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</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"></div><div class="body"><div class="t">Childhood Hodgkin Lymphoma Treatment (PDQ®): Patient Version</div><div class="j">PDQ Cancer Information Summaries [Internet]</div></div><div class="tail"></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 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class="title" itemprop="name">Childhood Hodgkin Lymphoma Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contribs">PDQ Pediatric Treatment Editorial Board.</p><p class="fm-aai"><a href="#_NBK65781_pubdet_">Publication Details</a></p></div></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 boxed-text-box whole_rhythm hide-overflow"><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 cancer that develops in the lymph system.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__134">The two main types of childhood Hodgkin lymphoma are classic and nodular lymphocyte-predominant. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__8">Epstein-Barr virus infection and a family history of Hodgkin lymphoma can increase
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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, drenching night sweats, and weight loss.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__16">Tests that examine the lymph system and other parts of the body are used to diagnose
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and stage childhood Hodgkin lymphoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__2714">You may want to get a second opinion.</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 cancer that develops in the lymph system.</h3><p id="CDR0000257999__4">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000793442/" class="def">lymph system</a> is part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>. It helps protect the body from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> and disease.</p><p id="CDR0000257999__279">The lymph system is made up of the following:</p><ul id="CDR0000257999__280"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046305/" class="def">Lymph</a>: Colorless, watery fluid that travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> and transports <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000467345/" class="def">T</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044953/" class="def">B lymphocytes</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045765/" class="def">Lymphocytes</a> are a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cell</a>.</div></li><li class="half_rhythm"><div>Lymph vessels: A network of thin tubes that collect lymph 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>: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are found along a network of lymph vessels throughout the body. Groups of lymph nodes are found in the neck, underarm, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046288/" class="def">mediastinum</a> (the area between the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>), <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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>. Hodgkin lymphoma most commonly forms in the lymph nodes above the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</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> that makes lymphocytes, stores <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a> and lymphocytes, filters the blood, and destroys old blood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>. The spleen is on the left side of the abdomen near the <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 in which T lymphocytes mature and multiply. The thymus is in the chest behind the <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_CDR0000045622/" class="def">Bone marrow</a>: The soft, spongy tissue in the center of certain bones, such as the hip bone and breastbone. White blood cells, red blood cells, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a> are made in the bone marrow.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046618/" class="def">Tonsils</a>: Two small masses of lymph tissue at the back of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a>. There is one tonsil on each side of the throat.</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=The%20lymph%20system%20is%20part%20of%20the%20body's%20immune%20system%20and%20is%20made%20up%20of%20tissues%20and%20organs%20that%20help%20protect%20the%20body%20from%20infection%20and%20disease&p=BOOKS&id=602723_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/bin/CDR0000653807.jpg" alt="Lymph system; drawing shows the tonsils, thymus, spleen, bone marrow, lymph vessels, and lymph nodes. One inset shows the inside structure of a lymph node and the attached lymph vessels with arrows showing how the lymph (clear, watery 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>The lymph system is part of the body's immune system and is made up of tissues and organs that help protect the body from infection and disease. These include the tonsils, thymus, spleen, bone marrow, lymph vessels, and lymph nodes. Lymph (clear, watery fluid) and lymphocytes (white blood cells) travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the bloodstream through a large vein near the heart.</p></div></div><p id="CDR0000257999__5">Bits of lymph tissue are also found in other parts of the body such as the lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046189/" class="def">gastrointestinal tract</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045629/" class="def">bronchus</a>, 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>. This summary is about the treatment of childhood Hodgkin lymphoma.</p><p id="CDR0000257999__7"> Hodgkin lymphoma occurs most often in adolescents 15 to 19 years of age. The
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treatment for children and adolescents is different than treatment for adults.</p><p id="CDR0000257999__293">Other PDQ summaries with information related to lymphoma include the following: </p><ul id="CDR0000257999__294"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000258002/?report=reader">Childhood Non-Hodgkin Lymphoma Treatment</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000257991/?report=reader">Hodgkin Lymphoma Treatment</a>
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</div></li></ul></div><div id="CDR0000257999__134"><h3>The two main types of childhood Hodgkin lymphoma are classic and nodular lymphocyte-predominant. </h3><ul id="CDR0000257999__157"><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574284/" class="def">Classic Hodgkin lymphoma</a></b> is the most common type of Hodgkin lymphoma. It occurs most often in adolescents. When a sample of lymph node tissue is looked at under a microscope, Hodgkin lymphoma <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> cells, called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046557/" class="def">Reed-Sternberg cells</a>, may be seen.<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=602723_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/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 (a type of white blood cell) that may contain more than one nucleus. These cells are found in people with Hodgkin lymphoma. Reed-Sternberg cells are also called Hodgkin and Reed-Sternberg cells.</p></div></div></div><div class="half_rhythm">Classic Hodgkin lymphoma is divided into four subtypes, based on how the cancer cells look under a microscope:<ul id="CDR0000257999__296"><li class="half_rhythm"><div>Nodular-sclerosing Hodgkin lymphoma occurs most often in older children and adolescents. It is common to have a chest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638197/" class="def">mass</a> at <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a>.</div></li><li class="half_rhythm"><div>Mixed cellularity Hodgkin lymphoma most often occurs in children younger than 10 years of age. It is linked to a history of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045684/" class="def">Epstein-Barr virus</a> (EBV) infection and often occurs in the lymph nodes of the neck.</div></li><li class="half_rhythm"><div>Lymphocyte-rich Hodgkin lymphoma is rare in children. When a sample of lymph node tissue is looked at under a microscope, there are Reed-Sternberg cells and many normal lymphocytes and other blood cells.</div></li><li class="half_rhythm"><div>Lymphocyte-depleted Hodgkin lymphoma is rare in children and occurs most often in adults or adults with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044985/" class="def">HIV</a>. When a sample of lymph node tissue is looked at under a microscope, there are many large, oddly shaped cancer cells and few normal lymphocytes and other blood cells.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574286/" class="def">Nodular lymphocyte-predominant Hodgkin lymphoma</a></b> is less common than classic Hodgkin lymphoma. It most often occurs in children younger than 10 years of age. Nodular lymphocyte-predominant Hodgkin lymphoma often occurs as a swollen lymph node in the neck, underarm, or groin. Most individuals do not have any other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> of cancer at diagnosis. When a sample of lymph node tissue is looked at under a microscope, the cancer cells are shaped like popcorn. </div></li></ul></div><div id="CDR0000257999__8"><h3>Epstein-Barr virus infection and a family history of Hodgkin lymphoma can increase
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the risk of childhood Hodgkin lymphoma.</h3><p id="CDR0000257999__10">Anything that increases a person's chance of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Not every person with one or more of these risk factors will develop childhood Hodgkin lymphoma, and it can develop in some children who don't have any known risk factors. 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 Epstein-Barr virus (EBV)</div></li><li class="half_rhythm"><div>being infected with HIV</div></li><li class="half_rhythm"><div>having certain diseases of the immune system, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797597/" class="def">autoimmune</a> lymphoproliferative syndrome</div></li><li class="half_rhythm"><div>having a weakened immune system after an organ <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a> or from medicine given after a transplant to stop the organ from being rejected by the body</div></li><li class="half_rhythm"><div>having a parent, brother, or sister with a personal history of Hodgkin lymphoma </div></li></ul><p id="CDR0000257999__2721"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045098/" class="def">Inherited</a> changes in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a> may increase the risk of childhood Hodgkin lymphoma.</p><p id="CDR0000257999__220">Being exposed to common infections in early childhood may decrease the risk of Hodgkin lymphoma in children.</p></div><div id="CDR0000257999__12"><h3>Signs of childhood Hodgkin lymphoma include swollen
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lymph nodes, fever, drenching night sweats, and weight loss.</h3><p id="CDR0000257999__14">The <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> of Hodgkin lymphoma depend on where the cancer forms in the body and the size of the cancer. It's important to check with your child's doctor if your child has any symptoms below:</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>fever for no known reason </div></li><li class="half_rhythm"><div>weight loss for no known reason</div></li><li class="half_rhythm"><div>drenching night sweats</div></li><li class="half_rhythm"><div>feeling very tired</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044103/" class="def">anorexia</a>
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</div></li><li class="half_rhythm"><div>itchy skin</div></li><li class="half_rhythm"><div>coughing</div></li><li class="half_rhythm"><div>trouble breathing, especially when lying down</div></li><li class="half_rhythm"><div>pain in the lymph nodes after drinking alcohol</div></li></ul><p id="CDR0000257999__221">Fever for no known reason, weight loss for no known reason, or drenching night sweats are called B symptoms. B symptoms are an important part of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a> Hodgkin lymphoma and understanding the patient's chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>.</p><p id="CDR0000257999__2707">These symptoms may be caused by conditions other than childhood Hodgkin lymphoma. The only way to know is to see your child's doctor. The doctor will ask you when the symptoms started and how often your child has been having them as a first step in making a diagnosis.</p></div><div id="CDR0000257999__16"><h3>Tests that examine the lymph system and other parts of the body are used to diagnose
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and stage childhood Hodgkin lymphoma.</h3><p id="CDR0000257999__297">If your child has symptoms that suggest Hodgkin lymphoma, their doctor will need to find out if these are due to cancer or to another condition. They will ask about your child's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642019/" class="def">personal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642015/" class="def">family health history</a> and do a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exam</a>. The doctor may recommend diagnostic tests to find out if your child has Hodgkin lymphoma. The results of these tests will also help you and your child's doctor plan treatment.</p><p id="CDR0000257999__2708">The following tests and procedures may be used:</p><ul id="CDR0000257999__19"><li class="half_rhythm"><div class="half_rhythm"><b>Complete blood count (CBC)</b>: A procedure in which a sample of blood is drawn and checked for the following:<ul id="CDR0000257999__298"><li class="half_rhythm"><div>The number of red blood cells, white blood cells, and platelets.</div></li><li class="half_rhythm"><div>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.</div></li><li class="half_rhythm"><div>The portion of the blood sample made up of red blood cells.<div id="CDR0000257999__304" 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=602723_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/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></div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Blood chemistry studies</b>: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616062/" class="def">albumin</a>, 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>C-reactive protein test</b>: A test in which a blood sample is checked to measure the amount of c-reactive protein in the blood. C-reactive protein is made by the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> and sent to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000809743/" class="def">bloodstream</a> in response to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflammation</a>. A higher-than-normal amount of c-reactive protein in the blood may be a sign of disease.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Sedimentation rate</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 inflammation 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>CT scan (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 vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. To learn more, see <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 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&p=BOOKS&id=602723_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/bin/CDR0000775531.jpg" alt="Computed tomography (CT) scan; drawing shows a child lying on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of areas inside the body." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Computed tomography (CT) scan. The child lies on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of areas inside the body.</p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b>PET scan (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. <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=602723_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/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>MRI (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, such as the lymph nodes. This procedure is also called nuclear magnetic resonance imaging (NMRI).<div id="CDR0000257999__292" 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)%20scan&p=BOOKS&id=602723_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/bin/CDR0000775532.jpg" alt="Magnetic resonance imaging (MRI) scan; drawing shows a child lying on a table that slides into the MRI machine, which takes a series of detailed pictures of areas inside the body." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Magnetic resonance imaging (MRI) scan. The child lies on a table that slides into the MRI machine, which takes a series of detailed pictures of areas inside the body. The positioning of the child on the table depends on the part of the body being imaged.</p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b>PET-CT scan</b>: A procedure that combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time with the same machine. The combined scans give more detailed pictures of areas inside the body than either scan gives by itself.</div></li><li class="half_rhythm"><div class="half_rhythm">
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<b>PET-MRI scan</b>: A procedure that combines the pictures from a positron emission tomography (PET) scan and a magnetic resonance imaging (MRI) scan. A PET scan uses a radioactive tracer to highlight abnormal areas in the body. An MRI uses radio waves and a powerful magnet to take detailed pictures of tissues in the body. For a PET-MRI, the scans are done at the same time with the same machine. The combined scans give more detailed pictures of areas inside the body than either scan gives by itself. The overall amount of radiation a person is exposed to is also reduced. A PET-MRI may be used to help diagnose disease, such as cancer, plan treatment, or find out how well treatment is working.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Chest x-ray</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>Bone marrow aspiration and biopsy</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 pathologist views the bone marrow and bone under a microscope to look for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> cells. Bone marrow aspiration and biopsy is done for patients with advanced disease and/or B symptoms.<div id="CDR0000257999__305" 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=602723_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/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><li class="half_rhythm"><div class="half_rhythm"><b>Lymph node biopsy</b>:
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The removal of all or part of one or more lymph nodes. 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"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin"><b>Excisional biopsy</b>: The removal of an entire lymph node. </p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin"><b>Incisional biopsy</b>: The removal of part of a lymph node.</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin"><b>Core biopsy</b>: The removal of tissue from a lymph node using a wide needle.</p></dd></dl></dl></div><div class="half_rhythm">A pathologist views the lymph node tissue under a microscope to check for cancer cells called Reed-Sternberg cells. Reed-Sternberg cells are common in classic Hodgkin lymphoma.</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>Immunophenotyping</b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to identify cancer 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 cells. This test is used to help diagnose specific types of lymphoma.</div></li></ul></div></li></ul></div><div id="CDR0000257999__2714"><h3>You may want to get a second opinion.</h3><p id="CDR0000257999__2716">You may want to get a second opinion to confirm your child's diagnosis and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000774686/" class="def">treatment plan</a>. If you seek a second opinion, you will need to get important medical test results from the first doctor to share with the second doctor. The second doctor will review the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044702/" class="def">pathology report</a>, slides, and scans before giving a recommendation. They may agree with the first doctor, suggest changes or another approach, or provide more information about your child's cancer. </p><p id="CDR0000257999__2717">To learn more about choosing a doctor and getting a second opinion, see <a href="https://www.cancer.gov/about-cancer/managing-care/finding-cancer-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Finding Cancer Care</a>. You can contact <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's Cancer Information Service</a> via chat, email, or phone (both in English and Spanish) for help finding a doctor or hospital that can provide a second opinion. For questions you might want to ask at your appointments, see <a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor</a>.</p></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">If your child has been diagnosed with Hodgkin lymphoma, you may have questions about how serious the cancer is and your child's chances of survival. The likely outcome or course of a disease is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a>. The prognosis 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 (the size of the cancer and whether the cancer has spread below the diaphragm or to more than one group of lymph nodes)</div></li><li class="half_rhythm"><div>the size of the tumor</div></li><li class="half_rhythm"><div> whether there are B symptoms (fever for no known reason, weight loss for no known reason, or drenching night sweats) at diagnosis</div></li><li class="half_rhythm"><div>the type of Hodgkin lymphoma</div></li><li class="half_rhythm"><div>having more than the usual number of white blood cells or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045360/" class="def">anemia</a> at the time of diagnosis</div></li><li class="half_rhythm"><div>whether there is fluid around the heart or lungs at diagnosis</div></li><li class="half_rhythm"><div>the sedimentation rate or the albumin level in the blood</div></li><li class="half_rhythm"><div>how well the cancer <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>the child's sex</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>whether there is a low, medium, or high risk the cancer will come back after treatment</div></li><li class="half_rhythm"><div>the child's age</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><p id="CDR0000257999__2713">Your child's cancer care team is in the best position to talk with you about your child's prognosis.</p></div></div><div id="CDR0000257999__24"><h2 id="_CDR0000257999__24_">Stages of Childhood Hodgkin Lymphoma</h2><div id="CDR0000257999__24.kp" class="box boxed-text-box whole_rhythm hide-overflow"><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__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__299">In addition to the stage number, the letters A, B, E, or S may be noted.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__148">Childhood Hodgkin lymphoma is treated according to risk groups.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__306">Sometimes childhood Hodgkin lymphoma does not respond to treatment or comes back after treatment.</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 cancer has spread is called staging. The information gathered from the staging
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process determines the stage of the
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disease. The results of the <a href="#CDR0000257999__16">tests and procedures</a> done to diagnose and stage <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a> are used to help make decisions about treatment.</p></div><div id="CDR0000257999__186"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000257999__186_md_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_md_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__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=602723_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/bin/CDR0000648701.jpg" alt="Stage I childhood Hodgkin lymphoma; drawing shows cancer in one lymph node group above the diaphragm and in the spleen. Also shown are the Waldeyer’s ring and the thymus. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Cancer cells are shown inside 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 a group of lymph nodes or, in rare cases, cancer is found in the Waldeyer’s ring, thymus, or spleen. In stage IE (not shown), cancer has spread to one area outside the lymph system.</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>Stage I: Cancer 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><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000777073/" class="def">Waldeyer's ring</a>.</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>Stage IE: Cancer is found outside the lymph system in one organ 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>Stage II: Cancer 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 diaphragm (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=602723_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/bin/CDR0000648702.jpg" alt="Stage II childhood Hodgkin lymphoma; drawing shows cancer in two lymph node groups above the diaphragm and below the diaphragm. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Cancer cells are shown inside 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 that are either above the diaphragm or below the diaphragm.</p></div></div></div></li><li class="half_rhythm"><div>Stage IIE: Cancer has spread from a group of lymph nodes to a nearby organ that is outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000793442/" class="def">lymph system</a>. Cancer may have spread to other lymph node groups on the same side of the diaphragm.<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=602723_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/bin/CDR0000648703.jpg" alt="Stage IIE childhood Hodgkin lymphoma; drawing shows cancer in a lymph node group above the diaphragm and cancer that has spread to a nearby area (the left lung). An inset shows a lymph node with a lymph vessel, an artery, and a vein. Cancer cells are shown inside the lymph node." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIE childhood Hodgkin lymphoma. Cancer has spread from a group of lymph nodes to a nearby organ or area that is outside the lymph system.</p></div></div></div></li></ul></div><div id="CDR0000257999__41"><h4>Stage III </h4><p id="CDR0000257999__43">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430898/" class="def">stage III</a>, the cancer is found:</p><ul id="CDR0000257999__201"><li class="half_rhythm"><div>in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups above and below the diaphragm (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>); or </div></li><li class="half_rhythm"><div>in lymph node groups above the diaphragm and in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.<div id="CDR0000257999__2722" 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=602723_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/bin/CDR0000648704.jpg" alt="Stage III childhood Hodgkin lymphoma; drawing shows (a) cancer in lymph node groups above and below the diaphragm. Also shown is (b) cancer in a lymph node group above the diaphragm and cancer in the spleen. The lungs are also shown. An inset shows a close-up of a lymph node with a lymph vessel, an artery, and a vein. Cancer cells are shown inside 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 (a) in lymph node groups above and below the diaphragm; or (b) in lymph node groups above the diaphragm and in the spleen.</p></div></div></div></li></ul></div><div id="CDR0000257999__44"><h4>Stage IV</h4><p id="CDR0000257999__204">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430899/" class="def">stage IV</a>, the cancer:</p><ul id="CDR0000257999__205"><li class="half_rhythm"><div>has spread throughout one or more organs outside the lymph system and may be in lymph nodes near those organs; or</div></li><li class="half_rhythm"><div>is found in two or more groups of lymph nodes that are on the same side of the diaphragm (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>) and in an organ that is outside the lymph system and not near the affected lymph nodes; or</div></li><li class="half_rhythm"><div>is found in groups of lymph nodes on both side of the diaphragm and in any organ that is outside the lymph system; or</div></li><li class="half_rhythm"><div>has spread to the lungs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> from areas far away. <div id="CDR0000257999__2723" 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=602723_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/bin/CDR0000648705.jpg" alt="Stage IV childhood Hodgkin lymphoma; drawing shows four panels: (a) the top left panel shows cancer in the liver; (b) the top right panel shows cancer in the left lung and in two groups of lymph nodes below the diaphragm; (c) the bottom left panel shows cancer in the left lung and in a group of lymph nodes above the diaphragm and below the diaphragm; and (d) the bottom right panel shows cancer in both lungs and the liver. There is also a pullout showing cancer in the bone marrow." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IV childhood Hodgkin lymphoma. Cancer (a) has spread throughout one or more organs outside the lymph system, such as the liver; or (b) is found in two or more groups of lymph nodes that are on the same side of the diaphragm and in an organ that is outside the lymph system, such as the lung, and not near the affected lymph nodes; or (c) is found in groups of lymph nodes on both sides of the diaphragm and in any organ that is outside the lymph system, such as the lung; or (d) has spread to the lungs, liver, or bone marrow from areas far away.</p></div></div></div></li></ul></div></div><div id="CDR0000257999__299"><h3>In addition to the stage number, the letters A, B, E, or S may be noted.</h3><p id="CDR0000257999__301">The letters A, B, E, or S may be used to further describe the stage of childhood Hodgkin lymphoma.</p><ul id="CDR0000257999__302"><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 drenching 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__148"><h3>Childhood Hodgkin lymphoma is treated according to 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 drenching night sweats). The risk group describes the likelihood that Hodgkin lymphoma will not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">respond</a> to treatment or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recur</a> (come back) after treatment. It is used to plan initial 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><p id="CDR0000257999__303">Low-risk Hodgkin lymphoma requires 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 high-risk lymphoma.</p></div><div id="CDR0000257999__306"><h3>Sometimes childhood Hodgkin lymphoma does not respond to treatment or comes back after treatment.</h3><p id="CDR0000257999__308">Primary refractory Hodgkin lymphoma is cancer that does not respond to initial treatment.</p><p id="CDR0000257999__309">Recurrent Hodgkin lymphoma is cancer that has recurred
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(come back) after it has been treated. The lymphoma may come back in the
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lymph system 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><div id="CDR0000257999__51"><h2 id="_CDR0000257999__51_">Treatment Option Overview</h2><div id="CDR0000257999__51.kp" class="box boxed-text-box whole_rhythm hide-overflow"><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__65">The following types of treatment may be 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__274">Immunotherapy</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">Clinical trials</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__238">Treatment for childhood Hodgkin lymphoma causes side effects and late effects.</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">There are different types of treatment for children with
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Hodgkin lymphoma. You and your child's care team will work together to decide treatment. Many factors will be considered, such as your child's overall health, and whether the tumor is newly diagnosed or has come back.</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">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, will oversee treatment of childhood Hodgkin lymphoma. The pediatric oncologist works with
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other pediatric health care providers who are experts in treating children
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with Hodgkin lymphoma and who specialize in certain areas of medicine. These
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may include the following specialists and others:</p><ul id="CDR0000257999__59"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000757278/" class="def">pediatrician</a>
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</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>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">radiation
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oncologist</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318821/" class="def">pediatric nurse specialist</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044716/" class="def">psychologist</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">social worker</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000690737/" class="def">child-life specialist</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000809738/" class="def">fertility specialist</a>
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</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__65"><h3>The following types of treatment may be used:</h3><div id="CDR0000257999__67"><h4>Chemotherapy </h4><p id="CDR0000257999__119">Chemotherapy is a cancer treatment that uses one or more drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Cancer treatment using more than one chemotherapy drug is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a vein 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>). </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">For more information, 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>.</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. <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 area of the body with cancer. </p><p id="CDR0000257999__310">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:</p><ul id="CDR0000257999__267"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270731/" class="def">Conformal radiation therapy</a> 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 tumor and shapes the radiation beams to fit the tumor.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335073/" class="def">Intensity-modulated radiation therapy</a> (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.</div></li></ul><p id="CDR0000257999__269">Radiation therapy may be given, based on the child's risk group and chemotherapy regimen. 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.</p></div><div id="CDR0000257999__207"><h4>Targeted therapy</h4><p id="CDR0000257999__209">Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Types of targeted therapy include the following:</p><ul id="CDR0000257999__283"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a> therapy: Monoclonal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a> made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then 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, toxins, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> material directly to cancer cells. </div><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045525/" class="def">Rituximab</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000710543/" class="def">brentuximab</a> may be used to treat high-risk, <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> childhood Hodgkin lymphoma.<div id="CDR0000257999__332" class="box boxed-text-box whole_rhythm hide-overflow"><h3><span class="title">monoclonal antibodies: how monoclonal antibodies treat cancer</span></h3><div class="caption"><p>How do monoclonal antibodies work to treat cancer? This video shows how monoclonal antibodies, such as trastuzumab, pembrolizumab, and rituximab, block molecules cancer cells need to grow, flag cancer cells for destruction by the body’s immune system, or deliver harmful substances to cancer cells. </p></div><p><a href="https://www.youtube.com/watch?v=dxnjAc-rqz8" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div></li></ul><ul id="CDR0000257999__285"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000393541/" class="def">Proteasome inhibitor</a> therapy blocks the action of proteasomes in cancer cells. Proteasomes remove proteins 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.</div><div class="half_rhythm">
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<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.</div></li></ul><p id="CDR0000257999__2710">To learn more, see <a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Therapy to Treat Cancer</a>.</p></div><div id="CDR0000257999__274"><h4>Immunotherapy</h4><p id="CDR0000257999__276">Immunotherapy uses the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. Types of immunotherapy include the following:</p><ul id="CDR0000257999__2706"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">Immune checkpoint inhibitor</a> therapy: Some types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797381/" class="def">immune cells</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T cells</a>, and some cancer cells have certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a>, called checkpoint proteins, on their surface that keep <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045722/" class="def">immune responses</a> in check. When cancer cells have large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins, and the ability of T cells to kill cancer cells is increased. The following is a type of immune checkpoint inhibitor therapy:<ul id="CDR0000257999__286"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000777027/" class="def">PD-1</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797389/" class="def">PD-L1</a> inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045722/" class="def">immune responses</a> in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells.</div><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">Pembrolizumab</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a> are types of PD-1 inhibitors that may be used in the treatment of childhood Hodgkin lymphoma that has come back after treatment. Nivolumab is being studied to treat high-risk childhood Hodgkin lymphoma. </div></li></ul><div id="CDR0000257999__290" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=602723_CDR0000774646.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/bin/CDR0000774646.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).</p></div></div><div id="CDR0000257999__291" class="box boxed-text-box whole_rhythm hide-overflow"><h3><span class="title">immune checkpoint inhibitors</span></h3><div class="caption"><p>Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.</p></div><p><a href="https://www.youtube.com/watch?v=GIUu239FWMg" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000771302/" class="def">CAR T-cell therapy</a> changes the patient's T cells (a type of immune system cell) so they will attack certain proteins on the surface of cancer cells. T cells are taken from the patient and special <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044958/" class="def">receptors</a> are added to their surface in the laboratory. The changed cells are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000787969/" class="def">chimeric antigen receptor</a> (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient's blood and attack cancer cells. CAR T-cell therapy is being studied to treat refractory or recurrent childhood Hodgkin lymphoma.<div id="CDR0000257999__2704" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=CAR%20T-cell%20therapy&p=BOOKS&id=602723_CDR0000774647.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/bin/CDR0000774647.jpg" alt="CAR T-cell therapy; drawing of blood being removed from a vein in a patient’s arm to get T cells. Also shown is a special receptor called a chimeric antigen receptor (CAR) being made in the laboratory; the gene for CAR is inserted into the T cells and then millions of CAR T cells are grown. Drawing also shows the CAR T cells being given to the patient by infusion and binding to antigens on the cancer cells and killing them." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>CAR T-cell therapy. A type of treatment in which a patient’s T cells (a type of immune cell) are changed in the laboratory so they will bind to cancer cells and kill them. Blood from a vein in the patient’s arm flows through a tube to an apheresis machine (not shown), which removes the white blood cells, including the T cells, and sends the rest of the blood back to the patient. Then, the gene for a special receptor called a chimeric antigen receptor (CAR) is inserted into the T cells in the laboratory. Millions of the CAR T cells are grown in the laboratory and then given to the patient by infusion. The CAR T cells are able to bind to an antigen on the cancer cells and kill them.</p></div></div></div></li></ul></div><div id="CDR0000257999__227"><h4>Surgery</h4><p id="CDR0000257999__229">Surgery 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>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574286/" class="def">nodular lymphocyte-predominant Hodgkin lymphoma</a> in children.</p></div><div id="CDR0000257999__169"><h4>High-dose chemotherapy with stem cell
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transplant </h4><p id="CDR0000257999__281">High doses of chemotherapy are given to kill cancer cells. Healthy cells, including blood-forming cells, are also destroyed by the cancer treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a> is a treatment to replace the blood-forming cells. <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 patient completes chemotherapy, the stored stem cells are thawed and given to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.</p><p id="CDR0000257999__247">For more information, 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>.</p></div></div><div id="CDR0000257999__74"><h3>Clinical trials</h3><p id="CDR0000257999__182">A treatment <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. Because cancer in children is rare, taking part in a clinical trial should be considered.</p><p id="CDR0000257999__2711">Use our <a href="https://www.cancer.gov/research/participate/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. Some clinical trials are open only to patients who have not started treatment. 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><p id="CDR0000257999__2712">To learn more, see <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Clinical Trials Information for Patients and Caregivers</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, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304766/" class="def">breast</a>, heart, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>.
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</p></div></div><div id="CDR0000257999__238"><h3>Treatment for childhood Hodgkin lymphoma causes side effects and late effects.</h3><p id="CDR0000257999__238_md_76">To learn more about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> that begin during treatment for cancer, visit <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a>.</p><p id="CDR0000257999__240">Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. 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"><dl class="bkr_refwrap"><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></dl><dl class="bkr_refwrap"><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></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">bone and muscle growth and development</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046036/" class="def">thyroid</a>, heart, or lung function</p></dd></dl><dl class="bkr_refwrap"><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></dl><dl class="bkr_refwrap"><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></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), such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444971/" class="def">breast</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445091/" class="def">thyroid</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445084/" class="def">skin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445043/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445087/" class="def">stomach</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444983/" class="def">colorectal</a></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 breast cancer. This risk depends on the amount of radiation the breast received during treatment and the chemotherapy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a> used. The risk of breast cancer is decreased if radiation to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> was also given.
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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> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> once a year starting 8 years after treatment or at age 25 years, whichever is later. It is also suggested that female survivors do a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304714/" class="def">breast self-exam</a> every month beginning at <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440113/" class="def">puberty</a> and have a breast exam done by a health professional every year beginning at puberty until age 25 years. The breast exams done by a health professional will increase to every 6 months at age 25 years.</p><p id="CDR0000257999__2705">For male survivors who received radiation therapy to the chest, there may be a higher risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748137/" class="def">cardiovascular disease</a>. Limiting radiation therapy to the chest is suggested if possible.</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. To learn more, see <a href="/books/n/pdqcis/CDR0000373791/?report=reader">Late Effects of Treatment for Childhood Cancer</a>.
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</p></div><div id="CDR0000257999__188"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000257999__188_md_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_md_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_md_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_md_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 recurring (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_md_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/research/participate/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_md_55">As your child goes through treatment, they will have follow-up tests or check-ups. Some tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> the cancer may be repeated 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_md_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 condition has changed or if the cancer has recurred (come back). </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 ends.</p></div></div><div id="CDR0000257999__83"><h2 id="_CDR0000257999__83_">Treatment of Low-Risk Classic Childhood 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><p id="CDR0000257999__84">Treatment of newly diagnosed low-risk <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574284/" class="def">classic Hodgkin lymphoma</a> in children may include: </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 cancer.</div></li></ul><p id="CDR0000257999__TrialSearch_83_19">Use our <a href="https://www.cancer.gov/research/participate/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/research/participate/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"><h2 id="_CDR0000257999__89_">Treatment of Intermediate-Risk Classic Childhood Hodgkin Lymphoma</h2><p id="CDR0000257999__2700">For information about the treatments listed below, see the <a href="#CDR0000257999__65">Treatment Option Overview</a> section.</p><p id="CDR0000257999__144">Treatment of newly diagnosed intermediate-risk <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574284/" class="def">classic Hodgkin lymphoma</a> in children may include:</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 cancer.</div></li></ul><p id="CDR0000257999__TrialSearch_89_19">Use our <a href="https://www.cancer.gov/research/participate/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/research/participate/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"><h2 id="_CDR0000257999__102_">Treatment of High-Risk Classic Childhood Hodgkin Lymphoma</h2><p id="CDR0000257999__2701">For information about the treatments listed below, see the <a href="#CDR0000257999__65">Treatment Option Overview</a> section.</p><p id="CDR0000257999__104">Treatment of newly diagnosed high-risk <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574284/" class="def">classic Hodgkin lymphoma</a> in children may include:</p><ul id="CDR0000257999__250"><li class="half_rhythm"><div>Higher-dose <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>.</div></li><li class="half_rhythm"><div>Combination chemotherapy with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</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_CDR0000045729/" class="def">immunotherapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</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 cancer.</div></li></ul><p id="CDR0000257999__TrialSearch_102_19">Use our <a href="https://www.cancer.gov/research/participate/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/research/participate/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"><h2 id="_CDR0000257999__234_">Treatment of Nodular Lymphocyte-Predominant Childhood Hodgkin Lymphoma</h2><p id="CDR0000257999__2702">For information about the treatments listed below, see the <a href="#CDR0000257999__65">Treatment Option Overview</a> section.</p><p id="CDR0000257999__235">Treatment of newly diagnosed <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000574286/" class="def">nodular lymphocyte-predominant Hodgkin lymphoma</a> in children may include:</p><ul id="CDR0000257999__236"><li class="half_rhythm"><div>Surgery, if the tumor 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/research/participate/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/research/participate/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__115"><h2 id="_CDR0000257999__115_">Treatment of 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">In children and adolescents, treatment of primary refractory Hodgkin lymphoma (cancer that does not respond to initial treatment) or recurrent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a> (cancer that came back after treatment) may include:</p><ul id="CDR0000257999__117"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000613764/" class="def">steroids</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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapies</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">pembrolizumab</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a>).</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>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a> therapy (brentuximab) may also be given. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> may be given after stem cell transplant using the patient's own stem cells or if the cancer has not responded to other treatments and the area with cancer has not been treated before.</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>Targeted therapy (brentuximab) for patients who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045866/" class="def">relapsed</a> after a stem cell transplant that used 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 href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000771302/" class="def">CAR T-cell therapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of immunotherapy (pembrolizumab).</div></li></ul><p id="CDR0000257999__TrialSearch_115_19">Use our <a href="https://www.cancer.gov/research/participate/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/research/participate/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__2718"><h2 id="_CDR0000257999__2718_">Coping With Your Child's Cancer</h2><p id="CDR0000257999__2720">When your child has cancer, every member of the family needs support. Taking care of yourself during this difficult time is important. Reach out to your child's treatment team and to people in your family and community for support. To learn more, see <a href="https://www.cancer.gov/about-cancer/coping/caregiver-support/parents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Support for Families When a Child Has Cancer</a> and <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>.</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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a>, see the following:</p><ul id="CDR0000257999__218"><li class="half_rhythm"><div>
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<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>
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</div></li><li class="half_rhythm"><div>
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<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>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Therapy to Treat Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/types/immunotherapy" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Immunotherapy to Treat Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Stem Cell Transplants in Cancer Treatment</a>
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</div></li></ul><p id="CDR0000257999__175_md_44">For more childhood cancer information and other general cancer resources, visit:</p><ul id="CDR0000257999__175_md_45"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<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>
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<a href="/books/n/pdqcis/CDR0000373791/?report=reader">Late Effects of Treatment for Childhood Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<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>
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</div></li><li class="half_rhythm"><div>
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<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>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Staging</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<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>
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</div></li><li class="half_rhythm"><div>
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<a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors, Caregivers, and Advocates</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 can be found online at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 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 3,000 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><div class="fm-sec"><h2 id="_NBK65781_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><h3>Publication History</h3><p class="small">Published online: March 1, 2024.</p><h3>Version History</h3><ul class="simple-list" style="padding:0"><li><span class="bk_col_itm">NBK65781.27</span> March 1, 2024 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65781.26/?report=reader">NBK65781.26</a></span> December 20, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65781.25/?report=reader">NBK65781.25</a></span> December 8, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65781.24/?report=reader">NBK65781.24</a></span> November 17, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65781.23/?report=reader">NBK65781.23</a></span> September 15, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65781.22/?report=reader">NBK65781.22</a></span> August 25, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65781.21/?report=reader">NBK65781.21</a></span> March 17, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65781.20/?report=reader">NBK65781.20</a></span> June 23, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65781.19/?report=reader">NBK65781.19</a></span> August 13, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65781.18/?report=reader">NBK65781.18</a></span> September 10, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65781.17/?report=reader">NBK65781.17</a></span> December 19, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65781.16/?report=reader">NBK65781.16</a></span> July 29, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65781.15/?report=reader">NBK65781.15</a></span> July 5, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65781.14/?report=reader">NBK65781.14</a></span> January 15, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65781.13/?report=reader">NBK65781.13</a></span> May 31, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65781.12/?report=reader">NBK65781.12</a></span> May 18, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65781.11/?report=reader">NBK65781.11</a></span> March 28, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65781.10/?report=reader">NBK65781.10</a></span> December 8, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65781.9/?report=reader">NBK65781.9</a></span> September 1, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65781.8/?report=reader">NBK65781.8</a></span> March 14, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65781.7/?report=reader">NBK65781.7</a></span> March 10, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65781.6/?report=reader">NBK65781.6</a></span> August 3, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65781.5/?report=reader">NBK65781.5</a></span> December 16, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65781.4/?report=reader">NBK65781.4</a></span> October 30, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65781.3/?report=reader">NBK65781.3</a></span> October 1, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65781.2/?report=reader">NBK65781.2</a></span> September 9, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65781.1/?report=reader">NBK65781.1</a></span> August 11, 2015</li></ul><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>PDQ Pediatric Treatment Editorial Board. Childhood Hodgkin Lymphoma Treatment (PDQ®): Patient Version. 2024 Mar 1. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="boxed-text" id="figobCDR00002579991kp"><div id="CDR0000257999__1.kp" class="box boxed-text-box whole_rhythm hide-overflow"><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 cancer that develops in the lymph system.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__134">The two main types of childhood Hodgkin lymphoma are classic and nodular lymphocyte-predominant. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__8">Epstein-Barr virus infection and a family history of Hodgkin lymphoma can increase
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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, drenching night sweats, and weight loss.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__16">Tests that examine the lymph system and other parts of the body are used to diagnose
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and stage childhood Hodgkin lymphoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__2714">You may want to get a second opinion.</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></article><article data-type="fig" id="figobCDR0000257999237"><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=The%20lymph%20system%20is%20part%20of%20the%20body's%20immune%20system%20and%20is%20made%20up%20of%20tissues%20and%20organs%20that%20help%20protect%20the%20body%20from%20infection%20and%20disease&p=BOOKS&id=602723_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 data-src="/books/NBK65781/bin/CDR0000653807.jpg" alt="Lymph system; drawing shows the tonsils, thymus, spleen, bone marrow, lymph vessels, and lymph nodes. One inset shows the inside structure of a lymph node and the attached lymph vessels with arrows showing how the lymph (clear, watery 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>The lymph system is part of the body's immune system and is made up of tissues and organs that help protect the body from infection and disease. These include the tonsils, thymus, spleen, bone marrow, lymph vessels, and lymph nodes. Lymph (clear, watery fluid) and lymphocytes (white blood cells) travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the bloodstream through a large vein near the heart.</p></div></div></article><article data-type="fig" id="figobCDR0000257999185"><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=602723_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 data-src="/books/NBK65781/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 (a type of white blood cell) that may contain more than one nucleus. These cells are found in people with Hodgkin lymphoma. Reed-Sternberg cells are also called Hodgkin and Reed-Sternberg cells.</p></div></div></article><article data-type="fig" id="figobCDR0000257999304"><div id="CDR0000257999__304" 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=602723_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 data-src="/books/NBK65781/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></article><article data-type="fig" id="figobCDR0000257999262"><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&p=BOOKS&id=602723_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 data-src="/books/NBK65781/bin/CDR0000775531.jpg" alt="Computed tomography (CT) scan; drawing shows a child lying on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of areas inside the body." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Computed tomography (CT) scan. The child lies on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of areas inside the body.</p></div></div></article><article data-type="fig" id="figobCDR0000257999263"><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=602723_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 data-src="/books/NBK65781/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></article><article data-type="fig" id="figobCDR0000257999292"><div id="CDR0000257999__292" 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)%20scan&p=BOOKS&id=602723_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 data-src="/books/NBK65781/bin/CDR0000775532.jpg" alt="Magnetic resonance imaging (MRI) scan; drawing shows a child lying on a table that slides into the MRI machine, which takes a series of detailed pictures of areas inside the body." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Magnetic resonance imaging (MRI) scan. The child lies on a table that slides into the MRI machine, which takes a series of detailed pictures of areas inside the body. The positioning of the child on the table depends on the part of the body being imaged.</p></div></div></article><article data-type="fig" id="figobCDR0000257999305"><div id="CDR0000257999__305" 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=602723_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 data-src="/books/NBK65781/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></article><article data-type="boxed-text" id="figobCDR000025799924kp"><div id="CDR0000257999__24.kp" class="box boxed-text-box whole_rhythm hide-overflow"><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__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__299">In addition to the stage number, the letters A, B, E, or S may be noted.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__148">Childhood Hodgkin lymphoma is treated according to risk groups.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__306">Sometimes childhood Hodgkin lymphoma does not respond to treatment or comes back after treatment.</a></div></li></ul></div></article><article data-type="fig" id="figobCDR0000257999211"><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=602723_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 data-src="/books/NBK65781/bin/CDR0000648701.jpg" alt="Stage I childhood Hodgkin lymphoma; drawing shows cancer in one lymph node group above the diaphragm and in the spleen. Also shown are the Waldeyer’s ring and the thymus. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Cancer cells are shown inside 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 a group of lymph nodes or, in rare cases, cancer is found in the Waldeyer’s ring, thymus, or spleen. In stage IE (not shown), cancer has spread to one area outside the lymph system.</p></div></div></article><article data-type="fig" id="figobCDR0000257999212"><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=602723_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 data-src="/books/NBK65781/bin/CDR0000648702.jpg" alt="Stage II childhood Hodgkin lymphoma; drawing shows cancer in two lymph node groups above the diaphragm and below the diaphragm. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Cancer cells are shown inside 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 that are either above the diaphragm or below the diaphragm.</p></div></div></article><article data-type="fig" id="figobCDR0000257999213"><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=602723_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 data-src="/books/NBK65781/bin/CDR0000648703.jpg" alt="Stage IIE childhood Hodgkin lymphoma; drawing shows cancer in a lymph node group above the diaphragm and cancer that has spread to a nearby area (the left lung). An inset shows a lymph node with a lymph vessel, an artery, and a vein. Cancer cells are shown inside the lymph node." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIE childhood Hodgkin lymphoma. Cancer has spread from a group of lymph nodes to a nearby organ or area that is outside the lymph system.</p></div></div></article><article data-type="fig" id="figobCDR00002579992722"><div id="CDR0000257999__2722" 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=602723_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 data-src="/books/NBK65781/bin/CDR0000648704.jpg" alt="Stage III childhood Hodgkin lymphoma; drawing shows (a) cancer in lymph node groups above and below the diaphragm. Also shown is (b) cancer in a lymph node group above the diaphragm and cancer in the spleen. The lungs are also shown. An inset shows a close-up of a lymph node with a lymph vessel, an artery, and a vein. Cancer cells are shown inside 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 (a) in lymph node groups above and below the diaphragm; or (b) in lymph node groups above the diaphragm and in the spleen.</p></div></div></article><article data-type="fig" id="figobCDR00002579992723"><div id="CDR0000257999__2723" 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=602723_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 data-src="/books/NBK65781/bin/CDR0000648705.jpg" alt="Stage IV childhood Hodgkin lymphoma; drawing shows four panels: (a) the top left panel shows cancer in the liver; (b) the top right panel shows cancer in the left lung and in two groups of lymph nodes below the diaphragm; (c) the bottom left panel shows cancer in the left lung and in a group of lymph nodes above the diaphragm and below the diaphragm; and (d) the bottom right panel shows cancer in both lungs and the liver. There is also a pullout showing cancer in the bone marrow." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IV childhood Hodgkin lymphoma. Cancer (a) has spread throughout one or more organs outside the lymph system, such as the liver; or (b) is found in two or more groups of lymph nodes that are on the same side of the diaphragm and in an organ that is outside the lymph system, such as the lung, and not near the affected lymph nodes; or (c) is found in groups of lymph nodes on both sides of the diaphragm and in any organ that is outside the lymph system, such as the lung; or (d) has spread to the lungs, liver, or bone marrow from areas far away.</p></div></div></article><article data-type="boxed-text" id="figobCDR000025799951kp"><div id="CDR0000257999__51.kp" class="box boxed-text-box whole_rhythm hide-overflow"><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__65">The following types of treatment may be 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__274">Immunotherapy</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">Clinical trials</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257999__238">Treatment for childhood Hodgkin lymphoma causes side effects and late effects.</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></article><article data-type="boxed-text" id="figobCDR0000257999332"><div id="CDR0000257999__332" class="box boxed-text-box whole_rhythm hide-overflow"><h3><span class="title">monoclonal antibodies: how monoclonal antibodies treat cancer</span></h3><div class="caption"><p>How do monoclonal antibodies work to treat cancer? This video shows how monoclonal antibodies, such as trastuzumab, pembrolizumab, and rituximab, block molecules cancer cells need to grow, flag cancer cells for destruction by the body’s immune system, or deliver harmful substances to cancer cells. </p></div><p><a href="https://www.youtube.com/watch?v=dxnjAc-rqz8" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></article><article data-type="fig" id="figobCDR0000257999290"><div id="CDR0000257999__290" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=602723_CDR0000774646.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 data-src="/books/NBK65781/bin/CDR0000774646.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).</p></div></div></article><article data-type="boxed-text" id="figobCDR0000257999291"><div id="CDR0000257999__291" class="box boxed-text-box whole_rhythm hide-overflow"><h3><span class="title">immune checkpoint inhibitors</span></h3><div class="caption"><p>Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.</p></div><p><a href="https://www.youtube.com/watch?v=GIUu239FWMg" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></article><article data-type="fig" id="figobCDR00002579992704"><div id="CDR0000257999__2704" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=CAR%20T-cell%20therapy&p=BOOKS&id=602723_CDR0000774647.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 data-src="/books/NBK65781/bin/CDR0000774647.jpg" alt="CAR T-cell therapy; drawing of blood being removed from a vein in a patient’s arm to get T cells. Also shown is a special receptor called a chimeric antigen receptor (CAR) being made in the laboratory; the gene for CAR is inserted into the T cells and then millions of CAR T cells are grown. Drawing also shows the CAR T cells being given to the patient by infusion and binding to antigens on the cancer cells and killing them." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>CAR T-cell therapy. A type of treatment in which a patient’s T cells (a type of immune cell) are changed in the laboratory so they will bind to cancer cells and kill them. Blood from a vein in the patient’s arm flows through a tube to an apheresis machine (not shown), which removes the white blood cells, including the T cells, and sends the rest of the blood back to the patient. Then, the gene for a special receptor called a chimeric antigen receptor (CAR) is inserted into the T cells in the laboratory. Millions of the CAR T cells are grown in the laboratory and then given to the patient by infusion. The CAR T cells are able to bind to an antigen on the cancer cells and kill them.</p></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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