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After Treatment for Lymphoma in Children
During treatment for childhood lymphoma, most families are focused on getting through treatment and beating the cancer. After treatment, the focus tends to shift toward the long-term effects of the lymphoma and its treatment, as well as the possibility of the cancer coming back.
It's normal to want to put lymphoma and its treatment behind you and to get back to a life that doesn’t revolve around cancer. Getting the right follow-up care offers your child the best chance for recovery and long-term survival.
Follow-up care after childhood lymphoma
After lymphoma treatment, it's very important for your child to go to regular follow-up exams with their cancer care team.
What to expect during follow-up visits
During these visits, the cancer care team will watch for short-term and long-term side effects of treatment and for any possible signs of lymphoma coming back (recurring).
How often your child follows up will depend on their type of lymphoma, what treatment they got, and other factors. These visits will be frequent at first, but the time between visits may get longer as time goes on.
For the most common types of lymphoma in children, the risk of recurrence goes down over time. If lymphoma comes back, it most often happens while a child or teen is still being treated or within a year or two of finishing treatment.
Exams and tests
Follow-up visits after treatment often include careful physical exams and lab tests. Your child might also get imaging tests such as CT, MRI, or PET scans.
Watching for late or long-term side effects
A benefit of follow-up care is that it gives you a chance to discuss questions and concerns that come up during and after your child’s recovery.
For example, almost any cancer treatment can have side effects. Some might last for only a short time, but others can last longer or might not show up until months or even years later. It's important to report any new symptoms to your child’s cancer care team right away so they can find the cause and treat it, if needed.
Creating a survivorship care plan
Talk with your child’s cancer care team about creating a survivorship care plan. This plan might include:
- A summary of their diagnosis, tests done, and treatment given
- A suggested schedule for follow-up exams and tests
- A schedule for other tests your child might need in the future, such as an echocardiogram to monitor their heart or tests to look for other long-term health effects
- A list of possible late or long-term side effects, including what to watch for and when to contact the cancer care team
- Diet and physical activity suggestions
Questions to ask the care team
- What type of follow-up will my child need after treatment?
- What side effects should we watch for?
- How will we know if the lymphoma comes back? What should we watch for?
- What will our options be if the cancer comes back?
Keeping health insurance and copies of medical records
Even after your child finishes treatment, it’s important to keep good records of their diagnosis and care.
Eventually, your child will grow up, be on their own, and have new doctors. They need to be able to give this new health care team the details of their cancer diagnosis and treatment. Gathering these details soon after treatment may be easier than trying to get them at some point in the future.
Ask your child’s cancer care team where and how to get this information. Learn more in Managing Your Medical Records.
It is also very important to keep health insurance coverage. It can help cover the cost of follow-up visits, tests, and any care your child may need in the future. No one wants to think about cancer coming back, but it’s best to be prepared.
Late and long-term effects of treatment
Because of major advances in treatment, most children treated for lymphoma will live long lives. Watching for late effects of treatment as children age is a vital part of their long-term health care.
The earlier any problems are recognized, the more likely it is they can be treated effectively.
Childhood lymphoma survivors are at risk for several possible late and long-term effects. Your child’s risk will depend on the type of lymphoma they had, the treatment they received, the doses of that treatment, and other factors.
It’s important to discuss these risks with your child’s cancer care team so you know what to watch for.
Children who were treated for lymphoma are often at higher risk of developing other cancers later in life. Of course, the risk of getting these second cancers must be balanced against the benefit of treating a life-threatening disease such as lymphoma.
Chemo drugs
Some chemo drugs carry a small risk of causing AML, a type of leukemia. This occurs in a small percentage of people after getting certain drugs:
- Epipodophyllotoxins (etoposide)
- Alkylating agents (cyclophosphamide)
- Anthracyclines (daunorubicin, doxorubicin)
Radiation therapy
Children who receive radiation are also at a higher risk of developing a second cancer.
The type of cancer depends on where the radiation was given. For example, girls who are treated with chest radiation are at a higher risk of getting breast cancer at younger ages, and anyone treated with abdominal (belly) radiation is at higher risk of colon cancer.
Talk to your child’s doctor about how to watch for signs of cancer and catch it early.
Certain treatments can cause heart problems later in life:
- Anthracycline chemo drugs (daunorubicin, doxorubicin)
- Radiation affecting the heart muscle
Some childhood lymphoma survivors will need echocardiograms to look at the strength of their heart muscle so any problems can be caught and treated early.
Children who receive radiation to the chest and neck can also have a higher risk of heart attacks or heart valve problems as they get older. Watching for other heart disease risk factors like high blood pressure, diabetes, and high cholesterol and treating them early may lower this risk.
Treatments that could cause lung problems include:
- Radiation to the lungs
- Treatment with the chemotherapy drug bleomycin
Doctors will watch for any breathing symptoms and may recommend testing called PFTs (pulmonary function tests) to check how well your child’s lungs work after treatment.
It’s important for your child to take care of their lungs as they age. Exercising regularly, avoiding smoking, and getting vaccines against influenza and pneumococcus can help keep the lungs healthy.
Some treatments may affect sexual development and the ability to have children later in life:
- Alkylating chemo drugs (cyclophosphamide)
- Stem cell transplant
- Radiation
Talk to your child’s cancer care team about the risks of infertility with treatment. Ask about options for preserving fertility, such as sperm banking or egg freezing. For more information, see Preserving Fertility in Children and Teens With Cancer.
Certain treatments can also impact sexual desire or pleasure by lowering sex hormones such as estrogen and testosterone. Low sex hormones can also impact bone health, energy, and the brain’s ability to create new memories or complete a task.
Some cancer treatments may affect a child’s growth, so they might end up a bit shorter as adults. This is especially true after radiation or stem cell transplants.
Treatment might also affect a child’s overall health and the levels of other hormones in their body, which can increase the risk of health issues such as thyroid problems, obesity, and diabetes.
For some children, radiation therapy to the brain and certain types of chemotherapy (intrathecal chemotherapy, methotrexate, cytarabine) may affect memory and the ability to learn.
Because of this, doctors try as much as possible to limit treatments that could affect the brain. Children treated for lymphoma may need extra support in school or the workplace later in life.
Children treated with radiation around the upper chest and neck may be at an increased risk of thyroid problems. Radiation can cause your thyroid to make less thyroid hormone, resulting in hypothyroidism. If you have this condition, it can be treated with thyroid hormone replacement medicine.
Children who have been treated with radiation to the neck or upper chest should have their thyroid function checked with blood tests at least once a year.
The immunotherapy drug rituximab (Rituxan) targets any cells with the CD20 protein, including healthy B cells. This can lead to a weaker immune system and lower levels of antibodies, sometimes for months or years after treatment. If your child received this treatment, doctors may ask about illnesses and infections and monitor their immune system with lab tests.
In the past, some people with Hodgkin lymphoma got high doses of radiation to the spleen. Their immune systems may be weaker and they may need extra vaccines to stay healthy. This treatment is not common today.
Steroids used during treatment, such as prednisone and dexamethasone, can cause bone damage or osteoporosis (thinning of the bones).
Bones, muscles, and other soft tissues may not grow well after radiation. Doctors will monitor how a child’s body grows and develops, with special attention to areas treated with radiation.
After treatment with drugs like vincristine, some children develop neuropathy (damage to the nerves that control how the body moves and feels).
Symptoms of neuropathy include numbness, tingling, or tripping while walking. These often go away or get better once treatment ends, but symptoms may be lifelong for some children.
Your child may have other complications from treatment as well. Their cancer care team should carefully go over any possible problems with you before treatment starts.
Social and emotional health after cancer
After a child finishes treatment, a number of emotional concerns can come up.
Some of these might last a long time and can include:
- Dealing with physical changes that happened because of treatment
- Worrying about the lymphoma returning or new health problems developing
- Being treated differently or discriminated against by friends, classmates, coworkers, employers, and others
Some children might also feel:
- Resentful for having had lymphoma
- Resentful for going through treatment when others didn’t have to
- Guilty for surviving cancer when other friends with cancer did not
- Concerned about dating, marrying, and having a family later in life
It’s normal to have some anxiety or other strong emotions after treatment. But feeling overly worried, depressed, or angry can affect many aspects of a young person’s growth. This can get in the way of relationships, school, work, and other aspects of life.
With support from others including family, friends, mental health professionals, and other survivors, many children who have survived lymphoma can thrive despite the challenges they’ve faced.
Long-term follow-up guidelines
The Children’s Oncology Group (COG), the major group of doctors who treat childhood cancer in the US, has developed long-term follow-up guidelines for survivors of childhood cancers.
The guidelines were written to help increase awareness of late effects and improve follow-up care for childhood cancer survivors throughout their lives.
These guidelines are used to help create a child's survivorship care plan. They can help you understand what to watch for, what types of screening tests your child needs, and how late effects can be treated.
You can ask your child’s cancer care team about the COG survivor guidelines or download them for free at: www.survivorshipguidelines.org.
The guidelines are written for health care professionals, but patient versions of some of the guidelines are available in the Health Links section of the site.
For more about some of the possible long-term effects of treatment, see Late and Long-term Effects of Childhood Cancer Treatment.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
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Last Revised: February 27, 2026
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