Hodgkin lymphoma is a cancer that starts in white blood cells called lymphocytes.
The main treatments are chemotherapy and radiation, either alone or in combination. Immunotherapy and stem cell transplant may also be options, particularly if other treatments aren’t working or you’re dealing with a recurrence.
There’s no single treatment plan that’s right for everybody. Each type of therapy has potential benefits and risks, and the right course depends on your individual circumstances.
Continue reading to learn more about the factors that will guide treatment for Hodgkin lymphoma.
Type of Hodgkin lymphoma
Each type of Hodgkin lymphoma has its own typical pattern of behavior. What works best for one type may not be the best choice to treat another.
Classic Hodgkin lymphoma makes up about 95 percent of Hodgkin lymphomas. It involves cancer cells called Reed-Sternberg cells. There are four subtypes of classic Hodgkin lymphoma:
- Nodular sclerosis Hodgkin lymphoma can occur at any age but is most common in adolescents and young adults. It typically starts in lymph nodes of the neck or chest. This type represents about 60 to 80 percent of Hodgkin lymphomas, and the majority of people who have it can be cured.
- Mixed cellularity Hodgkin lymphoma tends to be diagnosed in an advanced stage, usually in older adults. It’s normally found in the upper part of the body.
- Lymphocyte-rich Hodgkin lymphoma is usually found in the upper half of the body in only a few lymph nodes. This type is often diagnosed at an early stage in adults. The relapse rate is low.
- Lymphocyte-depleted Hodgkin lymphoma tends to be diagnosed in older adults. It’s found in the lymph nodes of the abdomen, liver, spleen, and bone marrow, usually in an advanced stage.
Nodular lymphocyte predominant Hodgkin lymphoma is another type of Hodgkin lymphoma. It involves large cancer cells called popcorn cells. This type begins in the lymph nodes under the arm or in the neck, and isn’t very aggressive.
Stage and location of the cancer
Knowing how far the cancer has spread and what areas of the body are affected helps your doctor offer a general outlook and choose the best treatments. Generally speaking, earlier stage cancer is easier to treat than later stage cancer.
Hodgkin lymphoma is staged as follows:
- Stage 1: Cancer is discovered in only one lymph node region or one organ.
- Stage 2: Cancer is found in two lymph node regions, or one organ and nearby lymph nodes. Also, the cancer is confined to one part of the body — either above or below the diaphragm.
- Stage 3: Cancer has spread to lymph nodes above and below the diaphragm. It might also be found in the spleen, tissue, or an organ near lymph node groups.
- Stage 4: In addition to lymph nodes, cancer is found in other tissue or organs such as the bones, liver, or lungs.
When cancer returns after you’ve received treatment, it’s called recurrent Hodgkin lymphoma. Treatment may involve combination chemotherapy and radiation therapy, which can be used to fight the cancer and to relieve symptoms and improve quality of life. Another option is a combination high-dose chemotherapy followed by a stem cell transplant (bone marrow transplant). Your doctor may also be able to refer you to a clinical trial.
Potential side effects of treatment
Treatments come with both short- and long-term side effects, some of which can be managed. All of this must be factored in when making your treatment decisions.
For example, chemotherapy is usually given in cycles over a number of weeks or months. You may be given one drug or a combination of drugs, or the regimen and doses may vary. Side effects of chemotherapy vary, but can initially include:
- nausea and vomiting
- hair loss
- finger and toenail damage
- risk of infection
- loss of appetite and weight loss
- changes in sexual functioning
Long-term risks of chemotherapy include infertility and secondary cancers. You’ll also need to have various blood and imaging tests along the way to see if chemotherapy is working.
Radiation therapy involves a specific number of treatments over the course of several weeks. You’ll have to stick to a fairly strict schedule. Short-term side effects can include fatigue and skin irritation. Radiation to the neck area can cause sore throat and mouth. Long-term side effects can include secondary cancers and damage to organs that are in range of the radiation.
A stem cell transplant requires you to have high-dose chemotherapy and radiation first. The procedure can increase your risk of infection.
Age, health, and other considerations
When deciding on treatment, you and your doctor may need to factor in your age. People over age 50 may require more intensive treatment.
Your general state of health also has a lot to do with how well you can withstand certain treatments. Other serious medical issues, such as heart disease or unmanaged diabetes, for example, might be a factor in your treatment decisions.
Symptoms such as excessive sweating, fevers, and weight loss may also affect your treatment.
If you’re pregnant, chemotherapy and radiation therapy can be harmful to your fetus. Your doctor may suggest “watchful waiting,” which means holding off on treatment, but monitoring you closely for changes. As the baby nears full term, labor can be induced so you can start treatment.
Be sure to tell your oncologist about all your medical conditions.
All these things, plus your personal preferences, should be considered when choosing treatment. That’s why it’s important to ask questions, express your concerns, and make your wishes known.
Together with your cancer care team, you’ll assess all your options and decide on the best course of treatment. Whatever treatment you ultimately choose, your doctor will monitor your progress and recommend changes as necessary.