BOOKS&id=506896_CDR0000775531.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000775531.jpg" alt="Computed tomography (CT) scan of the abdomen; drawing shows a child lying on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Computed tomography (CT) scan of the abdomen. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen.</p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a> tumor cells in the body. A small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> 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. Sometimes a PET scan and a CT scan are done at the same time. If there is any cancer, this increases the chance that it will be found.<div id="CDR0000257999__263" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Positron%20emission%20tomography%20(PET)%20scan&p=BOOKS&id=506896_CDR0000775456.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000775456.jpg" alt="Positron emission tomography (PET) scan; drawing shows a child lying on table that slides through the PET scanner." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do. </p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: 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.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045107/" class="def">Complete blood count</a> (CBC)</b>: A procedure in which a sample of blood is drawn and checked for the following:<dl id="CDR0000257999__159" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">The number of red blood cells, white blood cells, and platelets.</p></dd><dt>-</dt><dd><p class="no_top_margin">The amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> that carries <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a>) in the red blood cells.</p></dd><dt>-</dt><dd><p class="no_top_margin">The portion of the blood sample made up of red blood cells.</p></dd></dl><div id="CDR0000257999__179" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Complete%20blood%20count%20(CBC)&p=BOOKS&id=506896_CDR0000526546.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000526546.jpg" alt="Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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.</p></div></div>
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</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: 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.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354461/" class="def">Sedimentation rate</a></b>: 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. The sedimentation rate is a measure of how much <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflammation</a> is in the body. A higher than normal sedimentation rate may be a sign of lymphoma. Also called erythrocyte sedimentation rate, sed rate, or ESR.</div></li><li class="half_rhythm"><div class="half_rhythm"><b> Lymph node <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a></b>:
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The removal of all or part of a lymph node. The lymph node may be removed during an image-guided CT scan or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046119/" class="def">thoracoscopy</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046287/" class="def">mediastinoscopy</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045556/" class="def">laparoscopy</a>. One of the following types of
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biopsies may be done:
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<dl id="CDR0000257999__126" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046411/" class="def">Excisional
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biopsy</a></b>: The removal of an entire lymph node. </p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046698/" class="def">Incisional
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biopsy</a></b>: The removal of part of a lymph node.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045657/" class="def">Core
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biopsy</a></b>: The removal of tissue from a lymph node using a wide needle.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045691/" class="def">Fine-needle aspiration (FNA) biopsy</a></b>: The
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removal of tissue from a lymph node using a thin needle.</p></dd></dl></div><div class="half_rhythm">A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the tissue under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for cancer cells, especially <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046557/" class="def">Reed-Sternberg cells</a>. Reed-Sternberg cells are common in classical Hodgkin lymphoma.<div id="CDR0000257999__185" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Reed-Sternberg%20cell&p=BOOKS&id=506896_CDR0000576466.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000576466.jpg" alt="Reed-Sternberg cell; photograph shows normal lymphocytes compared with a Reed-Sternberg cell." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Reed-Sternberg cell. Reed-Sternberg cells are large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma.</p></div></div></div><div class="half_rhythm">The following test may be done on tissue that was removed:<ul id="CDR0000257999__223"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000341450/" class="def">Immunophenotyping</a></b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> used to identify cells, based on the types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a> on the surface of the cell. This test is used to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the specific type of lymphoma by comparing the cancer cells to normal cells of the immune system.</div></li></ul></div></li></ul></div><div id="CDR0000257999__20"><h3>Certain factors affect prognosis (chance
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of recovery) and treatment options.</h3><p id="CDR0000257999__127">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options depend
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on the following:</p><ul id="CDR0000257999__128"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer.</div></li><li class="half_rhythm"><div>The size of the tumor.</div></li><li class="half_rhythm"><div> Whether there are B symptoms at diagnosis.</div></li><li class="half_rhythm"><div>The type of Hodgkin lymphoma.</div></li><li class="half_rhythm"><div>Certain features of the cancer cells.</div></li><li class="half_rhythm"><div>Whether there are too many white blood cells or too few red blood cells at the time of diagnosis.</div></li><li class="half_rhythm"><div>How well the tumor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">responds</a> to initial treatment with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div>Whether the cancer is newly diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurred</a> (come back). </div></li></ul><p id="CDR0000257999__22">The treatment options also depend
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on:</p><ul id="CDR0000257999__129"><li class="half_rhythm"><div>The child's age and sex.</div></li><li class="half_rhythm"><div>The risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693593/" class="def">long-term side effects</a>.</div></li></ul><p id="CDR0000257999__147">Most children and adolescents with newly diagnosed
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Hodgkin lymphoma can be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318813/" class="def">cured</a>.</p></div></div><div id="CDR0000257999__24"><h2 id="_CDR0000257999__24_">Stages of Childhood Hodgkin Lymphoma</h2><div id="CDR0000257999__24.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000257999__25">After childhood Hodgkin lymphoma has been diagnosed,
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tests are done to find out if cancer cells have spread within the lymph
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system or to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__186">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__29">Stages of childhood Hodgkin lymphoma may include A, B, E, and S. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__33">The following stages are used for childhood Hodgkin lymphoma:
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</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000257999__35">Stage I</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__38">Stage II</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__41">Stage III</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__44">Stage IV</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000257999__148">Untreated Hodgkin lymphoma is divided into risk groups.</a></div></li></ul></div><div id="CDR0000257999__25"><h3>After childhood Hodgkin lymphoma has been diagnosed,
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tests are done to find out if cancer cells have spread within the lymph
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system or to other parts of the body.</h3><p id="CDR0000257999__27">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread within the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph
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system</a> or to other parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The information gathered from the staging
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process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the
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disease. Treatment is based on the stage and other factors that affect <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a>. </p><p id="CDR0000257999__253">The following tests and procedures may be used in the staging process: </p><ul id="CDR0000257999__28"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the body. A small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> 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. Sometimes a PET scan and a CT scan are done at the same time. If there is any cancer, this increases the chance that it will be found.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, 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.<div id="CDR0000257999__264" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Magnetic%20resonance%20imaging%20(MRI)%20of%20the%20abdomen&p=BOOKS&id=506896_CDR0000775532.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000775532.jpg" alt="Magnetic resonance imaging (MRI) of the abdomen; drawing shows a child lying on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Magnetic resonance imaging (MRI) of the abdomen. The child lies on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer.</p></div></div></div></li><li class="half_rhythm"><div>
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046505/" class="def">Bone marrow aspiration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046506/" class="def">biopsy</a></b>: The removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> and a small piece of bone by inserting a hollow needle into the hipbone or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000549425/" class="def">breastbone</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the bone marrow and bone under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> cells.<div id="CDR0000257999__265" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Bone%20marrow%20aspiration%20and%20biopsy&p=BOOKS&id=506896_CDR0000775458.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000775458.jpg" alt="Bone marrow aspiration and biopsy; drawing shows a child lying face down on a table and a bone marrow needle being inserted into the right hip bone. An inset shows the bone marrow needle being inserted through the skin into the bone marrow of the hip bone." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Bone marrow aspiration and biopsy. After a small area of skin is numbed, a bone marrow needle is inserted into the child’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.</p></div></div></div></li></ul></div><div id="CDR0000257999__186"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000257999__186_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000257999__186_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000257999__29"><h3>Stages of childhood Hodgkin lymphoma may include A, B, E, and S. </h3><p id="CDR0000257999__206">Childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a> may be described as follows:</p><ul id="CDR0000257999__130"><li class="half_rhythm"><div>A: The patient does not have B symptoms (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">fever</a>, weight loss, or night sweats).</div></li><li class="half_rhythm"><div>B: The patient has B symptoms.</div></li><li class="half_rhythm"><div>E: Cancer is found in an organ or tissue that is not part of the lymph
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system but which may be next to an area of the lymph system affected by the cancer. </div></li><li class="half_rhythm"><div>S: Cancer is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.</div></li></ul></div><div id="CDR0000257999__33"><h3>The following stages are used for childhood Hodgkin lymphoma:
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</h3><div id="CDR0000257999__35"><h4>Stage I</h4><div id="CDR0000257999__211" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20I%20childhood%20Hodgkin%20lymphoma&p=BOOKS&id=506896_CDR0000648701.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000648701.jpg" alt="Stage I childhood Hodgkin lymphoma; drawing shows cancer in one lymph node group above the diaphragm. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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.</p></div></div><p id="CDR0000257999__198"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430896/" class="def">Stage I</a> is divided into stage I and stage IE.</p><ul id="CDR0000257999__199"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430896/" class="def">Stage I</a>: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> is found in one of the following places in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>:<ul id="CDR0000257999__224"><li class="half_rhythm"><div>One or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> in one lymph node group.</div></li><li class="half_rhythm"><div>Waldeyer's ring.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046616/" class="def">Thymus</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">Spleen</a>.</div></li></ul></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430896/" class="def">Stage IE</a>: Cancer is found outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a> in one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> or area.</div></li></ul></div><div id="CDR0000257999__38"><h4>Stage II</h4><p id="CDR0000257999__40"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430897/" class="def">Stage II</a> is divided
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into stage II and stage IIE.</p><ul id="CDR0000257999__200"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430897/" class="def">Stage II</a>: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> is found in two or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups either above or below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a> (the thin muscle below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a> that helps breathing and separates the chest from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>).<div id="CDR0000257999__212" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20II%20childhood%20Hodgkin%20lymphoma&p=BOOKS&id=506896_CDR0000648702.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000648702.jpg" alt="Stage II childhood Hodgkin lymphoma; drawing shows cancer in lymph node groups above and below the diaphragm. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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.</p></div></div></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430897/" class="def">Stage IIE</a>: Cancer is found in one or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups either above or below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a> and outside the lymph nodes in a nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> or area.<div id="CDR0000257999__213" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIE%20childhood%20Hodgkin%20lymphoma&p=BOOKS&id=506896_CDR0000648703.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000648703.jpg" alt="Stage IIE childhood Hodgkin lymphoma; drawing shows cancer in one lymph node group above the diaphragm and in the left lung. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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).</p></div></div></div></li></ul></div><div id="CDR0000257999__41"><h4>Stage III</h4><div id="CDR0000257999__214" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20III%20childhood%20Hodgkin%20lymphoma&p=BOOKS&id=506896_CDR0000648704.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000648704.jpg" alt="Stage III childhood Hodgkin lymphoma; drawing shows cancer in lymph node groups above and below the diaphragm, in the left lung, and in the spleen. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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).</p></div></div><p id="CDR0000257999__43"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430898/" class="def">Stage III</a> is divided
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into stage III, stage IIIE, stage IIIS, and stage
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IIIE,S.</p><ul id="CDR0000257999__201"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430898/" class="def">Stage III</a>: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups above and below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a> (the thin muscle below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a> that helps breathing and separates the chest from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430898/" class="def">Stage IIIE</a>: Cancer is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups above and below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a> and outside the lymph nodes in a nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> or area.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430898/" class="def">Stage IIIS</a>: Cancer is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups above and below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>, and in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430898/" class="def">Stage IIIE,S</a>: Cancer is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups above and below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>, outside the lymph nodes in a nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> or area, and in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.</div></li></ul></div><div id="CDR0000257999__44"><h4>Stage IV</h4><div id="CDR0000257999__215" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IV%20childhood%20Hodgkin%20lymphoma&p=BOOKS&id=506896_CDR0000648705.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65781.13/bin/CDR0000648705.jpg" alt="Stage IV childhood Hodgkin lymphoma; drawing shows cancer in the liver, the left lung, and in one lymph node group below the diaphragm. The brain and pleura are also shown. One inset shows cancer spreading through lymph nodes and lymph vessels to other parts of the body. Lymphoma cells containing cancer are shown inside one lymph node. Another inset shows cancer cells in the bone marrow." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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.</p></div></div><p id="CDR0000257999__204">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430899/" class="def">stage IV</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>:</p><ul id="CDR0000257999__205"><li class="half_rhythm"><div>is found outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> throughout one or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, and may be in lymph nodes near those organs; or</div></li><li class="half_rhythm"><div>is found outside the lymph nodes in one organ and has spread to areas far away from that organ; or</div></li><li class="half_rhythm"><div>is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (CSF). The cancer has not spread to the lung, liver, bone marrow, or CSF from nearby areas.</div></li></ul></div></div><div id="CDR0000257999__148"><h3>Untreated Hodgkin lymphoma is divided into risk groups.</h3><p id="CDR0000257999__163">Untreated childhood Hodgkin lymphoma is divided into <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000711109/" class="def">risk groups</a> based on the stage, size of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>, and whether the patient has B symptoms (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">fever</a>, weight loss, or night sweats). The risk group is used to plan treatment.
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</p><ul id="CDR0000257999__164"><li class="half_rhythm"><div><a href="#CDR0000257999__83">Low-risk childhood Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="#CDR0000257999__89">Intermediate-risk childhood Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="#CDR0000257999__102">High-risk childhood Hodgkin lymphoma</a>.</div></li></ul></div></div><div id="CDR0000257999__48"><h2 id="_CDR0000257999__48_">Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents</h2><p id="CDR0000257999__141"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">Primary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045863/" class="def">refractory</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">lymphoma</a> that continues to grow or spread during treatment.
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</p><p id="CDR0000257999__254"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a> Hodgkin lymphoma is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a>
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(come back) after it has been treated. The lymphoma may come back in the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a> or in other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, bones, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>. </p></div><div id="CDR0000257999__51"><h2 id="_CDR0000257999__51_">Treatment Option Overview</h2><div id="CDR0000257999__51.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000257999__52">There are different types of treatment for children with
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Hodgkin lymphoma. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__56">Children with Hodgkin lymphoma should have their treatment
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planned by a team of health care providers who are experts in treating childhood
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cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__238">Treatment for childhood Hodgkin lymphoma may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__65">Five types of standard treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000257999__67">Chemotherapy </a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__70">Radiation therapy
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__207">Targeted therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__227">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__169">High-dose chemotherapy with stem cell
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transplant </a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000257999__74">New types of treatment are being tested in clinical trials.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__188">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__190">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__192">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000257999__52"><h3>There are different types of treatment for children with
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Hodgkin lymphoma. </h3><p id="CDR0000257999__54">Different types of treatment are available for children with
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a>
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and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical
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trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to
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help improve current treatments or obtain information on new treatments for
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patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical
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trials show that a new treatment is better than the
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standard treatment, the new
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treatment may become the standard treatment.</p><p id="CDR0000257999__55">Because cancer in children is rare, taking part in a clinical trial
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should be considered. Some clinical trials are open only to patients who have not started treatment. </p></div><div id="CDR0000257999__56"><h3>Children with Hodgkin lymphoma should have their treatment
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planned by a team of health care providers who are experts in treating childhood
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cancer.</h3><p id="CDR0000257999__58">Treatment will be overseen by a
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693555/" class="def">pediatric
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oncologist</a>, a doctor who specializes
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in treating children with cancer. The pediatric oncologist works with
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other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046245/" class="def">pediatric</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650566/" class="def">health care providers</a> who are experts in treating children
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with Hodgkin lymphoma and who specialize in certain areas of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>. These
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may include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a>:</p><ul id="CDR0000257999__59"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000757278/" class="def">Pediatrician</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046290/" class="def">Medical
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oncologist</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046370/" class="def">hematologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318823/" class="def">Pediatric surgeon</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">Radiation
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oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046439/" class="def">Endocrinologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318821/" class="def">Pediatric nurse specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318825/" class="def">Rehabilitation specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044716/" class="def">Psychologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">Social worker</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000690737/" class="def">Child-life specialist</a>.</div></li></ul><p id="CDR0000257999__233">The treatment of Hodgkin lymphoma in adolescents and young adults may be different than the treatment for children. Some adolescents and young adults are treated with an adult treatment <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a>.</p></div><div id="CDR0000257999__238"><h3>Treatment for childhood Hodgkin lymphoma may cause side effects.</h3><p id="CDR0000257999__238_76">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> that begin during treatment for cancer, see our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p><p id="CDR0000257999__240">Side effects from cancer treatment that begin after treatment and continue for months or years are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. Because late effects affect health and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000637716/" class="def">development</a>, regular <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> exams are important.</p><p id="CDR0000257999__241">Late effects of cancer treatment may include the following:</p><ul id="CDR0000257999__242"><li class="half_rhythm"><div>Physical problems that affect the following:<dl id="CDR0000257999__243" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Development of sex and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046564/" class="def">reproductive organs</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046399/" class="def">Fertility</a> (ability to have children).</p></dd><dt>-</dt><dd><p class="no_top_margin">Bone and muscle growth and development.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046036/" class="def">Thyroid</a>, heart, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a> function.</p></dd><dt>-</dt><dd><p class="no_top_margin">Teeth, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000481753/" class="def">gums</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046196/" class="def">salivary gland</a> function.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">Spleen</a> function (increased risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>).</p></dd></dl>
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</div></li><li class="half_rhythm"><div>Changes in mood, feelings, thinking, learning, or memory.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">Second cancers</a> (new types of cancer).</div></li></ul><p id="CDR0000257999__244">
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For female <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> of Hodgkin lymphoma, there is an increased risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444971/" class="def">breast cancer</a>. This risk depends on the amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> they received to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304766/" class="def">breast</a> during treatment and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> regimen used. The risk of breast cancer is decreased if these female survivors also received radiation therapy to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>.
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</p><p id="CDR0000257999__255">It is suggested that female survivors who received radiation therapy to the breast have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045775/" class="def">mammogram</a> once a year starting 8 years after treatment or at age 25 years, whichever is later. Female survivors of childhood Hodgkin lymphoma who have breast cancer have an increased risk of dying from the disease compared to patients with no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642019/" class="def">history</a> of Hodgkin lymphoma who have breast cancer.</p><p id="CDR0000257999__245">Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a> for more information).
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</p></div><div id="CDR0000257999__65"><h3>Five types of standard treatment are used:</h3><div id="CDR0000257999__67"><h4>Chemotherapy </h4><p id="CDR0000257999__119">Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> is treatment using more than one anticancer drug. </p><p id="CDR0000257999__225">The way the chemotherapy is given depends on the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000711109/" class="def">risk group</a>. For example, children with low-risk Hodgkin lymphoma receive fewer cycles of treatment, fewer anticancer drugs, and lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of anticancer drugs than children with high-risk lymphoma.</p><p id="CDR0000257999__219">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/hodgkin-lymphoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Hodgkin Lymphoma</a> for more information.</p></div><div id="CDR0000257999__70"><h4>Radiation therapy
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</h4><p id="CDR0000257999__120">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy:</p><ul id="CDR0000257999__267"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>. These types of external radiation therapy include the following:<dl id="CDR0000257999__268" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270731/" class="def">Conformal radiation therapy</a>: Conformal radiation therapy is a type of external radiation therapy that uses a computer to make a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045582/" class="def">3-dimensional</a> (3-D) picture of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> and shapes the radiation beams to fit the tumor.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335073/" class="def">Intensity-modulated radiation therapy</a> (IMRT): IMRT is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044487/" class="def">3-dimensional (3-D) radiation therapy</a> that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles.</p></dd></dl></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000257999__269">Radiation therapy may be given, based on the child’s risk group and chemotherapy regimen. External radiation therapy is used to treat childhood Hodgkin lymphoma. The radiation is given only to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or other areas with cancer. Internal radiation therapy is not used to treat Hodgkin lymphoma.</p></div><div id="CDR0000257999__207"><h4>Targeted therapy</h4><p id="CDR0000257999__209"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000393541/" class="def">proteasome inhibitor</a> therapy are being used in the treatment of childhood Hodgkin lymphoma.</p><p id="CDR0000257999__210">Monoclonal antibody therapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> made in the laboratory from a single type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. They may be used alone or to carry drugs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a>, or radioactive material directly to cancer cells. </p><p id="CDR0000257999__256">In children, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045525/" class="def">rituximab</a> may be used to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350245/" class="def">refractory</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> Hodgkin lymphoma. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000710543/" class="def">Brentuximab</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">pembrolizumab</a>, and atezolizumab are monoclonal antibodies being studied to treat children.</p><p id="CDR0000257999__266">Proteasome inhibitor therapy is a type of targeted therapy that blocks the action of proteasomes in cancer cells. Proteasomes remove <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a> no longer needed by the cell. When the proteasomes are blocked, the proteins build up in the cell and may cause the cancer cell to die. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269133/" class="def">Bortezomib</a> is a proteasome inhibitor used to treat refractory or recurrent childhood Hodgkin lymphoma. </p></div><div id="CDR0000257999__227"><h4>Surgery</h4><p id="CDR0000257999__229"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> may be done to remove as much of the tumor as possible for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045754/" class="def">localized</a> nodular <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045765/" class="def">lymphocyte</a>-predominant childhood Hodgkin lymphoma.</p></div><div id="CDR0000257999__169"><h4>High-dose chemotherapy with stem cell
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transplant </h4><p id="CDR0000257999__78"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">High-dose chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> is a way of giving high doses of chemotherapy and replacing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>-forming cells destroyed by the cancer treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">Stem cells</a> (immature blood cells) are removed from the blood or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> of the patient or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a> 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">reinfused</a> stem cells grow into (and restore) the body's blood cells.</p><p id="CDR0000257999__247">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/hodgkin-lymphoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Hodgkin Lymphoma</a> for more information.</p></div></div><div id="CDR0000257999__74"><h3>New types of treatment are being tested in clinical trials.</h3><p id="CDR0000257999__182">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 <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000257999__230"><h4>Proton beam radiation therapy</h4><p id="CDR0000257999__232">
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270726/" class="def">Proton-beam therapy</a> is a type of high-energy, external radiation therapy that uses streams of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044715/" class="def">protons</a> (small, positively-charged particles of matter) to make radiation. This type of radiation therapy may help lessen the damage to healthy tissue near the tumor.
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</p></div></div><div id="CDR0000257999__188"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000257999__188_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000257999__188_24">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.</p><p id="CDR0000257999__188_25">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.</p></div><div id="CDR0000257999__190"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000257999__190_29">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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000257999__190_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000257999__192"><h3>Follow-up tests may be needed.</h3><p id="CDR0000257999__192_55">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> 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.</p><p id="CDR0000257999__192_56">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 child's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p><p id="CDR0000257999__197">For patients who receive chemotherapy alone, a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> may be done 3 weeks or more after treatment ends. For patients who receive radiation therapy last, a PET scan should not be done until 8 to 12 weeks after treatment.</p></div></div><div id="CDR0000257999__82"><h2 id="_CDR0000257999__82_">Treatment Options for Children and Adolescents with Hodgkin Lymphoma </h2><p id="CDR0000257999__270">For information about the treatments listed below, see the <a href="#CDR0000257999__65">Treatment Option Overview</a> section.</p><div id="CDR0000257999__83"><h3>Low-Risk Classical Childhood Hodgkin Lymphoma</h3><p id="CDR0000257999__84">Treatment of low-risk <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574284/" class="def">classical childhood Hodgkin lymphoma</a> may include the following: </p><ul id="CDR0000257999__257"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> may also be given to the areas with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>.</div></li></ul><p id="CDR0000257999__TrialSearch_83_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000257999__89"><h3>Intermediate-Risk Classical Childhood Hodgkin Lymphoma</h3><p id="CDR0000257999__144">Treatment of intermediate-risk <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574284/" class="def">classical childhood Hodgkin lymphoma</a> may include the following:</p><ul id="CDR0000257999__258"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> may also be given to the areas with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>.</div></li></ul><p id="CDR0000257999__TrialSearch_89_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000257999__102"><h3>High-Risk Classical Childhood Hodgkin Lymphoma</h3><p id="CDR0000257999__104">Treatment of high-risk <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574284/" class="def">classical childhood Hodgkin lymphoma</a> may include the following:</p><ul id="CDR0000257999__250"><li class="half_rhythm"><div>Higher <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> may also be given to the areas with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> and combination chemotherapy. Radiation therapy may also be given to the areas with cancer. </div></li></ul><p id="CDR0000257999__TrialSearch_102_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000257999__234"><h3>Nodular Lymphocyte-Predominant Childhood Hodgkin Lymphoma</h3><p id="CDR0000257999__235">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574286/" class="def">nodular lymphocyte-predominant childhood Hodgkin lymphoma</a> may include the following:</p><ul id="CDR0000257999__236"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a>, if the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> can be completely removed.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> with or without low-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">external radiation therapy</a>.</div></li></ul><p id="CDR0000257999__TrialSearch_234_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000257999__115"><h2 id="_CDR0000257999__115_">Treatment Options for Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents</h2><p id="CDR0000257999__271">For information about the treatments listed below, see the <a href="#CDR0000257999__65">Treatment Option Overview</a> section.</p><p id="CDR0000257999__116">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045863/" class="def">refractory</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a> may include the following:</p><ul id="CDR0000257999__117"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045525/" class="def">rituximab</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000710543/" class="def">brentuximab</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269133/" class="def">bortezomib</a>), or both of these therapies.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">High-dose chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> using the patient's own <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cells</a>. Low-dose radiation therapy or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> (brentuximab) may be given after the transplant.</div></li><li class="half_rhythm"><div>High-dose chemotherapy with stem cell transplant using a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor's</a> stem cells.</div></li><li class="half_rhythm"><div>Monoclonal antibody therapy (brentuximab) in patients whose disease <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> after a stem cell transplant using the patient's own stem cells.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a monoclonal antibody (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">pembrolizumab</a>, or atezolizumab).</div></li><li class="half_rhythm"><div>A clinical trial that checks a sample of the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.</div></li></ul><p id="CDR0000257999__TrialSearch_115_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000257999__175"><h2 id="_CDR0000257999__175_">To Learn More About Childhood Hodgkin Lymphoma</h2><p id="CDR0000257999__176">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about childhood Hodgkin lymphoma, see the following:</p><ul id="CDR0000257999__218"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Computed Tomography (CT) Scans and Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/drugs/hodgkin-lymphoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Hodgkin Lymphoma</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant/stem-cell-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Blood-Forming Stem Cell Transplants</a></div></li></ul><p id="CDR0000257999__175_44">For more childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other general cancer resources, see the following:</p><ul id="CDR0000257999__175_45"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Childhood Cancers</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.curesearch.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CureSearch for Children's Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/guide-for-parents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Children with Cancer: A Guide for Parents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer in Children and Adolescents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000257999__AboutThis_1"><h2 id="_CDR0000257999__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000257999__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000257999__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000257999__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000257999__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000257999__AboutThis_6">This PDQ cancer information summary has current information about the treatment of childhood Hodgkin lymphoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000257999__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000257999__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000257999__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>.
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</p></div><div id="CDR0000257999__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000257999__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000257999__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000257999__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000257999__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000257999__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000257999__AboutThis_21">PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/lymphoma/patient/child-hodgkin-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/lymphoma/patient/child-hodgkin-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389224]</p><p id="CDR0000257999__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000257999__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000257999__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000257999__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000257999__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65781</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389224" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389224</a></span></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65781.13/?report=reader">PubReader</a></li><li><a href="/books/NBK65781.13/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65781" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65781" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Pediatric Treatment Editorial Board. Childhood Hodgkin Lymphoma Treatment (PDQ®): Patient Version. 2018 May 31. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65781.27/">NBK65781.27</a></span> March 1, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65781.26/">NBK65781.26</a></span> December 20, 2023</li><li><span class="bk_col_itm"><a 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2019</li><li><span class="bk_col_itm"><a href="/books/NBK65781.15/">NBK65781.15</a></span> July 5, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65781.14/">NBK65781.14</a></span> January 15, 2019</li><li><span class="bk_col_itm">NBK65781.13</span> May 31, 2018 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65781.12/">NBK65781.12</a></span> May 18, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65781.11/">NBK65781.11</a></span> March 28, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65781.10/">NBK65781.10</a></span> December 8, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65781.9/">NBK65781.9</a></span> September 1, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65781.8/">NBK65781.8</a></span> March 14, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65781.7/">NBK65781.7</a></span> March 10, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65781.6/">NBK65781.6</a></span> August 3, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65781.5/">NBK65781.5</a></span> December 16, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65781.4/">NBK65781.4</a></span> October 30, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65781.3/">NBK65781.3</a></span> October 1, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65781.2/">NBK65781.2</a></span> September 9, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65781.1/">NBK65781.1</a></span> August 11, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000257999__1" ref="log$=inpage&link_id=inpage">General Information About Childhood Hodgkin Lymphoma</a></li><li><a href="#CDR0000257999__24" ref="log$=inpage&link_id=inpage">Stages of Childhood Hodgkin Lymphoma</a></li><li><a href="#CDR0000257999__48" ref="log$=inpage&link_id=inpage">Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents</a></li><li><a href="#CDR0000257999__51" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000257999__82" ref="log$=inpage&link_id=inpage">Treatment Options for Children and Adolescents with Hodgkin Lymphoma </a></li><li><a href="#CDR0000257999__115" ref="log$=inpage&link_id=inpage">Treatment Options for Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents</a></li><li><a href="#CDR0000257999__175" ref="log$=inpage&link_id=inpage">To Learn More About Childhood Hodgkin Lymphoma</a></li><li><a href="#CDR0000257999__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65726/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389245" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hodgkin Lymphoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hodgkin Lymphoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" 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