Find out how your doctor decides which treatment you need, the types of treatment you might have and treatment by stage.
Deciding which treatment you need
When lymphoma is diagnosed, several doctors and other health professionals work together to decide on the most appropriate treatment. The team of doctors and health professionals is called a multidisciplinary team (MDT). The members of the team specialise in different areas of Hodgkin lymphoma treatment and support. The team usually includes the following people:
- a haematologist or medical oncologist (a specialist in treating lymphoma)
- a pathologist (a specialist in looking at biopsy samples)
- a transplant specialist
- a clinical oncologist (a specialist in radiotherapy)
- a specialist cancer nurse
- a pharmacist, social worker, psychologist and counsellor
The treatment of Hodgkin lymphoma is usually very successful and many people are cured. How much treatment you need depends on the stage of your disease.
The main types of treatment are:
- high dose chemotherapy with a stem cell or bone marrow transplant
Surgery is not used as a treatment for Hodgkin lymphoma. But you might have a small operation to remove a lymph node to check for lymphoma cells.
Some people only need one type of treatment. Others need a combination of treatments. You may have steroids alongside chemotherapy, depending on which chemotherapy drugs you are having. People with the rare lymphocyte predominant type of Hodgkin lymphoma may have a type of biological therapy called rituximab.
Planning your treatment
Your doctor takes a number of things into account when deciding your treatment:
- the stage of Hodgkin lymphoma you have
- whether you have fevers, sweating and weight loss (B symptoms) or not
- the type of Hodgkin lymphoma you have
- your general health and fitness
- your age
Age is included because large trials have shown that people over 50 do not always do as well as younger patients and so may need more intensive treatment.
Your doctor or specialist nurse may recommend that you have flu and pneumonia vaccinations. The vaccinations help to protect you from these infections if you have low immunity during treatment.
Early stage Hodgkin lymphoma
Early stage means the lymphoma is only in 1 group of lymph nodes (stage 1). Or it may be in 2 groups but they are on the same side of your diaphragm and you have no fevers, night sweats or unexplained weight loss (stage 2A).
You will probably have a short course of chemotherapy, if you have early stage disease. Your doctor might then recommend radiotherapy to the affected lymph nodes. You might also have radiotherapy to your spleen or other lymph nodes.
You might just have radiotherapy to the affected lymph nodes, if you have very early, localised disease and are not able to have chemotherapy for any reason.
Advanced stage Hodgkin lymphoma
Advanced stage generally means that the lymphoma is on both sides of your diaphragm (stage 3), or in body organs (stage 4).
You are most likely to have chemotherapy with or without steroids. You may also have radiotherapy to particular groups of lymph nodes if they are very swollen (enlarged) or causing symptoms.
Lymphoma that has come back
You might have high dose chemotherapy with a stem cell or bone marrow transplant, if your lymphoma comes back after treatment (relapses). Or your doctor might suggest treatment with a biological therapy drug called brentuximab.
Or you might have more chemotherapy or radiotherapy, depending on the treatment you have already had.
Lymphoma that does not respond
Sometimes Hodgkin lymphoma does not respond as well to initial treatment as your doctor would hope. You might have more treatment, for example, radiotherapy as well as chemotherapy. Or they may change your chemotherapy drugs, or give you the biological therapy drug brentuximab.
Or your doctor might suggest high dose chemotherapy treatment with a stem cell or bone marrow transplant.
Fertility and cancer treatment
Chemotherapy and radiotherapy for Hodgkin lymphoma can potentially affect your ability to have a child. So it is important to talk to your doctor about this before you start treatment. They may be able to arrange sperm banking or egg collection before treatment begins.
Clinical trials to improve treatment
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:
- making existing treatments better
- developing new treatments