Hodgkin’s Lymphoma in children: Symptoms, causes, and more

Receiving a cancer diagnosis for your child can feel like the ground has been pulled out from under you. The fear, uncertainty, and overwhelming rush of medical information can be difficult to process. But when the diagnosis is Hodgkin’s lymphoma, there is also a powerful reason for hope: this is one of the most treatable childhood cancers, with cure rates exceeding 90% in developed countries.

Hodgkin’s lymphoma — sometimes called Hodgkin’s disease — accounts for roughly 5% of all childhood cancers. It primarily affects the lymphatic system, a key part of the immune system that helps fight infections and filter harmful substances from the body. Unlike some aggressive cancers that spread unpredictably, Hodgkin’s lymphoma tends to follow a more organized path as it advances, making it easier to detect and treat successfully.

Thanks to modern advances in chemotherapy, radiation therapy, targeted drugs, and supportive care, most children with Hodgkin’s lymphoma not only survive but go on to lead full, healthy, and active lives. Understanding the early warning signs, risk factors, diagnostic process, and treatment options will help you feel more confident and prepared to support your child through this journey.

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Understanding the Role of the Lymphatic System

Before diving into symptoms and treatments, it’s essential to understand the lymphatic system, because Hodgkin’s lymphoma begins here.

The lymphatic system is a network of vessels, nodes, and organs — including the spleen, bone marrow, thymus, and tonsils — that helps maintain fluid balance, filter out harmful substances, and fight infections. The “workhorses” of this system are lymphocytes, a type of white blood cell that attacks bacteria, viruses, and other threats.

How Hodgkin’s Lymphoma Starts
In Hodgkin’s lymphoma, certain lymphocytes — usually B cells — begin growing and dividing abnormally. These cancerous cells, called Reed–Sternberg cells, are a hallmark of the disease. They can crowd out healthy immune cells and cause swelling in lymph nodes. The disease often begins in one lymph node region (such as the neck) and then spreads in a predictable pattern to nearby nodes and eventually other organs.

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Early Warning Signs of Hodgkin’s Lymphoma in Children

Spotting Hodgkin’s lymphoma early can dramatically improve treatment success. However, because its symptoms can resemble those of common infections, it’s easy to miss in the early stages.

Most Common Symptom: Painless Lymph Node Swelling

• Swelling often appears in the neck, armpits, or groin.
• Nodes are typically firm, rubbery, and painless.
• Unlike swollen nodes from an infection, they don’t shrink after a week or two.

Other Symptoms to Watch For

• Persistent fatigue that doesn’t improve with rest.
• Fever without a clear cause.
• Drenching night sweats that require changing clothes or bedding.
• Unexplained weight loss (more than 10% of body weight over six months).
• Itchy skin with no rash.
• Pain near lymph nodes after drinking alcohol — a rare but notable sign.

Tip: If swollen lymph nodes persist for more than two weeks, especially if combined with other symptoms like fever or night sweats, it’s important to consult a pediatrician promptly.

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Recognizing the Three Main Symptom Categories

Doctors often divide Hodgkin’s lymphoma symptoms into categories to guide diagnosis and treatment planning.

1. Localized Symptoms

• Swelling in one or more lymph node regions.
• Possible cough or breathing difficulty if swollen nodes press on airways in the chest.

2. Systemic “B” Symptoms

These are particularly important because they can affect staging and treatment decisions:

1. Fever over 38°C (100.4°F) for several days.
2. Night sweats soaking clothes or sheets.
3. Unintentional weight loss of over 10% of body weight in 6 months.

3. General Well-Being Changes

• Tiredness and low energy.
• Reduced appetite.
• General irritability or changes in mood (sometimes noticed by parents before other signs).

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Understanding Causes and Risk Factors

While the exact cause of Hodgkin’s lymphoma remains unknown, scientists believe it develops from a complex interaction of genetic, environmental, and immune system factors.

The Epstein–Barr Virus (EBV) Connection

• EBV, the virus that causes mononucleosis, has been linked to some cases of Hodgkin’s lymphoma.
• Most people contract EBV at some point, but only a small percentage develop lymphoma.
• EBV may cause DNA changes in B lymphocytes, making them more likely to grow abnormally.

Genetic and Family History

• First-degree relatives (siblings, parents) of a person with Hodgkin’s lymphoma have a slightly higher risk.
• However, most children diagnosed have no family history.

Weakened Immune System

Children are at higher risk if they:

• Have HIV infection.
• Live with autoimmune disorders.
• Take long-term immunosuppressive medication (e.g., after an organ transplant).
• Have inherited immune deficiencies.

Important: Having a risk factor doesn’t mean a child will develop Hodgkin’s lymphoma. Most children with risk factors remain cancer-free.

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Why Early Detection Matters

Early detection allows doctors to:

• Use less intensive treatments with fewer long-term side effects.
• Achieve higher cure rates.
• Reduce the impact on growth, fertility, and organ health.

Parents often play the most critical role in detection. If you notice a combination of persistent lymph node swelling, fatigue, and unexplained fever or weight loss, it’s better to seek medical evaluation early than to wait and “see if it goes away.”

Diagnosis: How Doctors Confirm Hodgkin’s Lymphoma in Children

Getting a timely and accurate diagnosis is the first step toward effective treatment. Because Hodgkin’s lymphoma symptoms often resemble those of viral infections, doctors rely on a series of tests to confirm the condition and determine how far it has progressed.

Step 1: Medical History and Physical Examination

Your child’s doctor will:

• Review symptoms, when they started, and how they’ve changed.
• Ask about family history of lymphoma or immune system disorders.
• Check for swollen lymph nodes in the neck, underarms, groin, and above the collarbone.
• Look for signs of enlarged spleen or liver.

Expert insight: Pediatric oncologists emphasize that lymph node swelling lasting more than 2–3 weeks without signs of infection warrants further testing.

Step 2: Blood Tests

Blood work helps evaluate your child’s overall health and can reveal indirect signs of cancer:

• Complete Blood Count (CBC): Measures red cells, white cells, and platelets.
• Erythrocyte Sedimentation Rate (ESR) or C-Reactive Protein (CRP): Detects inflammation.
• Blood chemistry panel: Assesses organ function (kidneys, liver).
• LDH levels: May be elevated in certain cancers.

Step 3: Imaging Studies

Imaging shows the size, location, and spread of lymph node swelling:

• Chest X-ray: Detects enlarged lymph nodes in the chest area.
• CT scan: Provides detailed cross-sectional images of the body.
• PET scan: Identifies areas of active cancer cells.
• MRI: Gives high-resolution images of soft tissues, useful for certain locations.

Step 4: Biopsy — The Definitive Test

The only way to confirm Hodgkin’s lymphoma is by removing and examining a lymph node or part of it under a microscope.

• The presence of Reed–Sternberg cells confirms the diagnosis.
• A biopsy also determines the specific subtype of Hodgkin’s lymphoma, which guides treatment.

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Understanding Staging in Childhood Hodgkin’s Lymphoma

Staging describes how far the cancer has spread, which is critical for deciding treatment. The most widely used system is the Ann Arbor Staging System.

Stage I

• Cancer in one lymph node region or a single area outside the lymphatic system.

Stage II

• Cancer in two or more lymph node regions on the same side of the diaphragm,
  or in one area outside the lymphatic system plus nearby lymph nodes.

Stage III

• Cancer on both sides of the diaphragm, possibly including the spleen or other nearby organs.

Stage IV

• Cancer has spread to multiple organs outside the lymphatic system (e.g., liver, lungs, bone marrow).

A and B Classification

• A: No “B” symptoms (fever, night sweats, weight loss).
• B: Presence of one or more “B” symptoms.

Why this matters: Staging not only determines how aggressive treatment should be but also helps predict prognosis.

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Types of Hodgkin’s Lymphoma in Children

Hodgkin’s lymphoma isn’t a single disease but a group of related conditions.

1. Classic Hodgkin’s Lymphoma (cHL) — 95% of pediatric cases

Subtypes include:

• Nodular Sclerosis: Most common in teens; characterized by fibrous bands in lymph nodes.
• Mixed Cellularity: More frequent in younger children; has varied immune cell types.
• Lymphocyte-Rich: Rare; tends to have an excellent prognosis.
• Lymphocyte-Depleted: Very rare; often more aggressive.

2. Nodular Lymphocyte-Predominant Hodgkin’s Lymphoma (NLPHL)

• Accounts for 5% of pediatric cases.
• Grows more slowly and may require less aggressive treatment.
• Reed–Sternberg cells are absent; instead, “popcorn cells” are found.

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Treatment Options for Childhood Hodgkin’s Lymphoma

Thanks to decades of research, treatment approaches are highly effective and increasingly targeted to reduce long-term side effects.

Standard Treatments

1. Chemotherapy
   • Main treatment for most stages.
   • Uses a combination of anti-cancer drugs given in cycles.
   • Side effects can include fatigue, nausea, hair loss, and lowered immunity.
2. Radiation Therapy
   • Often used alongside chemotherapy for localized disease.
   • Modern techniques focus radiation precisely on affected areas to protect healthy tissues.
3. Combined Modality Therapy
   • Chemotherapy followed by low-dose radiation.
   • Achieves high cure rates with reduced toxicity.

Advanced & Targeted Treatments

• Immunotherapy (e.g., checkpoint inhibitors) helps the immune system recognize and attack cancer cells.
• Targeted therapies like brentuximab vedotin attach to specific proteins on lymphoma cells.
• Stem cell transplant for relapse cases.

Treatment for NLPHL

• Early stages may be treated with surgery alone.
• Some children can avoid chemotherapy entirely if the disease is localized.

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Managing Side Effects and Supporting Recovery

Cancer treatment can take a toll on the body, but supportive care can make a huge difference.

Common side effects:

• Fatigue
• Loss of appetite
• Temporary hair loss
• Mouth sores
• Low immunity leading to infections

Support strategies:

• Nutritious meals rich in protein and vitamins.
• Adequate rest balanced with gentle physical activity.
• Emotional support from counselors or support groups.

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Life After Treatment: Thriving Beyond Hodgkin’s Lymphoma

Completing treatment for Hodgkin’s lymphoma is a major milestone — one that deserves celebration. But it’s also the beginning of a new chapter that focuses on recovery, follow-up care, and long-term wellness. Even after a child is declared cancer-free, regular monitoring is essential to safeguard their health, prevent recurrence, and address any late effects of treatment.

Many families describe this phase as a mix of relief and uncertainty. On one hand, the most intensive medical care is behind them; on the other, they must adjust to a “new normal” that still includes doctor visits, tests, and occasional health worries.

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The Importance of Follow-Up Care

Follow-up care is a structured plan created by your child’s oncology team to ensure ongoing health monitoring. It typically includes:

• Physical exams every few months during the first year, then gradually less frequent over time.
• Blood tests to check organ function and overall health.
• Imaging scans (if needed) to monitor for recurrence.
• Screening for late effects of treatment, such as heart, lung, or thyroid problems.

Expert tip: Keep a personal medical record of your child’s diagnosis, treatments received, and test results. This “survivorship care plan” will be valuable for future healthcare providers.

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Potential Long-Term Effects to Watch For

While most children go on to live completely normal lives, certain treatments — especially radiation and high-dose chemotherapy — can have delayed effects. These may include:

• Growth and development changes (especially if radiation involved growth plates).
• Thyroid dysfunction if the neck received radiation.
• Fertility concerns in later life.
• Cardiac or lung function changes from certain chemotherapy drugs or chest radiation.
• Increased risk of secondary cancers (although this is rare).

Your child’s follow-up plan will include preventive screenings for these issues so they can be managed early if they occur.

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Emotional and Psychological Support

Recovery is not only physical — it’s emotional. Childhood cancer can leave a lasting impact on a child’s sense of safety, confidence, and mental well-being.

For the Child

• Age-appropriate counseling can help them process what happened.
• Peer support groups allow them to connect with other survivors.
• Encourage open conversations about fears, school reintegration, and body image changes.

For the Family

• Parents often experience “scanxiety” — anxiety before follow-up scans.
• Siblings may have felt neglected during treatment and need reassurance.
• Couples may need support to cope with the stress cancer has placed on their relationship.

Practical tip: Many hospitals have child life specialists who can support both the child and family with coping strategies, school transition plans, and age-appropriate education about cancer.

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Helping Your Child Return to Normal Life

After treatment, children are eager to reclaim their independence and routines. Here’s how you can make the transition smoother:

1. School Reintegration
   • Arrange a meeting with teachers to discuss any temporary academic accommodations.
   • Some children may need reduced workloads or flexibility for medical appointments.
2. Physical Activity
   • Encourage gentle exercise to rebuild stamina — swimming, cycling, and walking are great options.
   • Avoid pushing them too hard too soon; recovery varies.
3. Nutrition
   • Focus on balanced meals with lean proteins, whole grains, fruits, and vegetables.
   • Keep them hydrated and limit processed foods to support long-term health.
4. Sleep
   • Adequate rest is essential for healing.
   • Encourage a consistent bedtime routine.

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Celebrating Milestones

Acknowledging your child’s resilience helps them see how far they’ve come. Families often celebrate:

• The end of treatment.
• The anniversary of remission.
• Achievements like returning to school or sports.

These celebrations can be small and personal or big and joyful — what matters is that they mark progress and hope.

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Staying Connected with Support Networks

No one should face the aftereffects of childhood cancer alone. Consider:

• Joining survivor networks for children and teens.
• Participating in family retreats organized by childhood cancer foundations.
• Staying in touch with hospital-based social workers or counselors.

Many families find that continuing involvement in the childhood cancer community — even after treatment — provides ongoing encouragement and a sense of purpose.

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The Outlook: A Life Full of Possibilities

The prognosis for childhood Hodgkin’s lymphoma remains among the best of all pediatric cancers, with more than 9 out of 10 children achieving long-term remission. With careful follow-up care, emotional support, and a healthy lifestyle, most survivors grow up to lead full, active, and successful lives.

Key message for parents: While the journey is challenging, the outcome for most children is overwhelmingly positive. Your love, advocacy, and attention to follow-up care are powerful tools in your child’s long-term health and happiness.