Hodgkin's Lymphoma Treatment

  • Treatment

    If you have Hodgkin's disease and have been prescribed chemotherapy, you may need to be hospitalized for treatment. Although chemotherapy is often given in a doctor’s office or clinic, sometimes patients are hospitalized for a short time to receive treatment.

    Swollen lymph nodes in the thymus gland, which is located in the neck, may produce life-threatening symptoms. Swollen lymph nodes in the thymus can block bloodflow inside the chest or airflow through the trachea. Blocked blood vessels cause the head and arms to swell, which can cause brain damage. Blockage of the trachea may cause shortness or breath, coughing, or suffocation. If you start to experience any of these symptoms, seek immediate medical attention.

    If you are undergoing chemotherapy, take steps to avoid infection: wash your hands thoroughly, avoid uncooked fruit or other germ-carrying foods, and avoid contact with children or other individuals suspected of having an infection. Patients receiving anticancer drugs are more likely to get an infection because such drugs weaken the immune system. Children are more likely than adults to get infections; however, taking precautions to avoid exposure to germs minimizes the risk.

    Update your vaccinations at least one week before being treated for Hodgkin's disease. Patients should make sure that their immunizations for the flu, pneumonia, and meningitis are current. This applies to patients who have and have not had their spleens removed. In some cases, doctors may recommend re-vaccinating two years after the end of treatment, and every six years thereafter with the pneumonia vaccine.

    Eat a healthy diet. Patients undergoing anticancer treatment need to make every effort to get enough calories and protein in their diet to help them regain strength, increase energy, and prevent weight loss.

    Your doctor is the best source of information on the drug treatment choices available to you.

    If you have stage I or II Hodgkin's disease, you may be treated with radiation therapy. [Table 2] Radiation therapy involves exposing cancer-infected areas to high-energy radiation, usually focusing on the neck, chest, armpit, and abdomen, where the radiation kills the cancer cells in those localized areas. Radiation alone is the treatment of choice for early-stage disease. Radiation treatment is usually given for three to four weeks, and, depending on the stage, is often combined with chemotherapy to treat Hodgkin's disease. This treatment can also be used to ease the symptoms associated with lymphoma in the internal organs, such as the brain and the spinal cord. Radiation treatment is provided by a hospital or clinic on an outpatient basis.

    If you are currently taking anticancer drugs or undergoing radiation therapy and your blood cell counts are low, you may need a blood transfusion.

    Platelet transfusions protect against bleeding; red cell transfusions are used to treat the fatigue associated with radiation-induced anemia.

    If you have Hodgkin's disease that relapses after treatment, your doctor may recommend a combination of chemotherapy and radiation therapy, or hospitalization for bone marrow or blood cell transplantation. [Table 1] [Table 2] Patients who relapse and are still sensitive to anticancer drugs usually receive bone marrow transplantation. Bone marrow can be retrieved either from the patient or from a relative whose basic cell type is identical. The goal of transplantation is to replace the blood-forming cells that have been destroyed by cancer treatment. Therefore, transplantation is done after chemotherapy. This helps the patient to produce healthy blood cells that are needed to fight infection.

    Bone marrow is obtained by placing a long needle in the hip and withdrawing the marrow. Marrow can also be obtained during a process called apheresis or leukopheresis. The procedure involves taking blood from one vein, filtering certain cells out through a machine, and then returning the blood to the body via another vein. This process usually takes three to four hours. The cells obtained may be purged of any unwanted cells, and the sample is then frozen. The cells are thawed and used when the patient is ready for transplantation.

    Patients who have transplants generally stay in the hospital for several weeks to be monitored for infection, because the procedure temporarily weakens the immune system. Patients can be discharged when their blood cell count is sufficient.

    Joining a support group may help you cope with Hodgkin's disease. Because support from friends and family may not be enough, some patients benefit from discussing their concerns with other cancer patients.

    A laparotomy and a splenectomy may be performed by a surgeon to remove the cancer cells and the spleen, respectively. Splenectomy (removal of the spleen) may be performed during the course of a staging laparotomy in Hodgkin’s disease. Staging is important to identify those whose cancer is widespread and therefore beyond management with irradiation alone. Splenectomy is currently less commonly performed because non-invasive studies (CT/MRI) permit staging in most patients. Splenectomy should only be performed if its results will alter the therapy in Hodgkin’s disease.

    Some patients may want to try alternative therapies in addition to standard cancer treatment to relieve pain, reduce side effects, and enhance emotional, physical, and spiritual well-being. Always consult your doctor before starting any alternative therapy to make sure it will not be harmful to you.

    If you are pregnant, discuss treatment options for Hodgkin’s disease with your doctor. Data are scarce regarding the long-term effects of anticancer drugs on the fetus. Some patients choose to deliver early, when possible, to avoid exposing the fetus to radiation and anticancer drugs.

    Hodgkin's disease is highly curable. Treatment of HD is one the great cancer success stories. Cure rates for patients who are treated for stage I and II disease are reported in excess of 90%. Patients who are treated for stages III and IV disease also have a high survival rate five years after treatment. Seventy to eighty percent of people with stage I or II Hodgkin's survive for a minimum of 10 years. With more aggressive disease, the 5-year survival rate is 20% to 50%.

    The prognosis for patients diagnosed with Hodgkin's disease depends on the stage of the cancer, the response to treatment, and the age and general health of the patient.

    Patients who relapse more than a year after initial treatment have long-term survival rates of 22% to 54% when retreated with chemotherapy. Even though HD recurs in 20% to 35% of patients on average, it is still considered to be potentially curable. People who relapse in less than a year after initial treatment have a reduced chance of living long-term.

    Schedule a visit with your physician every three months for one year after treatment. Regular follow-up visits are necessary to discuss changes in your health. During your appointment, the doctor will take a general medical history and conduct a physical examination, paying careful attention to the size and firmness of your lymph nodes. Repeat CT/MRI studies will be obtained at regular intervals.

    Report any new symptoms to your doctor immediately. New symptoms may be caused by side effects of treatment or recurrent cancer. People who have been treated for Hodgkin's disease have an increased risk of developing leukemia, non-Hodgkin's lymphoma, and cancers of the lung, colon, bone, thyroid, and breast.

    Contact your physician if your symptoms do not resolve after treatment.

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I'm Shereen A. Gharbia, PharmD. Welcome to PDR Health!

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