Childhood Hodgkin Lymphoma

Because of new and better therapies, cancer survival rates for children have improved dramatically during the last several decades. Scientists continue to search for the causes of childhood lymphoma so they can develop better treatments with less toxic side effects.

A child's cancer diagnosis can bring with it feelings of uncertainty for parents and other family members. Suddenly, you're thrust into a fast-paced world of change, worry, fear and concern. You'll need to make treatment decisions while taking the time to comfort your child - and at the same time trying to cope with your own emotions.

Your child's treatment depends on certain factors:
• The stage of the disease
• The subtype of the disease
• Fertility concerns
• The response to treatment-doctors measure the response rate by using imaging techniques such as PET-CT scans

Other potential risk factors
Your child's hematologist-oncologist (cancer specialist) should develop a treatment plan that limits the amount of therapy needed to bring about a remission. Be sure to ask the hematologist-oncologist about potential side effects and long-term effects when considering treatment options.

Children and young adults with HL are usually treated with one or more of the following approaches:
• Chemotherapy
• Radiation therapy
• Targeted therapy (monoclonal antibodies)
• Surgery (if a mass can be completely removed)
• High-dose chemotherapy with stem cell transplant

Chemotherapy Drug Combinations
Children and young adults with Hodgkin lymphoma are usually treated with combination chemotherapy and involved field radiation therapy.

Common chemotherapy drug combinations used to treat children and young adults include:
• ABVD: doxorubicin (Adriamycin®), bleomycin (Blenoxane®), vinblastine (Velban®), dacarbazine (DTIC-Dome®)
• AV-PC: doxorubicin (Adriamycin®), vincristine (Oncovin®), prednisone and cyclophosphamide (Cytoxan®)
• ABVE: doxorubicin (Adriamycin®), bleomycin (Blenoxane®), vincristine (Oncovin®), and etoposide (Etopophos®, Toposar®, VePesid®, VP-16)
• ABVE-PC: doxorubicin (Adriamycin®), bleomycin (Blenoxane®), vincristine (Oncovin®), etoposide (Etopophos®, Toposar®, VePesid®, VP-16), prednisone and cyclophosphamide (Cytoxan®)
• BEACOPP: bleomycin (Blenoxane®), etoposide (Etopophos®, Toposar®, VePesid®, VP-16), doxorubicin (Adriamycin®), cyclophosphamide (Cytoxan®), vincristine (Oncovin®), procarbazine (Matulane®) and prednisone
• OEPA: vincristine (Oncovin®), etoposide (Etopophos®, Toposar®, VePesid®, VP-16), prednisone, and doxorubicin (Adriamycin®)

Clinical Trials
A clinical trial may be an option when it comes to finding the right treatment for your child's cancer. Your child may have access to new or improved therapies under study and not yet on the market. Discuss with your child's doctor the possibility of taking part in a clinical trial, where treatment is administered in a safe, closely monitored environment.

Advances in treating childhood Hodgkin lymphoma, which have improved the cure rate and quality of life for survivors, are due, in large part, to the research of pediatric cooperative groups. The focus of ongoing research and clinical trials is to

Further improve the cure rate, especially for children with advanced HL
Minimize the risk of long-term and late effects associated with treatment (for example, infertility, impaired cardiac function and secondary cancers).

Survivorship and Special Healthcare Needs
After treatment, most children can expect to have full and productive lives. Many survivors return to school, attend college, enter the workforce, marry and become parents.

You may want to consider a survivorship program for your child that focuses on life after cancer. Many comprehensive cancer centers around the country offer these programs.

Follow-Up Care
Your child should visit his or her pediatrician or doctor at least once a year for a complete physical exam and any additional needed tests. Your child's oncologist should also regularly examine your child.

Regular doctor visits are encouraged to:
• Enable doctors to assess the full effect of therapy
• Detect and treat disease recurrence
• Identify and manage long-term and late effects of treatment

Your pediatrician should recommend a schedule for having your child's learning skills assessed. If your child appears to be experiencing learning disabilities, special education methods can help.

Coordination between your child's pediatrician and oncologist is important for the best care possible. Some treatment centers offer comprehensive follow-up care clinics for childhood cancer survivors. To find one near you, visit The Pediatric Oncology Resource Center.

Long-Term and Late Effects of Treatment
Some side effects of cancer treatment, such as fatigue, can linger for months or years after therapy. Some medical conditions like heart disease and other cancers may not appear until years after treatment ends. Long-term and late effects can affect your child's physical, mental and cognitive (brain function) health.

Most childhood survivors of lymphoma don't develop significant long-term or late effects of treatment. However, for some patients the effects can be severe.

Long-Term and Late Effects of Chemotherapy
Children treated for lymphoma may be at increased risk for:
• Fatigue
• Growth delays
• Thyroid dysfunction
• Hearing loss
• A secondary cancer

Some long-term and late effects become evident with maturation (puberty), growth and the normal aging process. Early intervention and healthy lifestyle practices (not smoking, good nutrition, exercise, regular screenings and follow-up) may have a positive effect on the occurrence and/or severity of long-term and late effects.

Long-Term and Late Effects of Radiation Therapy
Girls (as well as women under age 30) who had radiation to the breast area are at risk for developing breast cancer 15 to 20 years after treatment. Male survivors of childhood cancer are at risk for developing secondary cancers, but they don't have as high a risk for developing breast cancer as female childhood cancer survivors do.

Girls who had radiation therapy in the chest (mediastinal) area should:
• Perform monthly breast self-examinations
• Have yearly breast examinations by a healthcare professional
• Have early baseline mammograms within 8 to 10 years after therapy or by age 40, whichever occurs earlier.
• Have breast MRIs in addition to mammography for women who received irradiation of the chest when they were between 10 and 30 years of age.

Both girls and boys who've undergone mediastinal radiation therapy should have baseline testing for heart function. This should be followed by testing every three to five years after treatment or more regularly if any abnormalities are found.

Returning to School
Learning disabilities can begin during treatment or appear months or years after treatment. Educate family members, friends, school personnel and healthcare providers about your child's possible long-term and late effects of treatment. Talk with teachers about your child's needs before he or she returns to school. Work with your child's teachers and medical providers to develop a program tailored to his or her needs that features baseline testing, special accommodations and long-term planning.

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