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Lymphoma - Hodgkin - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Hodgkin Lymphoma. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

Hodgkin lymphoma, previously called Hodgkin’s disease, is one category of lymphoma, a cancer of the lymphatic system. Lymphoma begins when cells in the lymphatic system change and grow uncontrollably. This uncontrolled growth may form a tumor, involve many parts of the lymphatic system, or spread to other parts of the body.

About the lymphatic system

The lymphatic system is made up of thin tubes that branch out to all parts of the body. Its job is to fight infection and disease. The lymphatic system carries lymph, a colorless fluid containing lymphocytes. Lymphocytes are a type of white blood cell that make up part of the immune system and help fight germs in the body. B-lymphocytes, also called B cells, make antibodies to fight bacteria, and T-lymphocytes, also called T cells, kill viruses and foreign cells and trigger the B cells to make antibodies.

Groups of bean-shaped organs called lymph nodes are located throughout the body at different areas in the lymphatic system. The largest groups of lymph nodes are located in the abdomen, groin, pelvis, underarms, and neck. Other parts of the lymphatic system include the spleen, which makes lymphocytes and filters the blood; the thymus, an organ under the breastbone; and the tonsils, which are located in the throat.

Hodgkin lymphoma most commonly affects lymph nodes in the neck or the area between the lungs and behind the breastbone. It can also begin in groups of lymph nodes under an arm, in the groin, or in the abdomen or pelvis.

If Hodgkin lymphoma spreads, it may spread to the spleen, liver, bone marrow, or bone. Spread to other parts of the body can also occur, but it is unusual.

This section covers Hodgkin lymphoma in adults. Learn more about childhood Hodgkin lymphoma or non-Hodgkin lymphoma in adults.

Types of Hodgkin lymphoma

There are different types of Hodgkin lymphoma. It is important to know the type, as this may affect the choice of treatment. Doctors determine the type of Hodgkin lymphoma based on how the cells collected during a biopsy (see the Diagnosis section) look under a microscope and whether the cells contain certain abnormal proteins.

The American Joint Committee on Cancer (AJCC) recognizes two major categories of Hodgkin lymphoma: classical Hodgkin lymphoma, which is divided into four subtypes based on the appearance of the cells, and nodular lymphocyte-predominant Hodgkin lymphoma.

Classical Hodgkin lymphoma (cHL). cHL is the most common type of Hodgkin lymphoma, occurring about 95% of the time. It is diagnosed when characteristic abnormal lymphocytes, known as Reed-Sternberg cells, are found. As mentioned above, cHL can be divided into four different subtypes:

  • Nodular sclerosis Hodgkin lymphoma: Nodular sclerosis Hodgkin lymphoma is the most common form of cHL, affecting up to 80% of people diagnosed with cHL. It is most common in young adults, especially women. In addition to Reed-Sternberg cells, there are bands of connective tissue in the lymph node. This type of lymphoma often involves the lymph nodes in the mediastinum (chest).
  • Lymphocyte-rich classical Hodgkin lymphoma: About 6% of people with cHL have this subtype. It is more common in men and usually involves areas other than the mediastinum. The tissue contains many normal lymphocytes, in addition to Reed-Sternberg cells.
  • Mixed cellularity Hodgkin lymphoma: This subtype of lymphoma occurs in older adults and, commonly, in the abdomen. It carries many different cell types, including large numbers of Reed-Sternberg cells.
  • Lymphocyte-depleted Hodgkin lymphoma: Lymphocyte-depleted Hodgkin lymphoma is the least common subtype of cHL, and about 1% of people with cHL have this form. It is most common in older adults; people with the human immunodeficiency virus (HIV), the virus that causes autoimmune deficiency syndrome or AIDS; and people in non-industrialized countries. The lymph node contains almost all Reed-Sternberg cells.

There is another type of Hodgkin lymphoma that is not a part of the cHL group, called nodular lymphocyte-predominant Hodgkin lymphoma. This type is more similar at the protein and genetic level to B-cell non-Hodgkin lymphoma.

Nodular lymphocyte-predominant Hodgkin lymphoma. About 5% of people with Hodgkin lymphoma have nodular lymphocyte-predominant Hodgkin lymphoma, which is often found in the lymph nodes in the neck, groin, or armpit. It is most common in younger patients. People with this type of Hodgkin lymphoma not only have Reed-Sternberg-like cells, but a marker called “CD20” on the surface of the lymphoma cells as well. CD20 is a protein that is usually found in people diagnosed with B-cell non-Hodgkin lymphoma.

Nodular lymphocyte-predominant Hodgkin lymphoma is often treated differently than cHL. Some people with nodular lymphocyte-predominant Hodgkin lymphoma do not need treatment right away, while others may benefit from a treatment plan that includes radiation therapy or a limited amount of chemotherapy combined with radiation therapy. Patients with this type of lymphoma tend to have a very good prognosis, which means a very good chance of the treatment’s success and the patient’s recovery. However, a small number of patients with nodular lymphocyte-predominant Hodgkin lymphoma may develop a more aggressive type of non-Hodgkin lymphoma called diffuse large B-cell lymphoma through a process called “transformation.”

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Lymphoma - Hodgkin - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 9,190 people (5,070 men and 4,120 women) in the United States will be diagnosed with Hodgkin lymphoma. It is estimated that 1,180 deaths (670 men and 510 women) from this disease will occur this year. Hodgkin lymphoma affects both children and adults. It is most common in two age groups: ages 15 to 40 (particularly young adults in their 20s) and after age 55.

The one-year relative survival rate is the percentage of people who survive at least one year after the cancer is detected, excluding those who die from other diseases. The one-year relative survival rate of patients with Hodgkin lymphoma is 92%. The five-year and ten-year relative survival rates are 85% and 80%, respectively.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with Hodgkin lymphoma. Because the survival statistics are measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2014.

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Lymphoma - Hodgkin - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The exact cause of Hodgkin lymphoma is not known, but the following factors may raise a person’s risk of developing Hodgkin lymphoma:

Age. People between the ages of 15 and 40 and people older than 55 are more likely to develop Hodgkin lymphoma.

Gender. In general, men are slightly more likely to develop Hodgkin lymphoma than women, although the nodular sclerosis subtype is more common among women.
 
Family history. Brothers and sisters of people with Hodgkin lymphoma have a higher chance of developing the disease, although this increased risk is small.

Virus exposure. People who have been infected with the Epstein-Barr virus (EBV), the virus that causes infectious mononucleosis or "mono," may be at increased risk for developing some types of Hodgkin lymphoma. About 20% to 25% of people with cHL in the United States and Western Europe have had an infection with EBV. However, the role of EBV in the development of Hodgkin lymphoma is not yet clear. There are probably several other factors involved, as EBV is a very common disease, but Hodgkin lymphoma is very uncommon. People with the human immunodeficiency virus also have a higher risk of developing Hodgkin lymphoma, particularly lymphocyte-depleted Hodgkin lymphoma (see the Overview section). 

It is important to note that, although viruses may be involved in the development of Hodgkin lymphoma, there is no evidence that this type of cancer is contagious. Close contact with someone with Hodgkin lymphoma does not increase a person’s risk of developing the disease.

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Lymphoma - Hodgkin - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with Hodgkin lymphoma may experience the following symptoms or signs. Sometimes, people with Hodgkin lymphoma do not show any of these symptoms, or these symptoms may be caused by a medical condition that is not cancer. Common symptoms caused by Hodgkin lymphoma include:

  • Painless swelling of lymph nodes in the neck, underarm, or groin area that does not go away within a few weeks
  • Unexplained fever that does not go away
  • Unexplained weight loss
  • Night sweats, usually drenching
  • Pruritus, a generalized itching that may be severe
  • Fatigue
  • Pain in the lymph nodes triggered by alcohol intake

If the lymph nodes in the chest are affected, they may press on structures in the lung and cause shortness of breath, cough, or chest discomfort.

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

The doctor may also use certain symptoms to help describe the disease in a process known as staging. Each stage may be subdivided into "A" and "B" categories.

A means that a person has not experienced B symptoms, listed below.

B means that a person has experienced one or more of the following symptoms:

  • Unexplained weight loss of more than 10% of original body weight during the six months before diagnosis
  • Unexplained fever, with temperatures above 38º C (100.4º F)
  • Drenching night sweats. Most patients say that their nightclothes or the sheets on the bed are wet enough to have to change them during the night. Sometimes, heavy sweating occurs during the day.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out the extent of the disease. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

The following tests may be used to help diagnose Hodgkin lymphoma:

Medical history and physical examination. A thorough medical history and physical examination can show evidence of typical symptoms, such as night sweats, fevers, and enlarged lymph nodes or spleen.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but Hodgkin lymphoma can only be diagnosed after a biopsy of an affected piece of tissue. Most commonly, this will be a lymph node in the neck, under the arm, or in the groin. If there are no lymph nodes in these areas, a biopsy of other lymph nodes, such as those in the center of the chest, may be necessary. This type of biopsy usually requires minor surgery, although occasionally it is possible to do a biopsy using a core needle and local anesthesia (medication to block the awareness of pain) during a scan, most commonly a computed tomography (CT or CAT) scan (see below). The CT scan is used to help the doctor guide the needle to the correct location.

The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A hematopathologist is a doctor who had received additional training in blood diseases and blood cancers. It is important that this sample is large enough to allow the pathologist to make an accurate diagnosis and to tell the subtype of Hodgkin lymphoma. As described in the Overview, a biopsy of cHL usually has Reed-Sternberg cells. For people with nodular lymphocyte-predominant Hodgkin lymphoma, the Reed-Sternberg cells often look different and are given the name “LP” cells. In contrast to classic Reed-Sternberg cells, LP cancer cells have a protein on their surface called CD20. CD20 is a protein that is usually seen on B-cell non-Hodgkin lymphoma cells.  

Once Hodgkin lymphoma is diagnosed, other tests can help find out the extent of the disease, the stage, and other information to help the doctors plan treatment. These tests include the following:

Laboratory tests. Blood tests may include a complete blood count (CBC) and an analysis of the different types of white blood cells, in addition to the erythrocyte sedimentation rate (ESR or "sed rate") and liver and kidney function tests.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities, such as enlarged lymph nodes, or tumors. A CT scan can also be used to measure the size of a tumor. A special dye called a contrast medium is usually given before the scan to improve the details of the images. This dye can be injected into a patient’s vein or given as a liquid to swallow. People with a history of kidney disease or poor kidney function should not receive an IV contrast medium. A CT scan of the chest, abdomen, and pelvis can help find cancer that has spread to other parts of the body.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s vein. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. PET scans may be used to determine the stage of Hodgkin lymphoma, although they are usually done with a CT scan, known as a PET-CT scan. PET scans may also be used to see how the lymphoma is responding to treatment.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow. This is sometimes used for Hodgkin lymphoma.

Lung function tests. Also called pulmonary function tests or PFTs, lung function tests evaluate how much air the lungs can hold, how quickly air can move in and out of the lungs, and how well the lungs add oxygen and remove carbon dioxide from the blood. These tests may be done if certain types of chemotherapy that could affect the lungs will be part of a person's treatment plan.

Heart evaluation. A heart evaluation, including an echocardiogram (ECHO) or a multigated acquisition (MUGA) scan, may be used to check the functioning of the heart if certain types of chemotherapy will be included in a person's treatment plan.

Bone marrow aspiration and biopsy. These two procedures are similar and often done at the same time to examine the bone marrow. Bone marrow is the soft, spongy tissue found inside the center of bones. It has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. The sample(s) are then analyzed by a pathologist.

Hodgkin lymphoma can spread to the bone marrow, so looking at a sample of the bone marrow can be important for doctors to diagnose lymphoma and determine the stage. The sample removed during the aspiration is also used to find any chromosome changes. Current guidelines do not recommend a bone marrow examination for people with stage I or II disease (see the Stages section) because there is a lower likelihood of lymphoma in the bone marrow. It is important to talk with your doctor about whether you should have a bone marrow biopsy.

The most common site for a bone marrow aspiration and biopsy is the iliac crest of the pelvic bone, located in the lower back of the hip. This is generally a safe area of the body to perform the procedure. The skin and bone in that area are numbed with medication beforehand, and other types of anesthesia may be used.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. You will also discover what prognostic factors help doctors predict how well treatment will work. To see other pages, use the menu on the side of your screen.

Staging helps to describe where the Hodgkin lymphoma is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis. There are different stage descriptions for different types of cancer.

When staging Hodgkin lymphoma, doctors evaluate the following:

  • The number of cancerous lymph node areas
  • Whether the cancerous lymph nodes are localized, meaning they are located only in one area of the body, or generalized, meaning they are located in many areas of the body
  • Whether the cancerous lymph nodes are on one or both sides of the diaphragm, the thin muscle under the lungs and heart that separates the chest from the abdomen
  • Whether the disease has spread to the bone marrow, spleen, or extralymphatic organs (organs outside the lymphatic system; noted using an “E” below), such as the liver, lungs, or bone

The stage of lymphoma describes the extent of the spread of the tumor, using the terms stage I through IV (one through four). As explained in the Symptoms section, each stage may also be subdivided into “A” and “B” categories, based on the presence or absence of specific symptoms. 

Stage I. The cancer is found in one lymph node region.

Stage II. Either one of these conditions:

  • The cancer is in two or more lymph node regions on the same side of the diaphragm (stage II).
  • The cancer involves a single organ and its regional lymph nodes (lymph nodes located near the site of the lymphoma), with or without cancer in other lymph node regions on the same side of the diaphragm (stage IIE).

Stage III. There is cancer in lymph node areas on both sides of the diaphragm (stage III). In addition, there may be involvement of an extralymphatic organ (stage IIIE), involvement of the spleen (using the letter “S,” stage IIIS), or both (stage IIIES).

Stage IV. There is disseminated (multifocal) involvement, meaning that the lymphoma has spread throughout more than one area of the body. Common sites for disseminated disease include the liver, bone marrow, or lungs.

Recurrent. Recurrent lymphoma is lymphoma that has come back after treatment. Lymphoma may return in the area where it first started or in another part of the body. Recurrence may occur shortly after the first treatment or years later. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Prognostic factors

In addition to stage, doctors use other prognostic factors to help plan the best treatment and predict how well this treatment will work. For patients with Hodgkin lymphoma, several factors can predict whether the disease will return and which treatments will be successful. A patient may be described as having high-risk disease or low-risk disease based on how many of the following prognostic factors there are.

Factors that are considered less favorable and lead to a poorer prognosis include:

  • Having low blood albumin (a type of protein) levels, defined as less than 4 g/L
  • Having low hemoglobin (red blood cell count), defined as less than 10.5 g/dL
  • Being a male
  • Being age 45 and older
  • Having stage IV disease
  • Having a white blood cell count greater than 15,000 per cubic millimeter (mm3)
  • Having a lymphocyte count less than 600 per mm3, less than 8% of the total white blood cell count, or both

Other prognostic factors that are considered, especially for early-stage Hodgkin lymphoma, include:

  • A higher ESR (described in the Diagnosis section) is associated with a poorer prognosis.
  • People with lymphocyte-predominant Hodgkin lymphoma, nodular sclerosis Hodgkin lymphoma, and lymphocyte-rich classical Hodgkin lymphoma have a better prognosis, compared with other subtypes of Hodgkin lymphoma.
  • A large mediastinal mass, a large lymph node mass in the center of the chest that is larger than 10 centimeters (cm), is associated with a poorer prognosis. Small mediastinal masses are not associated with a poorer prognosis.
  • Having a high number of lymph node sites involved is associated with a poorer prognosis.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage and prognostic factors will help the doctor recommend a treatment plan. The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors and other health care professionals often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

The original treatments for Hodgkin lymphoma, developed in the 1960s and 1970s, were very effective. However, long-term follow-up care of people who received these treatments has shown that they are at risk for side effects later in life, including infertility (the inability to have children), heart problems (such as heart failure, leaky heart valves, and heart attacks), and secondary cancers, such as lung cancer and breast cancer (in women). These long-term problems were partly caused by the types of chemotherapy used at that time and partly caused by the use of high doses of radiation therapy delivered to large areas of the body. Learn more about the late effects of treatment for Hodgkin lymphoma.

To avoid or reduce the risk of these problems, today’s treatments for Hodgkin lymphoma involve newer types and doses of chemotherapy and the use of radiation therapy directed at smaller areas of the body. Most patients with classical Hodgkin lymphoma, even stage I or stage II, often receive some chemotherapy, followed by radiation therapy to the affected lymph node areas. For some patients with early-stage disease (stage I or II), it may be possible to have treatment with only a relatively short course of chemotherapy, with or without radiation therapy. This applies to only a few patients and should be discussed with your doctor. For stage III or stage IV disease, chemotherapy is still the primary treatment, although additional radiation therapy may be recommended, especially to areas of large lymph nodes.

Descriptions of the most common treatment options for Hodgkin lymphoma are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment, including any potential side effects. Learn more about making treatment decisions.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication, or a hematologist, a doctor who specializes in treating blood disorders.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

Many different types of chemotherapy may be used for Hodgkin lymphoma. The most commonly used combination of drugs in the United States is called ABVD. Another combination of drugs, known as BEACOPP, is now widely used in Europe and is being used more often in the United States. There are other combinations that are less commonly used and not listed here. The drugs that make up these two more common combinations of chemotherapy are listed below.

  • ABVD: Doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban, Velsar), and dacarbazine (DTIC-Dome). ABVD chemotherapy is usually given every two weeks for two to eight months.
  • BEACOPP: Bleomycin, etoposide (Toposar, VePesid), doxorubicin, cyclophosphamide (Cytoxan, Neosar), vincristine (Vincasar PFS, Oncovin), procarbazine (Matulane), and prednisone (multiple brand names). There are several different treatment schedules, but different drugs are usually given every two weeks.

The type of chemotherapy, number of cycles of chemotherapy, and the additional use of radiation therapy are based on the stage of the Hodgkin lymphoma and the type and number of prognostic factors. A final decision on the exact treatment should be carefully discussed with your doctor. 

If Hodgkin lymphoma comes back after initial (first-line) treatment with ABVD or BEACOPP, known as a recurrence, there are several second-line treatments. Many of these treatments are given in preparation for an autologous stem cell transplant (see below), but they can also be given to control the disease and its symptoms.

  • ICE: Ifosfamide (Ifex), carboplatin (Paraplatin), etoposide. ICE is usually given every two or three weeks for two to three months.
  • ESHAP or DHAP: Etoposide, methylprenisolone sodium succinate (Solu-Medrol), high dose cytarabine (Cytosar-U), cisplatin (Platinol); OR dexamethasone (multiple brand names), high dose cytarabine, cisplatin. ESHAP or DHAP regimens are given every three weeks for two to three months.
  • GVD, Gem-Ox, or GDP: Gemcitabine (Gemzar), vinorelbine (Navelbine), doxorubicin; OR gemcitabine, oxaliplatin (Eloxatin); OR gemcitabine, dexamethasone, cisplatin. Gemcitabine-based regimens are either given two weeks in a row followed by an off-week or every other week.
  • Brentuximab vedotin (Adcetris): Brentuximab vedotin is an antibody-drug conjugate, which means it delivers chemotherapy only to cells that have a special protein on the surface called CD30. Brentuximab vedotin is usually given every three weeks for up to sixteen cycles, although sometimes it is given every four weeks.

It is unclear which of these chemotherapy treatments is best for patients with Hodgkin lymphoma, and the best treatment may differ depending on the type and stage of the lymphoma. For this reason, many clinical trials are underway to compare these different chemotherapy treatments. These clinical trials are designed to find out which combination works best with the fewest short-term and long-term side effects.

During chemotherapy, your doctors will usually repeat some of the original tests, especially CT scans and PET scans. These tests are used to watch the lymphoma and see how well treatment is working.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Although the risk of long-term side effects has decreased as treatments have improved, chemotherapy still can cause long-term side effects.  People with lymphoma may also have concerns about if or how their treatment may affect their sexual function and fertility. Talk about these topics with the health care team before treatment begins. Learn more about late effects of treatment.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy for Hodgkin lymphoma is always external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Whenever possible, radiation therapy is now directed only at the affected lymph node areas to reduce the risk of damaging healthy surrounding tissues. Some newer radiation therapy techniques that may be used for some patients include involved-site radiotherapy, which focuses the radiation on the lymph nodes that contain cancer; intensity modulated radiotherapy (IMRT), which varies the strength and direction of the radiation beams so less healthy tissue is affected; and proton therapy, which uses protons rather than x-rays to treat the cancer.

Immediate side effects from radiation therapy depend on the area of the body that is being treated. These may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Patients who receive radiation to the neck may have a sore mouth and/or throat. Most side effects go away soon after treatment is finished.

Although the risk for long-term side effects had decreased with improvements in treatment, radiation therapy may still cause long-term side effects, also called late effects. To reduce the risk of long-term side effects, clinical trials are being done to find out the best doses and smallest possible area to direct the radiation therapy.

Learn more about radiation therapy.

Stem cell transplantation/bone marrow transplantation

A stem cell transplant is a medical procedure in which a patient’s bone marrow is replaced by highly specialized cells, called hematopoietic stem cells, that develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is stem cells in the blood that are typically being transplanted, not the actual bone marrow tissue.

Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the results of any previous treatment and the patient’s age and general health. It is very important to talk with a doctor at an experienced transplant center about the risks and benefits of stem cell transplantation. Stem cell transplantation is not used as a first treatment for Hodgkin lymphoma, but it may be recommended for patients who have lymphoma remaining after chemotherapy or if the lymphoma returns following treatment.

There are two types of stem cell transplantation depending on the source of the replacement blood stem cells: autologous (AUTO) and allogeneic (ALLO).

In an AUTO transplant, the patient’s own stem cells are used. The stem cells are collected from the patient when he or she is in remission from previous treatment. The stem cells are then frozen until they are needed.

In an ALLO transplant, stem cells are obtained from a donor whose tissue matches the patient’s on a genetic level. This testing is called HLA-typing. Most often, a patient’s brother or sister serves as the donor, although an unrelated person can be a donor as well.

For both types, the goal of transplantation is to destroy all of the cancer cells in the marrow, blood, and other parts of the body using high doses of chemotherapy and/or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow. The high doses of chemotherapy and/or radiation therapy given before the transplant also destroy the patient’s bone marrow tissue and suppress the patient’s immune system so that, in an ALLO transplant, the donor cells are not rejected by the body.

It is important to talk about the potential risks and benefits of both these types of transplants with the doctor in order to determine the best choice for an individual patient.

Learn more about stem cell/bone marrow transplantation.

Getting care for symptoms and side effects

Lymphoma and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the disease, an important part of care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the lymphoma and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional support, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible.

Learn more about palliative care.

Progressive Hodgkin lymphoma

Progressive disease occurs when the cancer becomes larger or spreads while the original lymphoma is being treated. However, progressive disease is uncommon for people with Hodgkin lymphoma.

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Most patients will be advised to receive a stem cell transplant (see above), which appears to be more effective at treating progressive Hodgkin lymphoma than standard chemotherapy. Supportive care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of progressive lymphoma is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group. 

Remission and the chance of recurrence

A remission is when lymphoma cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the disease will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the disease returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the lymphoma does return. Learn more about coping with the fear of recurrence.    

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

Recurrent cancer is uncommon for people with Hodgkin lymphoma. However, if Hodgkin lymphoma does recur, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options.

Most often, the first step is to give a "second-line" chemotherapy treatment, such as ICE, ESHAP, DHAP, or gemcitabine-based treatments (see Chemotherapy above). The drug brentuximab vedotin has been approved by the U.S. Food and Drug Administration (FDA) for patients with recurrent Hodgkin lymphoma, so it may also be a treatment option. The goal of chemotherapy is to regain control over the recurrent Hodgkin lymphoma. For most patients, this treatment is used to prepare for a stem cell transplant, which provides the best possible chance of curing the disease. Radiation therapy may be incorporated into the treatment plan, either before or after a stem cell transplant, especially if radiation therapy was not used during the initial treatment period. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope.

Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from lymphoma is not always possible. If treatment is not successful, the disease may be called advanced or terminal disease.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with Hodgkin lymphoma. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating Hodgkin lymphoma. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with Hodgkin lymphoma.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient's options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for Hodgkin lymphoma, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about Hodgkin lymphoma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Measuring treatment effectiveness. A main focus of research for Hodgkin lymphoma is monitoring how well treatment is working to help make decisions about when to change treatment. Some new clinical trials are looking at changing chemotherapy depending on the results of a PET scan early in the treatment period.

New chemotherapy. New drugs, new combinations of chemotherapy, lower doses, and shorter schedules are being studied in clinical trials to reduce short-term side effects and long-term health risks to patients being treated for Hodgkin lymphoma. Other drugs are being tested for recurrent Hodgkin lymphoma and may be added to the current standard chemotherapy regimens used for progressive disease.

Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Some treatments involve the use of antibodies that attach to proteins on the surface of cancer cells. Sometimes these antibodies have radioactive substances attached to them that will direct radiation therapy specifically to the lymphoma cells, called radioimmunotherapy. Other antibodies are used to direct drugs to the cancer cells. Research on the recently approved drug brentuximab vedotin is ongoing to find out how to best use this drug.

Gene profiling. Some researchers are looking at the specific genes and proteins that are found in Hodgkin lymphoma. These genes and proteins provide more information about the behavior of Hodgkin lymphoma, which may help better target the lymphoma with chemotherapy or immunotherapy.

Other treatments. Stem cell transplantation is being studied in combination with chemotherapy and immunotherapy regimens for new or recurrent Hodgkin lymphoma. Mini-allogeneic, also called non-myeloablative or reduced intensity transplant, or allogeneic transplantation is being tested in combination with chemotherapy and immunotherapy for new or recurrent Hodgkin lymphoma. Several new types of drugs which work in a different way than chemotherapy, called targeted therapy, are also being studied. Many of these are given in tablet (pill) form.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current Hodgkin lymphoma treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding Hodgkin lymphoma, explore these related items that take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of lymphoma, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for Hodgkin lymphoma are described in detail within the Treatment Options section. Learn more about the most common side effects of lymphoma and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with Hodgkin lymphoma. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

Many people with Hodgkin lymphoma are young adults. Being diagnosed with cancer at this point in life can bring unique concerns and challenges. Learn more about being a young adult with cancer.

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Late Effects of Treatment and After Treatment sections or by talking with your doctor.

The next section describes side effects that may develop months or years after treatment has ended. Use the menu on the side of your screen to select Late Effects of Treatment, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - Late Effects of Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find out more about the physical and emotional side effects that can occur long after treatment for this type of cancer has ended and how these late effects can be prevented and/or managed. To see other pages, use the menu on the side of your screen.

People who received treatment for Hodgkin lymphoma have an increased risk of developing other diseases or conditions later in life because both chemotherapy and radiation therapy can cause permanent damage. Treatments have improved in the last 30 years, and now patients are less likely to experience late effects; however, there is still some risk. Therefore, it is important that patients see their doctors regularly for follow-up care and watch for any new side effects.

  • Radiation therapy to the pelvic area can lead to infertility in women or men unless the ovaries or testicles are shielded from the radiation during treatment. Also, teenagers and adults who received chemotherapy may be at higher risk for low sperm counts (for men) or damage to the ovaries (for women).

    Men who received combination chemotherapy may be at risk for infertility after treatment. The risk appears to be associated with drugs known as alkylating agents, which are used much less often in current chemotherapy regimens for Hodgkin lymphoma. Although the risk of infertility for men is low after chemotherapy for Hodgkin lymphoma, it is still possible, and men who are considering having a family should consider sperm storage before starting chemotherapy. Men who have had a stem cell transplant are almost always infertile after this treatment.

    Women who received chemotherapy for Hodgkin lymphoma have an increased risk of infertility or early menopause. Again, this is mostly related to alkylating drugs and is less common with modern chemotherapy treatments. It is unusual, but not impossible, for women to become pregnant after stem cell transplantation.

    Learn more about fertility concerns and preservation for men and women.

  • Some survivors of Hodgkin lymphoma have a higher risk of developing a secondary cancer, especially acute myeloid leukemia (following certain types of chemotherapy or radiation therapy), non-Hodgkin lymphoma, lung cancer, or breast cancer. The risk of a secondary cancer is likely to decrease in the future because the treatments used now have fewer risks. Patients can lower their risk of developing a secondary cancer by limiting or avoiding other risk factors, such as smoking.
  • Radiation therapy to the chest area can cause lung damage, increase the risk of heart disease, and increase the risk of lung cancer and breast cancer. It is important that men and women who received radiation to the chest limit other risk factors that may lead to heart damage, such as smoking, obesity, and high cholesterol. It is important that women who received radiation therapy to the chest begin regular breast cancer screening at an early age.
  • Patients who received anthracyclines (doxorubicin) or bleomycin during chemotherapy have a higher risk of both heart and lung damage.
  • Radiation therapy to the neck area specifically or as part of total body irradiation (TBI) before a stem cell transplant can cause thyroid problems, most commonly hypothyroidism. Hypothyroidism is when the body produces too little thyroid hormone, which regulates metabolism. This problem can be managed by taking a thyroid hormone supplement pill.
  • Survivors of Hodgkin lymphoma may also have a higher risk of depression or other emotional concerns.

Learn more about possible late effects of cancer treatment.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for Hodgkin lymphoma ends, talk with your doctor about developing a follow-up care plan. This plan may include doctor visits and medical tests to monitor your recovery for the coming months and years. Follow-up care after treatment for Hodgkin lymphoma is important to monitor for possible recurrence of the lymphoma and late effects of treatment.

ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

How often a person needs follow-up care and which tests are performed depends on several factors, including the original extent of the Hodgkin lymphoma and the type of treatment. Typically, all of the tests, including CT scans, PET scans, and bone marrow biopsies, are repeated after treatment ends to make sure the lymphoma is gone. Then, the frequency of additional screening depends on the results of the tests done immediately after treatment has finished.

In general, each follow-up visit includes a discussion with the doctor, a physical examination, and blood tests. During some visits, scans are done. At most cancer centers, follow-up visits are scheduled every two to three months during the time right after treatment when the risk of recurrence is highest, and the time between visits increases over time. Later visits may only be two to three times per year until five years has passed. Then, annual visits should be continued with an oncologist. Special attention should be paid to cancer screening and detection, as well as heart risk factors, throughout the person’s lifetime. For patients who received radiation therapy to the neck or chest, monitoring thyroid function is important.

Follow-up care should also address the person’s quality of life, including emotional concerns. In particular, Hodgkin lymphoma survivors are encouraged to be aware of the symptoms of depression and talk with their doctor immediately if they have such symptoms.

Patients who had Hodgkin lymphoma should get a yearly flu shot. It may be recommended that some patients get an immunization against pneumonia, which may be done every five to seven years.

People recovering from Hodgkin lymphoma are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, limiting alcohol, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of Hodgkin lymphoma do I have?
  • How experienced are you in treating patients with Hodgkin lymphoma?
  • Can you explain my pathology report (laboratory test results) to me?
  • Has my biopsy been reviewed by a pathologist who is an expert in lymphoma?
  • What is the stage of my Hodgkin lymphoma? What is the subtype?
  • What good and poor prognostic factors do I have?
  • What are my treatment options?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • What chemotherapy treatment do you recommend? How many treatments? Why?
  • What are the advantages and disadvantages of chemotherapy alone versus chemotherapy plus radiation treatment?
  • What, if any, radiation treatment do you recommend, and why?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • Should I get a second opinion?
  • What are the possible side effects of treatment, both in the short term and the long term?
  • What symptoms should I be most concerned about during treatment? When and how should I contact the health care team if they appear or get worse?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins? If I’m a man, should I bank my sperm?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • How can I stay as healthy as possible during treatment?
  • What follow-up tests will I need, and how often will I need them?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Lymphoma - Hodgkin - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Hodgkin Lymphoma. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

This is the end of the Cancer.Net’s Guide to Hodgkin Lymphoma. Use the menu on the side of your screen to select another section to continue reading this guide.