Treating Hodgkin lymphoma

Hodgkin lymphoma can usually be treated successfully with chemotherapy alone, or chemotherapy followed by radiotherapy.

Your treatment plan

Your specific treatment plan will depend on your general health and your age, asmany of the treatments can put a tremendous strain on the body. How far the cancer has spread is also an important factor in determining the best treatment.

Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. This is known as a multidisciplinary team (MDT).

Your MDT will recommend the best treatment optionsfor you. However, you shouldn't be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner.

Treatment options

The main treatments for Hodgkin lymphoma are chemotherapy alone, or chemotherapy followed by radiotherapy. In a few cases, chemotherapy may be combined with steroid medication.

Surgery isn't generally usedto treat the condition, except for the Biopsy used to diagnose it.

Overall, treatment for Hodgkin lymphoma is highly effective and most people with the condition are eventually cured.

The main treatments you may have are described in more detail below.

Chemotherapy

Chemotherapy is a type of cancer treatment where medicine is used to kill cancer cells. This medication can be given in a number of different ways, depending onthe stage of your cancer.

If doctors think your cancer is curable, you'll normally receive chemotherapy through a drip directly into a vein (intravenous chemotherapy).If a cure is unlikely, you may only need to take chemotherapy tablets to help relieve your symptoms.

Chemotherapy is usually given over a period of a few months on an outpatient basis, which means you shouldn't have to stay in hospital overnight. However, there may be times when your symptoms or the side effects of treatment become particularly troublesome and a longer hospital stay may be needed.

Chemotherapy can have several side effects, the most significant of which is potential damage to your bone marrow. This can interfere with the production of healthy blood cells and cause the following problems:

• fatigue
• breathlessness
• increased vulnerability to infection
• bleeding and bruising more easily

If you experience these problems, treatment may need to be delayed so you can produce more healthy blood cells. Growth factor medicines can also stimulate the production of blood cells.

Other possible side effects of chemotherapy include:

• nausea and vomiting
• diarrhoea
• loss of appetite
• mouth ulcers
• tiredness
• skin rashes
• hair loss
• infertility , which may be temporary or permanent (see complications of Hodgkin lymphoma for more information)

Mostside effects should pass once your treatment has finished.Tell your care team if the side effects become particularly troublesome, as there are treatmentsthat can help.

You'llneed a stem cell or bone marrow transplant to replace the damaged bone marrow.

Radiotherapy

Radiotherapy is most often used to treat early-stage Hodgkin lymphoma, where the cancer is only in one part of the body.

Treatment is normally given in shortdaily sessions, Monday to Friday, over several weeks. You shouldn't have to stay in hospital between appointments.

Radiotherapy itself is painless, but it can have some significant side effects. These can vary and will be directly related to thepart of your body being treated. For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss.

Other common side effectsinclude:

• tiredness
• nausea and vomiting
• dry mouth
• loss of appetite

Most side effects are temporary,but there's a risk of long-term problems, including infertility and permanently darkened skin in the treatment area.

Common side effects of steroid medication include:

• increased appetite, which can lead to weight gain
• indigestion
• problems sleeping
• feeling agitated

The side effects of steroid medication usually start to improve once treatment finishes.

Rituximab

If you're diagnosed with a rare type of Hodgkin lymphoma called lymphocyte-predominant Hodgkin lymphoma, you may have chemotherapy in combination with a medication called rituximab.

Rituximab is a type ofbiological therapycalled a monoclonal antibody. Itattaches itself to the surface of cancerous cells and stimulates the immune system to attack and kill the cell.

It's given through a drip directly into a vein over the course of a few hours.

Side effects of the drug can include:

• flu -like symptoms, such as headaches , feverand muscle pain
• tiredness
• nausea
• diarrhoea

You may be given additional medication to prevent or reduce side effects. Any side effects should improve over time as your body gets used to the medication.

Follow-up

After your course of treatment ends, you'll need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning.

These appointments start off being every few weeks or months, but will become gradually less frequent over time.

Want to know more?

For more information, see:

• Cancer Research UK:treating Hodgkin lymphoma
• Cancer Research UK:living with Hodgkin lymphoma
• Macmillan: treating Hodgkin lymphoma
• Macmillan: living with Hodgkin lymphoma