Non-Hodgkin lymphoma in children — what every parent needs to know

Non-Hodgkin lymphoma (NHL) is a cancer of the lymphatic system — the network of vessels, nodes, and organs that helps the body fight infection. In children with NHL, lymphocytes (a type of white blood cell) grow abnormally and form tumours in lymph nodes or in organs like the abdomen, chest, or tonsils. Unlike Hodgkin lymphoma, NHL in children tends to grow quickly and can spread to the bone marrow or the fluid around the brain and spinal cord. However, it also responds well to intensive chemotherapy — most children with NHL are treated with curative intent, especially when diagnosed early and managed by an experienced multidisciplinary team. NHL accounts for roughly 7–8% of all childhood cancers worldwide.

The most common early warning sign is a painless swollen lymph node — often in the neck, armpit, or groin — that does not shrink after two to four weeks. Other signs that should prompt a doctor's review include persistent or recurring fever without an obvious cause; drenching night sweats that soak through clothes or bedsheets; unexplained weight loss over a few weeks; a visibly swollen or uncomfortable abdomen (which can suggest a tumour in the gut or enlarged abdominal lymph nodes); and difficulty breathing or swallowing, which can indicate a mass in the chest (mediastinum). These symptoms are also seen in many non-cancerous conditions, so a swollen node alone is usually not cause for alarm — but if multiple signs appear together or a lump persists, your child should be assessed promptly.

Childhood NHL is divided into several subtypes based on which cell type is involved and where the tumour starts. The four most common are: Burkitt lymphoma, a very fast-growing B-cell lymphoma that often starts in the abdomen or jaw; Diffuse Large B-Cell Lymphoma (DLBCL), also a B-cell type but with slightly less aggressive behaviour than Burkitt; Lymphoblastic lymphoma, a T-cell or B-cell type that often produces a chest mass and shares biology with T-cell leukaemia; and Anaplastic Large Cell Lymphoma (ALCL), which arises from T-cells and can affect lymph nodes, skin, and soft tissue. Each subtype needs a different treatment protocol, which is why a detailed biopsy and immunophenotyping are essential before therapy starts.

Diagnosis starts with a clinical examination and blood tests including a full blood count, kidney and liver function, LDH (lactate dehydrogenase — a marker of tumour activity), and uric acid. Imaging — usually an ultrasound first, then a CT scan or PET-CT — maps where the tumour is and whether it has spread. The definitive step is a biopsy: a small piece of the tumour is taken and examined by a pathologist. The biopsy sample is tested with immunohistochemistry and sometimes flow cytometry to identify the exact cell type and subtype. A bone marrow biopsy and lumbar puncture (spinal tap) are also done to check whether the lymphoma has reached the bone marrow or the cerebrospinal fluid. All these results together determine the subtype and stage, which guide the treatment plan.

Treatment for childhood NHL is primarily chemotherapy, and the specific regimen depends on the subtype and stage. Burkitt lymphoma and DLBCL are typically treated with short, intensive chemotherapy cycles given over a few months. Lymphoblastic lymphoma uses a longer protocol — similar to leukaemia treatment — with induction, consolidation, and maintenance phases lasting up to two years. ALCL is treated with a shorter chemotherapy programme. All protocols include medicines given directly into the spinal fluid to protect the central nervous system. In certain high-risk or relapsed cases, stem cell transplantation may be recommended. Radiation therapy is used only in selected situations. Your child's exact treatment plan is decided by a multidisciplinary tumour board — decisions are never made by a single doctor alone.

Yes, these are two distinct diseases. Hodgkin lymphoma (HL) is identified by the presence of specific abnormal cells called Reed-Sternberg cells and tends to spread in an orderly, predictable pattern along lymph node chains. NHL does not have Reed-Sternberg cells and is a broader category covering many different lymphoma subtypes; it grows more unpredictably and can involve sites outside the lymph nodes — such as the gut, liver, bone marrow, or brain — more readily than HL. In children, NHL is overall more common than Hodgkin lymphoma and tends to be faster-growing. The treatment approaches also differ significantly: NHL uses intensive, short chemotherapy, while HL is often treated with a combination of chemotherapy and, in some cases, low-dose radiation.