Children's cancer
Non-Hodgkin lymphoma (NHL) is a type of blood cancer that affects white blood cells called lymphocytes. Because it starts in or other parts of the lymphatic system, it is also called a cancer of the lymphatic system.
The lymphatic system is a system of thin tubes and lymph nodes that run throughout the body. These tubes are called lymph vessels or lymphatic vessels. The lymph system is an important part of our . It plays a role in fighting bacteria and other infections and destroying old or abnormal cells, such as cancer cells
The diagram below shows the lymph vessels, lymph nodes and other organs. These make up the lymphatic system.
Read about the lymphatic system
There are 2 main types of lymphoma. They are called Hodgkin lymphoma and non-Hodgkin lymphoma.
Hodgkin lymphomas have a particular appearance under the microscope and contain cells called Reed-Sternberg cells. Non-Hodgkin lymphomas look different under the microscope and do not contain Reed-Sternberg cells.
It’s important that doctors can tell the difference between Hodgkin and non-Hodgkin lymphomas. They are two different diseases and the treatment for them is not the same.
Any type of cancer in children is less common than adult cancer. Around 85 children (aged 0 to 14 years) are diagnosed with non-Hodgkin lymphoma (NHL) in the UK every year.
NHL is more common in boys than in girls, the reasons for this are unclear.
The most common symptom of NHL is one or more painless swellings of the lymph nodes in the:
neck
throat
armpit
groin
Some lymph nodes might be swollen in areas you can’t feel.
Your child might feel breathless or have a cough that doesn’t go away if they have swollen lymph nodes in the chest.
They might also complain of pain or discomfort if they have cancer in their chest or tummy (abdomen).
Some children also might feel full quickly if they have swollen lymph nodes in their abdomen or if they have an enlarged .
In some children with a type of NHL called Burkitt’s lymphoma, enlarged lymph nodes cause one part of the gut to slide forward and become stuck in the next part of the gut. This causes swelling and maybe a blockage. It can cause symptoms such as:
severe pain in the abdomen
blood in their poo
feeling or being sick
a high temperature
Some of the other symptoms of NHL in children are less specific. This includes:
a high temperature that comes and goes with no obvious cause
feeling sick
loss of appetite
weight loss
swelling of the face
having heavy night sweats – you may be needing to change your child’s pyjamas and bed sheets overnight
Your child might be extremely tired, even when they have had plenty of rest. They might also be very itchy, which can be quite frustrating for them. But this is less common.
Find out more about the signs and symptoms of cancer in children
You usually take your child to see their GP first. The GP might do some tests to help them decide if they need to see a specialist. These tests include:
blood tests
a physical examination
Depending on the results of their examination and blood tests, their GP may also arrange for them to have other tests. For example an x-ray of their chest. They usually have these tests at their local hospital.
If your child’s test results suspect NHL they will refer them to see a specialist children’s cancer doctor. These doctors are called paediatric haematologists.
There are guidelines for GPs to help them decide who needs a referral to see a specialist or have tests. The GP will use these guidelines as well as their experience and judgement.
These guidelines vary slightly between the different UK nations.
These guidelines apply to anyone from birth to 24 years of age.
Your GP should refer your child to see a specialist within 48 hours (2 days) if they have any of the following and your GP can't explain the cause:
swollen lymph nodes
an enlarged spleen
Their doctor will ask about other symptoms, such as:
unexplained fevers
weight loss
night sweats
itchy skin
shortness of breath
Their doctor will also want to know about any other symptoms. So do mention anything else you are concerned about.
There are separate detailed guidelines for Northern Ireland and Scotland. If you live in these nations, your GP will use these to guide their decision. You can find these on the following websites. Please note these are intended for health professionals. Your GP can explain whether or not they are going to refer your child and why this is.
Your child will need a number of tests if their doctor suspects they have NHL. For some types of tests your child might need to have or a .
Your child’s team are specially trained in helping children feel comfortable while having these tests. They do everything they can to make sure your child and you are prepared. They will explain in detail what tests your child will have. They will also tell you about any special instructions to help prepare for the test.
The tests they might have include one or more of the following:
blood tests
a chest x-ray
a bone marrow test
a spinal fluid test (lumbar puncture)
a CT scan
an MRI scan
a PET-CT scan
a PET scan
taking a sample of tissue (biopsy)
genetic tests
We have detailed information about having certain tests and scans. This information is written for adults with cancer, but you might find some of it useful.
Go to our A to Z list of tests and scans in adults
You should get your child's results within 1 or 2 weeks. But some more complex tests such as looking for changes (mutations) in your child's can take longer.
Waiting for test results can be a very worrying time. You might have contact details for a children’s cancer specialist nurse also known as a CNS. You can contact them for information if you need to. It can help to talk to a close friend or relative about how you feel.
There are many different types of NHL. Doctors put them into groups based on how fast they grow or the type of white blood cell (lymphocyte) that it affects.
One way of grouping NHL is by the type of lymphocyte affected. These can be B cells or T cells. Most children have B cell NHL.
Other less common types of B cell lymphoma include:
diffuse large B cell lymphoma (DLBCL)
primary mediastinal B cell lymphoma
Rare types include:
paediatric type follicular lymphoma
marginal zone lymphoma
Lymphoblastic lymphomas are lymphomas that come from very young (immature) lymphocytes. The most common is T cell lymphoblastic lymphoma. B cell lymphoblastic lymphoma is rare.
Peripheral T cell lymphomas (PTCL) are lymphomas that come from developed (mature) T cell lymphocytes. The most common is anaplastic large cell lymphoma (ALCL). Other PTCL’s are very rare.
Each type of lymphoma has its own treatment.
The stages of childhood NHL tell your child’s doctor about the number and places in the body that have lymphoma. This helps your child’s doctor plan the best treatment possible.
There are different staging systems for different types of NHL, and these can change slightly over time. Your child's doctor will follow the latest guidelines at the time your child gets their diagnosis.
While adults with NHL mainly have disease in their lymph nodes, children often have lymphoma in their:
chest
abdomen
head and neck area
NHL that is outside of the lymph node is called .
There are 4 stages to childhood NHL. Stage 1 is an early stage and stage 4 is advanced stage.
In general the stages of NHL depend on:
where the lymphoma is
what type of lymphoma it is
how many areas of lymph nodes have cancer cells in them
if other organs in the body have cancer cells in them
There are successful treatments for all stages of NHL. Around 90 out of 100 children (around 90%) with non-Hodgkin lymphoma in the UK survive for 5 years or more after they are diagnosed.
Your child’s doctor will talk with you about the treatment plan. Treatment depends on many factors including:
the stage
the type of lymphoma
your child’s age
how well your child is at diagnosis
is the main treatment for children with NHL. Children usually have a combination of chemotherapy drugs and .
Some children with B cell lymphoma have treatment with a called rituximab. Rituximab targets a protein called CD20 on the surface of the lymphoma cells. Rituximab sticks to all the CD20 proteins it finds. Then the cells of the pick out the marked cells and kills them.
Some children might have radiotherapy, but this is very rare. Radiotherapy is not part of for any type of NHL in children.
Your child usually has more chemotherapy. These may be with some of the same drugs as before or new ones.
Some children have high dose chemotherapy treatment, followed by a .
Other treatments you doctor might recommend include one or more of the following:
treatment as part of a
Treatment for NHL can have short and long term side effects. Your child’s doctors are unable to predict which side effects your child is likely to have. Everyone reacts differently to cancer treatment.
Chemotherapy damages dividing cells. Cancer cells divide much more often than most normal cells. So, chemotherapy damages cancer cells and can destroy them. Some normal cells divide very often too. This happens in tissues that need a steady supply of new cells, such as the skin, hair and nails.
Chemotherapy can also damage these cells, and this causes side effects. But the damaged normal tissues can generally repair themselves and recover.
Short term side effects of chemotherapy include:
a drop in leading to an increased risk of infection
breathlessness and looking pale from a drop in
a drop in the number of that help clot your blood, leading to bruising or bleeding
feeling or being sick
a sore mouth
constipation or diarrhoea
If your child is having other treatment they might have side effects specific to that treatment.
The doctors and nurses that look after your child can help manage any side effects they might get. It's important to let the team know as soon as you think your child is not quite right.
There are different treatments such as medicines and that can help. Your specialist team will be able to discuss with you any that maybe helpful.
Most treatment side effects are temporary and disappear once treatment is over.
But for some people treatment can cause long term changes in the body. Some of these changes may happen months or many years after the treatment has finished.
Late side effects can include:
early
problems
heart or lung problems
hormonal changes
getting another cancer
Your doctor and specialist nurse can talk to you about the risk of late side effects for your child.
Doctors are looking at ways to lower the number of late effects that children have from their treatment. A lot of current research focuses on treating childhood cancer successfully, while reducing the side effects.
Children have follow up appointments for many years after cancer treatment. These appointments are to check:
how they are recovering
their development
if they are having any problems following treatment
if there are any signs of the lymphoma coming back
Long term follow up clinics are available for those once the risk of the cancer returning is considered very low. For NHL this is for those who are 3 years or more from the end of their cancer treatment. Your child usually sees a doctor or specialist nurse. Alongside their general health check, your child might have discussions around:
emotional and mental wellbeing
employment
fertility
second cancers
The long term follow up service can make referrals to other professionals when needed.
Some children have their NHL treatment as part of a clinical trial. Researchers in the UK and around the world are always looking for new treatments to help children whose cancer doesn’t go away or has come back.
Talk to your child’s doctor or clinical nurse specialist to find out more about clinical trials. You can also search for a clinical trial on our clinical trials database.
Find out more about clinical trials for NHL
It is understandably devastating when a child is diagnosed with cancer. Although many children with cancer are successfully treated, it is a difficult time for everyone affected.
As well as the doctors and nurses on the ward, you and your child will be supported by a number of professionals during and after treatment. These include your GP, cancer nurse specialists, social workers, play specialists and a psychologist or psychotherapist.
We have detailed information about what to expect when your child is first diagnosed with cancer. And ideas about supporting their siblings.
My child has just been diagnosed with cancer
Supporting brothers or sisters
Talking to other people who are experiencing the same thing can also help. We have a discussion forum called Cancer Chat. It is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.
There are children's organisations that you can contact for help and support.
Lymphoma Action are a good source of advice and support for people affected by lymphoma. They have information especially for parents and for young people.
Visit the Lymphoma Action website
The Children and Young People's Cancer Association provide information on all aspects of childhood cancer. They have information and videos on childhood NHL.
Find out more on the CCLG website
Young Lives vs Cancer offer help and support for parents who have a child recently diagnosed or living with childhood cancer. They can also help you access financial support.
Go to the Young Lives vs Cancer website
This programme is run by a team of doctors, researchers and tissue bank specialists from the University of Oxford and the Oxford University Hospitals NHS Foundation Trust.
It aims to help children and young people at risk of infertility due to illness or treatment.
Last reviewed: 21 Mar 2025
Next review due: 21 Mar 2028
Get information about the possible symptoms of cancer and when to see a cancer specialist.
Find out about what to expect when your child is first diagnosed.
Find out where to get help and support for you, your child, your family and friends.
We have more detailed information on some of the more common types of children's cancer.
About Cancer generously supported by Dangoor Education since 2010. Learn more about Dangoor Education
Search our clinical trials database for all cancer trials and studies recruiting in the UK.
Meet and chat to other cancer people affected by cancer.
Questions about cancer? Call freephone 0808 800 40 40 from 9 to 5 - Monday to Friday. Alternatively, you can email us.
