If you’ve been diagnosed with advanced Hodgkin lymphoma, you may have questions about what treatments are available and how those treatments work. It’s impossible to know exactly how well a specific medical treatment will improve your condition, but you can learn more about what most people experience. This may help you manage your expectations while you’re being treated.
In order to understand the treatment options for Hodgkin lymphoma, it’s important to know how this type of cancer affects the body. The treatment your doctor recommends will depend on the stage of the cancer and your symptoms. Even in its advanced stages, doctors consider Hodgkin lymphoma to be one of the most treatable forms of cancer.
The lymphatic system is made up of thin vessels that circulate a colorless liquid called lymph throughout the body. The lymph collects viruses, bacteria, and other germs that make us sick and carries them to small glands, or “nodes,” to be filtered out.
Lymphoma is a form of cancer that originates in the lymphocytes, a type of white blood cell. Lymphocytes are a vital part of the lymphatic system and the body’s immune response. There are 35 to 60 subtypes of lymphoma. Hodgkin lymphoma accounts for roughly 1 percent of all new cancer cases in the United States, with around 8,200 people diagnosed in 2017, according to the National Cancer Institute.
Your doctor will likely use a staging system, known as the Lugano classification, to assess how much the cancer has spread in your body. There are four main stages. Doctors consider multiple factors when assigning a stage. Here is a general overview of what each stage means:
- Stage 1: The cancer is limited to a single node region, usually in the underarms, groin, neck, chest, and abdomen where nodes cluster together.
- Stage 2: The cancer is found in two or more lymph node regions. In stage 2, the parts of your body affected by cancer are located on the same side of your diaphragm, which is a thin muscle that separates your chest from your abdomen.
- Stage 3: The cancer is found in lymph node regions on both sides of your diaphragm.
- Stage 4: The cancer has spread into at least one organ outside of the lymph system, such as the liver, bone marrow, or lungs.
Depending on your symptoms, your doctor may also use the letters “A” or “B” to describe your condition. Having B symptoms generally means that the lymphoma is in an advanced stage and needs more aggressive treatment. B symptoms may include weight loss, unexplained fevers, and night sweats. If these symptoms aren’t present, the letter A is added.
Your doctor may also include the letter “x” at the end of the stage. This indicates the disease is bulky. The term “bulky,” for Hodgkin lymphoma, means that chest tumors are at least one-third the width of your chest, or at least 4 inches across when located in different areas. Bulky tumors are more common in advanced stages and will likely require more aggressive treatment options.
The success rate for treating Hodgkin lymphoma depends on the stage of the disease when it is diagnosed. Doctors often use five-year survival rates to help you better understand the likelihood of your treatment being effective. Five-year survival rates refer to the percentage of people who are alive five years after first being diagnosed. For Hodgkin lymphoma, the five-year survival rates are:
- Stage 1: 90 percent
- Stage 2: 90 percent
- Stage 3: 80 percent
- Stage 4: 65 percent
Keep in mind that many live much longer than five years or see their cancer disappear completely. Steady advancements in treatment mean that the five-year survival rate has increased since the mid-1970s.
Hodgkin lymphoma is highly treatable, even in stages 3 and 4. When deciding the best course of treatment, your doctor will consider factors such as the type of Hodgkin lymphoma, the stage, and whether it’s bulky.
Your doctor will also consider your overall health, age, and personal preferences. That means it’s important for you to understand what different treatments involve. The most common treatment options are:
Chemotherapy treatments use drugs to destroy lymphoma cells. If you have stage 3 or 4 Hodgkin lymphoma, your doctor is likely to recommend chemotherapy at a higher dose than what would be given in earlier stages. You’ll likely start on a four-drug chemotherapy called ABVD, which is an acronym for the medications used. The ABVD treatment includes:
- doxorubicin (Adriamycin)
- bleomycin (Blenoxane)
- vinblastine (Velban)
- dacarbazine (DTIC-Dome)
The ABVD treatment usually lasts six weeks. Depending on your condition, your doctor may recommend longer and more intense regimens.
Another common treatment regimen is called BEACOPP. It includes:
- etoposide (VP-16)
- cyclophosphamide (Cytoxan)
- vincristine (Oncovin)
The BEACOPP regimen is generally given to people with stage 2 or higher forms of lymphoma. It’s administered as cycles of treatment, with each cycle lasting three weeks. You may need to have up to eight cycles of treatment over a course of six months.
ABVD and BEACOPP are the most common chemotherapy regimens available. But there are other combinations that your doctor may suggest. Whichever regimen you receive, the side effects of chemotherapy are generally similar. These most commonly include:
- hair loss
- easy bruising and bleeding
- anemia, which refers to low red blood cell counts
- nausea and vomiting
- appetite changes
The extent of these side effects can vary from person to person. There are sometimes ways to lessen the severity of side effects, so don’t hesitate to ask your doctor about your options.
Radiation treatment is commonly used after you complete chemotherapy. Sometimes it may not be necessary, depending on the stage of the cancer and how well it responds to chemotherapy. If you have bulky tumors, it’s likely that you’ll be offered radiation treatment in combination with chemotherapy.
During treatment, a large machine uses high-energy beams, such as X-rays and protons, to target the cancer cells in your body. Radiation treatments are commonly administered five days a week over the course of two to four weeks. The procedure itself is painless, much like getting an X-ray. The actual treatment itself usually only lasts several minutes at a time. However, be aware that getting you into place for the treatment and adjusting the machines may take hours.
Radiation therapy often has side effects. These can include:
- skin changes in areas getting radiation, ranging from redness to blistering and peeling and hair loss at the site
- feeling tired
- weight changes
- mouth soars
- trouble swallowing
These side effects generally go away quite quickly after your course of treatment is over. There are, however, several longer-term side effects that may linger:
- If you receive radiation to the chest, damage to the lungs is a possibility, which may lead to respiratory issues and an increased risk of heart attack.
- Radiation to the neck increases chances of thyroid problems, swallowing difficulties, and stroke later in life.
- Though rare, radiation therapy also increases the risk of forming other cancers later in life, such as breast and lung cancers.
Bone marrow transplant
This therapy is also referred to as stem cell transplants. Bone marrow transplants replace cancerous cells with healthy stem cells that grow into new bone marrow. Bone marrow transplants are often used if Hodgkin lymphoma returns despite treatment.
People who undergo bone marrow transplant may be at increased risk of infection. After receiving treatment, it may take six months or more for your immune system to recover. During this period, you’ll be highly susceptible to infections. Be sure to take extra precautions not to expose yourself to germs.
Targeted therapy uses medications designed to target specific vulnerabilities in cancer cells.
Immune system cells have a substance preventing them from targeting healthy cells. Cancer cells can take advantage of this to shield themselves from your immune system defenses. Targeted therapies allow your immune system cells to attack the cancer cells.
These types of drugs don’t work in the same way as standard chemo drugs, but they can still cause difficult side effects in some people. Many of these side effects are related to the skin. Some people may feel a sunburned sensation even without exposure to ultraviolet rays. People may also develop sensitive rashes or dry, itchy skin.
If you have late-stage Hodgkin lymphoma, it’s important to talk to your doctor about whether the risks involved in treatment outweigh the benefits. There’s a risk that chemo and radiation therapies can cause second types of cancer.
A study published in the Journal of Clinical Oncology found that out of 5,798 people treated for Hodgkin lymphoma, more than 459 people – or almost 8 percent – developed a second cancer. In some cases, second cancers, such as lung, breast, bone, and leukemia, are more serious than Hodgkin lymphoma. That’s another reason why it’s important to understand your treatment options. Discussing your treatment plan with your doctor and loved ones is a key step toward recovering.
If your treatment is successful, it should remove all of the cancer from your body. After your initial treatment, doctors will conduct tests looking for any remaining signs of the disease. If the cancer is still present, it’s unlikely that more of the same treatment will be effective. At that point, you and your doctor can discuss new options.