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Childhood Cancer Types — Parent’s Guide
Childhood lymphoma — Hodgkin & non-Hodgkin, explained
Medically reviewed by Dr. C. Raghavendra Reddy, DM (Medical Oncology, Gold Medal) · Last reviewed June 2026
If your child has been found to have a swollen lymph node that won’t go away — or has been diagnosed with lymphoma — you deserve a clear, honest explanation of what that means. Childhood lymphoma is a cancer of the lymph nodes and lymphatic system. It is one of the more common cancers in children and teenagers, and many children with lymphoma go on to complete treatment and live full lives. This page explains the two main types — Hodgkin and non-Hodgkin lymphoma — how they differ, the signs to watch for, and what treatment involves.
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Understanding childhood lymphoma
Types of lymphoma in children — what every parent should know
Childhood lymphoma is not a single disease. There are two main categories — Hodgkin and non-Hodgkin — and each contains further subtypes that behave differently and need different treatment. Here is a clear overview of each.
More common in teens & older children
Hodgkin Lymphoma (Classical)
Classical Hodgkin lymphoma is the most common form of Hodgkin lymphoma in children and teenagers. It is recognised under the microscope by the presence of large abnormal cells called Reed-Sternberg cells. HL tends to spread in a step-by-step pattern from one adjacent group of lymph nodes to the next, which makes it predictable enough that staging scans can accurately map how far it has spread. Most children with classical Hodgkin lymphoma are diagnosed with enlarged lymph nodes in the neck or chest.
- Peak incidence in adolescents and young adults
- Often presents with a painless neck or chest mass
- Generally responds well to chemotherapy
Less common HL subtype
Nodular Lymphocyte-Predominant Hodgkin Lymphoma
This is a less common and biologically distinct subtype of Hodgkin lymphoma. The abnormal cells look different under the microscope from classical Reed-Sternberg cells and the disease tends to be slower-growing. It often presents at an early stage and, in many children, the treatment approach is tailored to be less intensive than classical Hodgkin lymphoma while still being highly effective.
- Slower-growing than classical HL
- Often diagnosed at an earlier stage
- Treatment may differ from classical HL
Fast-growing NHL — common in younger children
Burkitt Lymphoma (Non-Hodgkin)
Burkitt lymphoma is one of the most rapidly-growing cancers known — tumour cells can double in number within hours. It most commonly affects younger children and often presents in the abdomen, causing a quickly enlarging mass or abdominal swelling. Despite its fast growth, Burkitt lymphoma is highly sensitive to intensive chemotherapy and many children respond rapidly and dramatically to the first cycle of treatment.
- Most often presents in the abdomen
- Requires prompt, intensive treatment
- High sensitivity to chemotherapy
Aggressive NHL — B-cell origin
Diffuse Large B-Cell Lymphoma (Non-Hodgkin)
Diffuse large B-cell lymphoma (DLBCL) is a fast-growing non-Hodgkin lymphoma that arises from B-lymphocytes. In children it can occur in lymph nodes or in other organs including the bone marrow, central nervous system, or mediastinum (the space between the lungs). DLBCL responds to intensive multi-agent chemotherapy and, in many children, treatment leads to complete remission.
- B-lymphocyte origin
- Can arise in multiple sites including the mediastinum
- Intensive chemotherapy is the primary treatment
NHL closely related to ALL
Lymphoblastic Lymphoma (Non-Hodgkin)
Lymphoblastic lymphoma (LBL) is closely related to acute lymphoblastic leukaemia (ALL). The distinction is based on how much of the disease is in the bone marrow versus the lymph nodes: when the marrow is not predominantly affected, the condition is classified as lymphoma rather than leukemia. LBL most commonly arises from T-lymphocytes and often presents with a large mass in the chest (mediastinum). Treatment is similar to ALL protocols, with chemotherapy given in phases.
- Frequently presents as a mediastinal (chest) mass
- Closely related to ALL in biology and treatment
- Multi-phase chemotherapy over several months to years
T-cell NHL with characteristic marker
Anaplastic Large Cell Lymphoma (Non-Hodgkin)
Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma that most commonly occurs in children and young adults. Most paediatric ALCL cases carry a specific genetic rearrangement (ALK gene fusion), which is associated with a favourable response to chemotherapy. ALCL can involve lymph nodes as well as other sites including the skin, bones, and soft tissue. The ALK status is always determined at diagnosis as it influences the treatment plan.
- Most cases carry ALK gene fusion — prognostically favourable
- Can involve skin, bone, and soft tissue in addition to lymph nodes
- Chemotherapy is first-line; ALK status guides planning
Recognising childhood lymphoma
Warning signs of lymphoma in children — what parents need to know
Most swollen lymph nodes in children are caused by common infections — and that is exactly what they should be assumed to be at first. But some signs are worth bringing to a doctor, especially when they persist. Here is what to look for.
Swollen lymph nodes that stay enlarged. The most common presenting sign of childhood lymphoma is a lymph node — most often in the neck, above the collarbone, in the armpit, or in the groin — that remains enlarged for more than three to four weeks. Nodes caused by infection are usually tender and shrink once the infection clears. Lymphoma nodes are more often rubbery, painless, and gradually growing. A node above the collarbone that is not explained by an obvious local infection deserves prompt evaluation.
Chest symptoms and breathlessness. A mass in the mediastinum — the space between the lungs — is a common presentation of both Hodgkin lymphoma and lymphoblastic NHL in children. Your child may develop a persistent cough, shortness of breath, a feeling of pressure in the chest, or difficulty breathing when lying flat. These symptoms warrant an immediate chest X-ray, not a wait-and-watch approach.
“B symptoms” — the systemic warning signs. In lymphoma, three particular symptoms — known as “B symptoms” — are specifically significant: (1) unexplained weight loss of more than 10% of body weight over six months; (2) drenching night sweats that soak pyjamas and bedsheets; and (3) a fever above 38°C on and off without any clear infection. Individually, each has many innocent causes. Together — or alongside persistent swollen nodes — they make a haematology referral necessary.
Abdominal swelling or a lump in the belly. Fast-growing NHL subtypes such as Burkitt lymphoma often first appear as a rapidly expanding abdominal mass. A parent may notice the child’s belly looking distended, or the child may complain of stomach pain and poor appetite. Sometimes the spleen or liver is enlarged and can be felt just below the rib cage. Abdominal masses in children always deserve urgent imaging.
Generalised itching without a skin rash. Some children with Hodgkin lymphoma experience persistent, unexplained itching all over the body without any visible skin problem. The mechanism is not fully understood, but it is a recognised feature worth mentioning to a doctor alongside other symptoms.
Important: These signs do not mean your child has lymphoma. Most children with swollen glands have a straightforward infection. What matters is: if the node or symptom does not resolve within three to four weeks, or if you are worried, a blood test and a doctor’s assessment will give you clarity. Getting checked is never the wrong decision.
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From first concern to treatment
How childhood lymphoma is diagnosed and treated — step by step
If lymphoma is suspected, the diagnostic process is thorough and methodical. Every step has a reason — and at CION, no child’s treatment plan is finalised until all the information is in.
Physical examination and first blood tests
The starting point is a careful physical examination by a doctor — feeling all lymph node groups, checking the spleen and liver for enlargement, and listening to the chest. Blood tests including a complete blood count (CBC), inflammatory markers (ESR, CRP, LDH), and liver and kidney function tests help build an initial picture. These tests alone cannot diagnose lymphoma, but they guide what comes next and rule out common infections.
Imaging to map the disease
A chest X-ray is often the first imaging test and can immediately reveal a mediastinal mass. CT scanning of the neck, chest, abdomen, and pelvis maps the full extent of lymph node involvement and identifies any organ masses. A PET-CT scan (where available and appropriate for the child’s age and presentation) adds metabolic information — showing which nodes are actively involved — and is used both for staging and for assessing response to treatment. CION offers same-day PET-CT with expert review at its Hyderabad diagnostic centres.
Biopsy — the definitive diagnosis
Diagnosis cannot be made from imaging alone. A tissue sample — taken from the most accessible affected lymph node or mass — is essential. The biopsy is performed under sedation or general anaesthesia so the child is comfortable and still. The sample is examined by a pathologist under the microscope and then processed through immunophenotyping (testing specific markers on the cell surface) to identify the exact subtype of lymphoma. In some cases, molecular and genetic testing of the sample identifies specific markers that influence treatment. No treatment is planned until the biopsy result is confirmed.
Bone marrow test and lumbar puncture (when needed)
Some subtypes of lymphoma — particularly NHL subtypes — can involve the bone marrow or the fluid around the brain and spinal cord. When this is possible, a bone marrow aspirate and biopsy is done to check the marrow, and a lumbar puncture (spinal tap) checks the cerebrospinal fluid. These tests are done under sedation. The results determine the stage and whether treatment needs to protect or treat the central nervous system.
Multidisciplinary tumor board review
Once all the information is gathered — biopsy, staging scans, blood tests, and marrow results — the case is presented at a multidisciplinary tumor board attended by the medical oncologist, haematologist, radiation oncologist, radiologist, and pathologist. Together they agree on the diagnosis, the stage, the risk category (which determines how intensive the treatment will be), and the treatment protocol. At CION, no treatment plan is finalised by a single doctor. This meeting is the standard of care for every child.
Chemotherapy — the primary treatment for most children
Chemotherapy is the backbone of treatment for both Hodgkin and non-Hodgkin lymphoma in children. For Hodgkin lymphoma, chemotherapy is given in cycles over a period of months, and the initial response is assessed with interim imaging. For NHL subtypes, the chemotherapy protocol and total duration vary by subtype — some programmes are shorter and more intensive, others span a longer maintenance period similar to ALL therapy. The team will explain the specific protocol your child will follow, including how many cycles, the expected side effects, and how the response will be monitored.
Radiation therapy — when and how it is used
Radiation therapy is no longer used routinely for all children with lymphoma. For Hodgkin lymphoma, the decision to add radiation depends on whether the disease responded completely to chemotherapy on interim scans, and on the stage at diagnosis. For most NHL subtypes in children, radiation is not part of the standard first-line treatment. When radiation is needed, modern techniques focus the dose precisely on the involved area while protecting surrounding healthy growing tissue. The radiation oncologist will explain exactly what will be treated, the dose, and the schedule.
Walking this journey with you
What parents can expect during their child’s lymphoma treatment
Treatment for childhood lymphoma is intensive, and you will carry most of it as a family. Here is what the road ahead typically looks like — honestly, and with the things that really matter.
Treatment happens in cycles, not all at once. Chemotherapy is given in planned cycles separated by rest periods. This is not an oversight — the rest periods allow the body to recover between cycles, which makes the treatment more tolerable and the next cycle safer. During rest periods, blood counts are monitored regularly. Your child will have scheduled clinic visits for blood tests and review even on “off weeks.”
Infection risk is real — and manageable. Chemotherapy affects the immune system. The period of lowest blood counts after a cycle (the nadir) is when the child is most vulnerable to infection. The team will teach you exactly which symptoms require an emergency call — fever above 38°C in a child on chemotherapy is always treated as urgent and should not be managed at home overnight. CION’s team is reachable for guidance between visits.
Nutrition and weight need active attention. Many children find eating difficult during chemotherapy due to nausea, mouth soreness, or loss of appetite. Supporting nutrition — through dietary modifications, oral supplements, and when needed, nutritional support through a tube — is part of the standard care plan. At CION, a nutritionist is part of the care team, not an afterthought.
Schooling and development matter during treatment. Long treatment courses in children are designed to interfere with normal development as little as possible. Many children with lymphoma continue some schooling during maintenance or less intensive phases of treatment. The oncology team at CION will discuss what is realistic for your child’s specific situation and help families plan around hospital visits.
Response is monitored at every stage. Interim imaging — typically a PET-CT or CT scan after a defined number of cycles — is used to assess how the lymphoma is responding. Good early response is a strong sign that the planned treatment is working. This monitoring allows the team to adapt the plan if needed — reducing intensity if response is excellent, or escalating if response is inadequate.
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Common questions
Your questions about childhood lymphoma — answered
What is childhood lymphoma and how is it different from leukemia?
Lymphoma is a cancer of the lymphatic system — the network of lymph nodes, lymph vessels, and lymphoid organs (including the spleen and thymus) that forms part of the body’s immune defences. The cells that become cancerous in lymphoma are lymphocytes (a type of white blood cell), which is why lymphoma and leukemia can seem similar. The key difference is where the cancer primarily lives: leukemia starts in the bone marrow and spills into the blood, while lymphoma starts in the lymph nodes or other lymphoid tissue and may or may not involve the marrow later. Lymphoma often first shows itself as a visible or palpable swollen lymph node — most commonly in the neck, armpit, or groin. Both conditions are treated by specialist oncologists, and the two can overlap in advanced cases, which is why accurate diagnosis is essential before any treatment begins.
What is the difference between Hodgkin and non-Hodgkin lymphoma in children?
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) are the two broad categories of childhood lymphoma, and they behave quite differently. Hodgkin lymphoma is defined by the presence of a distinctive abnormal cell called the Reed-Sternberg cell, visible under the microscope. HL tends to spread in an orderly, predictable way from one lymph node group to the next, making it relatively amenable to treatment. It is more common in older children and teenagers. Non-Hodgkin lymphoma is a much more diverse group — it includes several subtypes that behave quite differently from one another. Some subtypes of childhood NHL grow very rapidly, while others are slower-growing. NHL is more common in younger children. The treatment approach, the number of treatment cycles, and the expected course differ substantially between HL and NHL, which is why the distinction matters from the very beginning.
What are the warning signs of lymphoma in children?
The most common warning sign of lymphoma in children is a lymph node that stays swollen for more than three to four weeks without an obvious infection to explain it. Lymph nodes that are rubbery, painless, and growing gradually are more concerning than those that are tender and appeared after a cold or sore throat. Beyond swollen glands, parents should watch for: unexplained weight loss over a few weeks; drenching night sweats that soak the bedclothes; a fever that comes and goes without infection; persistent, unexplained tiredness; difficulty breathing or a new persistent cough (which can indicate a mass in the chest); and an itchy skin without rash. These warning signs, known as “B symptoms” in lymphoma, do not mean the child definitely has lymphoma — many common illnesses cause similar features. However, when several are present together, or when swollen glands persist beyond three to four weeks, a proper medical evaluation is the right step.
How is lymphoma diagnosed in children?
Diagnosing lymphoma in a child involves several steps, starting with a careful physical examination and blood tests. The blood count (CBC) is checked for abnormalities, and blood tests for inflammatory markers and organ function help build a picture. Imaging is usually the next step: a chest X-ray may reveal a mediastinal mass, and a CT scan or PET-CT scan maps where in the body enlarged lymph nodes or masses are present and how active they are. The definitive diagnosis requires a tissue sample — a biopsy of an affected lymph node or mass, usually taken under sedation or general anaesthesia so the child is comfortable. The biopsy sample is examined under a microscope, classified by immunophenotyping, and tested for specific molecular markers. All of this information together — the histology, the staging scans, the blood tests — determines the subtype of lymphoma, the stage, and the most appropriate treatment plan.
Is childhood lymphoma treatable?
Yes — childhood lymphoma, particularly Hodgkin lymphoma, has excellent outcomes when diagnosed and treated at a specialist centre. Many children with Hodgkin lymphoma complete treatment and go on to lead full, healthy lives. Non-Hodgkin lymphoma encompasses a range of subtypes with varying outcomes, but many subtypes in children also respond well to treatment. Treatment is not easy — it requires commitment from the family, careful coordination between specialists, and close monitoring — but it is structured to give the child the best possible outcome at every step. At CION, every child’s case is reviewed at a multidisciplinary tumor board where medical, surgical, and radiation oncologists discuss the plan together before any treatment begins. No rushed decisions are made.
Does a child need radiation therapy for lymphoma?
Not always — and this is an important area where the approach to childhood lymphoma has evolved considerably. In the past, radiation therapy was used more broadly for lymphoma. Today, for many children — particularly those with Hodgkin lymphoma — radiation is used selectively or avoided altogether, especially in children who respond very well to initial chemotherapy. This approach reduces the risk of long-term side effects from radiation in growing children. In some subtypes of non-Hodgkin lymphoma, radiation is not part of the standard treatment at all. When radiation is recommended, modern techniques allow the radiation oncologist to precisely target the involved area while protecting surrounding healthy tissue. Whether radiation is part of your child’s plan is a decision made by the tumor board based on the specific subtype, the stage, and how the disease responds to the first phase of treatment.
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