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Stages of Childhood Hodgkin Lymphoma

Key Points

  • After childhood Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • The following stages are used for childhood Hodgkin lymphoma:
    • Stage I
    • Stage II
    • Stage III
    • Stage IV
  • In addition to the stage number, the letters A, B, E, or S may be noted.
  • Childhood Hodgkin lymphoma is treated according to risk groups.
  • Sometimes childhood Hodgkin lymphoma does not respond to treatment or comes back after treatment.

"VSports手机版" After childhood Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.

The process used to find out if cancer has spread is called staging. The information gathered from the staging process determines the stage of the disease. The results of the VSports最新版本 - tests and procedures done to diagnose and stage Hodgkin lymphoma are used to help make decisions about treatment.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

The following stages are used for childhood Hodgkin lymphoma:

Stage I

EnlargeStage 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.
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.

Stage I is divided into stage I and stage IE.

Stage II

Stage II is divided into stage II and stage IIE.

  • Stage II: Cancer is found in two or more lymph node groups either above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
    EnlargeStage 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.
    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.
  • Stage IIE: Cancer has spread from a group of lymph nodes to a nearby organ that is outside the "V体育官网" lymph system. Cancer may have spread to other lymph node groups on the same side of the diaphragm.
    EnlargeStage 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.
    Stage IIE childhood Hodgkin lymphoma. Cancer has spread from a group of lymph nodes to a nearby organ or area that is outside the "V体育官网" lymph system.

Stage III

In stage III, the cancer is found:

  • in V体育官网入口 - lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen); or
  • in lymph node groups above the diaphragm and in the spleen.
    EnlargeStage 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.
    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.

Stage IV

In stage IV, the cancer:

  • has spread throughout one or more organs outside the lymph system and may be in lymph nodes near those organs; or
  • is found in two or more groups of lymph nodes that are on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen) and in an organ that is outside the lymph system and not near the affected lymph nodes; or
  • is found in groups of lymph nodes on both side of the diaphragm and in any organ that is outside the lymph system; or
  • has spread to the lungs, liver, or bone marrow from areas far away.
    EnlargeStage 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.
    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.

In addition to the stage number, the letters A, B, E, or S may be noted.

The letters A, B, E, or S may be used to further describe the stage of childhood Hodgkin lymphoma.

  • A: The patient does not have B symptoms (V体育官网入口 - fever, weight loss, or drenching night sweats).
  • B: The patient has B symptoms.
  • E: Cancer is found in an organ or tissue that is not part of the lymph system but which may be next to an area of the lymph system affected by the cancer.
  • S: Cancer is found in the spleen.

"V体育官网" Childhood Hodgkin lymphoma is treated according to risk groups.

Untreated childhood Hodgkin lymphoma is divided into risk groups based on the stage, size of the tumor, and whether the patient has B symptoms (fever, weight loss, or drenching night sweats). The risk group describes the likelihood that Hodgkin lymphoma will not respond to treatment or recur (come back) after treatment. It is used to plan initial treatment.

Low-risk Hodgkin lymphoma requires fewer cycles of treatment, fewer anticancer drugs, and lower doses of anticancer drugs than high-risk lymphoma.

Sometimes childhood Hodgkin lymphoma does not respond to treatment or comes back after treatment.

Primary refractory Hodgkin lymphoma is cancer that does not respond to initial treatment.

Recurrent Hodgkin lymphoma is cancer that has recurred (come back) after it has been treated. The lymphoma may come back in the lymph system or in other parts of the body, such as the lungs, liver, bones, or bone marrow.

Treatment Option Overview

Key Points

  • There are different types of treatment for children with Hodgkin lymphoma.
  • Children with Hodgkin lymphoma should have their treatment planned by a team of health care providers who are experts in treating childhood cancer.
  • The following types of treatment may be used:
    • Chemotherapy
    • Radiation therapy
    • Targeted therapy
    • Immunotherapy
    • Surgery
    • High-dose chemotherapy with stem cell transplant
  • Clinical trials
    • Proton beam radiation therapy
  • Treatment for childhood Hodgkin lymphoma causes side effects and late effects.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up care may be needed.

There are different types of treatment for children with Hodgkin lymphoma.

There are different types of treatment for children with 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.

Children with Hodgkin lymphoma should have their treatment planned by a team of health care providers who are experts in treating childhood cancer.

A pediatric oncologist, a doctor who specializes in treating children with cancer, oversees treatment of childhood Hodgkin lymphoma. The pediatric oncologist works with other pediatric health care providers who are experts in treating children with Hodgkin lymphoma and who specialize in certain areas of medicine. Other specialists may include:

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 regimen.

The following types of treatment may be used:

Chemotherapy

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 combination chemotherapy. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

The way the chemotherapy is given depends on the risk group. For example, children with low-risk Hodgkin lymphoma receive fewer cycles of treatment, fewer anticancer drugs, and lower doses of anticancer drugs than children with high-risk lymphoma.

For more information, visit Drugs Approved for Hodgkin Lymphoma.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of external radiation therapy include:

Radiation therapy may be given, based on the child's risk group and chemotherapy regimen. The radiation is given only to the lymph nodes or other areas with cancer.

Targeted therapy

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:

  • Monoclonal antibody therapy: Monoclonal antibodies are immune system proteins 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 infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

    Rituximab or brentuximab may be used to treat high-risk, refractory, or recurrent childhood Hodgkin lymphoma.

    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.
  • Proteasome inhibitor 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.

    Bortezomib is a proteasome inhibitor used to treat refractory or recurrent childhood Hodgkin lymphoma.

Learn more about Targeted Therapy to Treat Cancer.

Immunotherapy

Immunotherapy uses the patient's immune system 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:

  • Immune checkpoint inhibitor therapy: Some types of immune cells, such as T cells, and some cancer cells have certain proteins, called checkpoint proteins, on their surface that keep immune responses 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:
    • PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body's immune responses 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.

      Pembrolizumab and nivolumab are types of PD-1 inhibitors that may be used in the treatment of childhood Hodgkin lymphoma that has come back after treatment.

    EnlargeImmune 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.
    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).
    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.

Surgery

Surgery may be done to remove as much of the tumor as possible for localized nodular lymphocyte-predominant Hodgkin lymphoma in children.

High-dose chemotherapy with stem cell transplant

High doses of chemotherapy are given to kill cancer cells. Healthy cells, including blood-forming cells, are also destroyed by the cancer treatment. Stem cell transplant is a treatment to replace the blood-forming cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor 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.

For more information, visit Drugs Approved for Hodgkin Lymphoma.

Clinical trials

A treatment clinical trial 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.

Use our clinical trial search 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 ClinicalTrials.gov website.

Learn more at Clinical Trials Information for Patients and Caregivers.

Proton beam radiation therapy

Proton beam therapy is a type of high-energy, external radiation therapy that uses streams of protons (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 breast, heart, and lungs.

V体育安卓版 - Treatment for childhood Hodgkin lymphoma causes side effects and late effects.

To learn more about side effects that begin during treatment for cancer, visit Side Effects.

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 development, regular follow-up exams are important.

Late effects of cancer treatment may include:

For female survivors 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 regimen used. The risk of breast cancer is decreased if radiation to the ovaries was also given.

Doctors may recommend that female survivors who received radiation therapy to the breast have a mammogram and MRI once a year starting 8 years after treatment or at age 25 years, whichever is later. They may also suggest that female survivors do a breast self-exam every month beginning at puberty 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.

For male survivors who received radiation therapy to the chest, there may be a higher risk of cardiovascular disease. Limiting radiation therapy to the chest is suggested if possible.

Dexrazoxane is a drug that can reduce the risk of long-term heart damage in Hodgkin lymphoma survivors. The drug is usually taken alongside chemotherapy and other treatments.

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. Learn more about Late Effects of Treatment for Childhood Cancer.

"VSports注册入口" Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial 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 standard treatment.

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.

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.

Patients can enter clinical trials before, during, or after starting their cancer treatment. (VSports最新版本)

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 side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up care may be needed.

As your child goes through treatment, they will have follow-up tests or check-ups. Some tests that were done to diagnose or stage 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.

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).

For patients who receive chemotherapy alone, a PET scan 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.

Treatment of Low-Risk Classic Childhood Hodgkin Lymphoma

For information about the treatments listed below, visit the Treatment Option Overview section.

Treatment of newly diagnosed low-risk classic Hodgkin lymphoma in children may include:

Use our clinical trial search 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. General information about clinical trials is also available.

Treatment of Intermediate-Risk Classic Childhood Hodgkin Lymphoma

For information about the treatments listed below, visit the Treatment Option Overview section.

Treatment of newly diagnosed intermediate-risk classic Hodgkin lymphoma in children may include:

Use our clinical trial search 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. General information about clinical trials is also available.

Treatment of High-Risk Classic Childhood Hodgkin Lymphoma

For information about the treatments listed below, visit the Treatment Option Overview section.

Treatment of newly diagnosed high-risk classic Hodgkin lymphoma in children may include:

Use our clinical trial search 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. General information about clinical trials is also available.

V体育2025版 - Treatment of Nodular Lymphocyte-Predominant Childhood Hodgkin Lymphoma

For information about the treatments listed below, visit the Treatment Option Overview section.

Treatment of newly diagnosed nodular lymphocyte-predominant Hodgkin lymphoma in children may include:

Use our clinical trial search 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. General information about clinical trials is also available.

Treatment of Primary Refractory or Recurrent Hodgkin Lymphoma in Children and Adolescents

For information about the treatments listed below, visit the Treatment Option Overview section.

In children and adolescents, treatment of primary refractory Hodgkin lymphoma (cancer that does not respond to initial treatment) or recurrent Hodgkin lymphoma (cancer that came back after treatment) may include:

Use our clinical trial search 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. General information about clinical trials is also available.

Coping With Your Child's Cancer

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, visit Support for Families: Childhood Cancer and Children with Cancer: A Guide for Parents.

To Learn More About Childhood Hodgkin Lymphoma

About This PDQ Summary

About PDQ

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 Spanish.

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.

Purpose of This Summary

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.

Reviewers and Updates

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.

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.

VSports在线直播 - Clinical Trial Information

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.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary (V体育官网入口)

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].”

The best way to cite this PDQ summary is:

PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Updated . Available at: https://www.cancer.gov/types/lymphoma/patient/child-hodgkin-treatment-pdq. Accessed . [PMID: 26389224]

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 Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

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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 Managing Cancer Care page.

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