Skip to Content
Cancer in children and adolescents is rare. Children and adolescents with cancer should be referred to medical centers that have a multidisciplinary team of cancer specialists with experience treating the cancers that occur during childhood and adolescence. This multidisciplinary team approach incorporates the skills of the primary care physician, pediatric surgical subspecialists, radiation oncologists, pediatric medical oncologists/hematologists, rehabilitation specialists, pediatric nurse specialists, social workers, and others to ensure that children receive treatment, supportive care, and rehabilitation that will achieve optimal survival and quality of life.
Guidelines for pediatric cancer centers and their role in the treatment of children with cancer have been outlined by the American Academy of Pediatrics. At these pediatric cancer centers, clinical trials are available for most of the types of cancer that occur in children and adolescents, and the opportunity to participate in these trials is offered to most patients/families. Clinical trials for children and adolescents with cancer are generally designed to compare potentially better therapy with therapy that is currently accepted as standard. Most of the progress made in identifying curative therapies for childhood cancers have been achieved through clinical trials.
In recent decades, dramatic improvements in survival have been achieved for children and adolescents with cancer. Childhood and adolescent cancer survivors require close follow-up because cancer therapy side effects may persist or develop months or years after treatment.
Lymphoma (Hodgkin and non-Hodgkin) is the third most common childhood malignancy, and non-Hodgkin lymphoma (NHL) accounts for approximately 7% of cancers in children younger than 20 years. In the United States, about 800 new cases of NHL are diagnosed each year. The incidence is approximately 10 per 1,000,000. Although there is no sharp age peak, NHL occurs most commonly in the second decade of life, and occurs less frequently in children younger than 3 years. The incidence of NHL is increasing overall, and there is a slight increase in the incidence for those aged 15 to 19 years; however, the incidence of NHL for children younger than 15 years has remained constant over the past several decades. The incidence of NHL is higher in Caucasians than in African Americans, and NHL is more common in males than in females. Immunodeficiency, both congenital and acquired (HIV infection or posttransplant), increases the risk of NHL. Epstein-Barr virus (EBV) is associated with most cases of NHL seen in the immunodeficient population.
With current treatments, about 80% of children and adolescents with NHL will survive at least 5 years, though outcome is variable depending on a number of factors. The most important prognostic determinant, given optimal therapy, is the extent of disease at diagnosis as determined by pretreatment staging. Patients with localized disease, i.e., single extra-abdominal/extrathoracic tumor or totally resected intra-abdominal tumor, have an excellent prognosis (a 5-year survival rate of approximately 90%), regardless of histology. Patients with NHL arising in bone have an excellent prognosis regardless of histology, and testicular disease does not affect prognosis. Unlike adults, children and adolescents with nonlymphoblastic NHL involving the mediastinum have an inferior outcome, as compared with other sites of disease. Patients with intrathoracic or extensive intra-abdominal disease and patients with bone marrow or central nervous system involvement at diagnosis require intensive therapy. These intensive therapies have improved the outcome for patients with disseminated or advanced-stage disease.
Source: National Cancer Institute