Treatment may depend on whether the cancer is in category A or B and where tumors occur.
Stage IA: If cancer is found above the diaphragm and not in a large part of the chest, treatment may be mantle radiation only or mantle radiation and radiation to the upper abdominal lymph nodes. Chemotherapy and possibly radiation therapy to areas containing cancer is another possible choice. A clinical trial of low-dose new chemotherapy drugs with or without radiation is an option at this stage.
If tumors are found above the diaphragm and in a large part of the chest, treatment may include chemotherapy followed by mantle or chest radiation. Another possibility is mantle radiation and radiation to the upper abdominal lymph nodes and the spleen. A clinical trial involving new chemotherapy drugs plus low-dose radiation is another option at this point.
Stage IB: The same as IA, except radiation may also be given to the spleen when cancer is found above the diaphragm and not in a large part of the chest.
Stage IIA: If cancer is found above the diaphragm and not in a large part of the chest, treatment may include mantle radiation and radiation to the spleen and abdominal lymph nodes. Chemotherapy plus radiation to areas containing tumors is another option. Patients may want to participate in a clinical trial of new low-dose chemotherapy, possibly with radiation therapy.
If tumors are found above the diaphragm and in a large part of the chest, treatment may include chemotherapy and mantle or chest radiation. Mantle radiation and radiation to the spleen and the upper abdominal lymph nodes is another option. The patient may want to consider a clinical trial of new chemotherapy drugs and low-dose radiation.
Stage IIB: Therapy is the same as in Stage IIA.
Stage IIIA: Chemotherapy or a combination of chemotherapy and radiation to areas containing many tumors are options. Patients may want to participate in a clinical trial of new chemotherapy drugs and possibly irradiation of all the lymph nodes in the body.
Stage IIIB: Treatment may include only chemotherapy or a combination of chemotherapy and radiation to areas containing many tumors. Treatment in a clinical trial is an option.
Stage IV: Chemotherapy or a combination of chemotherapy and radiation to areas containing numerous tumors are options. A clinical trial of chemotherapy and possibly irradiation of all lymph nodes in the body is another option.
Recurrent: Treatment depends on where the disease recurs and the form of therapy initially received. For example, if radiation was the original treatment, then the child may undergo chemotherapy. If chemotherapy was given initially, the child may receive another round of chemotherapy, possibly with new drugs. An autologous bone marrow transplant may be an option at this stage.
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