Hodgkin's disease treatment
The doctor develops a treatment plan to fit each patient's needs. Treatment for Hodgkin's disease depends on the stage of the disease, the size of the enlarged lymph nodes, which symptoms are present, the age and general health of the patient, and other factors.
Hodgkin's disease is often treated by a team of specialists that may include a medical oncologist, oncology nurse, and/or radiation oncologist. Hodgkin's disease is usually treated with radiation therapy or chemotherapy. The doctors may decide to use one treatment method or a combination of methods.
Taking part in a clinical trial (research study) to evaluate promising new ways to treat Hodgkin's disease is an important option for many people with this disease.
Preparing for treatment
Many people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for people to think of everything they want to ask the doctor. Often, it helps to make a list of questions. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor – to take part in the discussion, to take notes, or just to listen.
These are some questions a patient may want to ask the doctor before treatment begins:
Patients do not need to ask all their questions or remember all the answers at one time. They will have other chances to ask the doctor to explain things and to get more information.
Methods of treatment
Radiation therapy and chemotherapy are the most common treatments for Hodgkin's disease, although bone marrow transplantation, peripheral stem cell transplantation, and biological therapies are being studied in clinical trials.
Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells. Depending on the stage of the disease, treatment with radiation may be given alone or with chemotherapy. Radiation therapy is local therapy; it affects cancer cells only in the treated area. Radiation treatment for Hodgkin's disease usually involves external radiation, which comes from a machine that aims the rays at a specific area of the body. External radiation does not cause the body to become radioactive. Most often, treatment is given on an outpatient basis in a hospital or clinic.
These are some questions a patient may want to ask the doctor before having radiation therapy:
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for Hodgkin's disease usually consists of a combination of several drugs. It may be given alone or followed by radiation therapy.
Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel throughout the body.
Usually, a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.
These are some questions patients may want to ask the doctor before starting chemotherapy:
Many people with Hodgkin's disease take part in clinical trials. Doctors conduct clinical trials to learn about the effectiveness and side effects of new treatments. Trials are exploring new ways of giving radiation therapy and chemotherapy, new drugs and new drug combinations, and biological therapies. High-dose chemotherapy with bone marrow or peripheral blood stem cell transplantation is also being evaluated. In some trials, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the standard treatment to another group; or they may compare one standard treatment with another. Research like this has led to significant advances in the treatment of Hodgkin's disease. Each achievement brings researchers closer to the eventual control of cancer.
People who take part in clinical trials have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science.
Patients who are interested in entering a clinical trial should talk with their doctor.
Because cancer treatment may damage healthy cells and tissues, unwanted side effects sometimes occur. These side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Doctors and nurses will explain the possible side effects of treatment and how they will help the patient manage them.
The side effects of radiation depend on the treatment dose and the part of the body that is treated. During radiation therapy, people are likely to become extremely tired, especially in the later weeks of treatment. Rest is important, but doctors usually advise patients to try to stay as active as they can.
It is common to lose hair in the treated area and for the skin to become red, dry, tender, and itchy. There may also be permanent darkening or "bronzing" of the skin in the treated area.
When the chest and neck are treated, patients may have a dry, sore throat and some trouble swallowing. Sometimes, they have shortness of breath or a dry cough. Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or urinary discomfort. Often, changes in diet or medicine can ease these problems.
Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection, or platelets, cells that help the blood to clot. If that happens, patients need to be careful to avoid possible sources of infection or injury. The doctor monitors a patient's blood count very carefully during radiation treatment. If necessary, treatment may have to be postponed to let the blood counts return to normal.
Although the side effects of radiation therapy can be difficult, they can usually be treated or controlled. It may also help to know that, in most cases, side effects are not permanent. However, patients may want to discuss with their doctor the possible long-term effects of radiation treatment on fertility (the ability to produce children) and the increased chance of second cancers after treatment is over. (The "Follow-up care" section includes more information about the chance for second cancers.) Loss of fertility may be temporary or permanent, depending on if the testes or ovaries received radiation and the patient's age. For men, sperm banking before treatment may be a choice. Women's menstrual periods may stop, and they may have hot flashes and vaginal dryness. Menstrual periods are more likely to return for younger women
The side effects of chemotherapy depend mainly on the specific drugs and the doses the patient receives. As with other types of treatment, side effects may vary from person to person.
Anticancer drugs generally affect cells that divide rapidly. In addition to cancer cells, these include blood cells, which fight infection, help the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected, the patient is more likely to get infections, may bruise or bleed easily, and may feel unusually weak and tired.
Cells in hair roots also divide rapidly; therefore, chemotherapy may lead to hair loss. Hair loss is a major concern for many patients. Some anticancer drugs only cause the hair to thin out, while others may result in the loss of all body hair. People may cope with hair loss better if they decide how to handle hair loss before starting treatment.
Cells that line the digestive tract also divide rapidly, and are often damaged by chemotherapy. As a result, side effects may include poor appetite, nausea and vomiting, and/or mouth and lip sores.
Most side effects go away gradually during the recovery periods between treatments or after treatment is over.
Nutrition during cancer treatment
Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss and regain strength. Good nutrition often helps people feel better and have more energy.
Some people with cancer find it hard to eat a balanced diet because they may lose their appetite. In addition, common side effects of treatment, such as nausea, vomiting, or mouth sores, can make eating difficult. Often, foods taste different. Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired.
Doctors, nurses, and dietitians can offer advice on how to get enough calories and protein during cancer treatment.
Recovery and outlook
It is natural for anyone facing cancer to be concerned about what the future holds. Understanding the nature of cancer and what to expect can help patients and their loved ones plan treatment, anticipate lifestyle changes, and make quality of life and financial decisions.
Cancer patients frequently ask their doctors or search on their own for statistics to answer the question, "What is my prognosis?" Prognosis is a prediction of the future course and outcome of a disease and an indication of the likelihood of recovery from that disease. However, it is only an estimate. When doctors discuss a patient's prognosis, they are attempting to project what is likely to occur for that individual patient. The prognosis for Hodgkin's disease can be affected by many factors, particularly the stage of the cancer, the patient's response to treatment, and the patient's age and general health.
Sometimes people use statistics to try to figure out their chances of being cured. However, statistics reflect the experience of a large group of patients. They cannot be used to predict what will happen to a particular patient because no two patients are alike; treatment and responses vary greatly. The doctor who is most familiar with a patient's situation is in the best position to help interpret statistics and discuss the patient's prognosis.
When doctors talk about surviving cancer, they may use the term remission rather than cure. Although many people with Hodgkin's disease are successfully treated, doctors use the term remission because cancer can return. It is important to discuss the possibility of recurrence with the doctor.
People who have had Hodgkin's disease should have regular follow-up examinations after their treatment is over and for the rest of their lives. Follow-up care is an important part of the overall treatment process, and people who have had cancer should not hesitate to discuss it with their health care provider. Patients treated for Hodgkin's disease have an increased chance of developing leukemia; non-Hodgkin's lymphoma; and cancers of the colon, lung, bone, thyroid, and breast. Regular follow-up care ensures that patients are carefully monitored, any changes in health are discussed, and new or recurrent cancer can be detected and treated as soon as possible. Between follow-up appointments, people who have had Hodgkin's disease should report any health problems as soon as they appear.
Support for people with Hodgkin's disease
Living with a serious disease is not easy. People with cancer and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services.
Friends and relatives can be very supportive. Also, it helps many patients to discuss their concerns with others who have cancer. Cancer patients often get together in support groups, where they can share what they have learned about coping with cancer and the effects of treatment. It is important to keep in mind, however, that each person is different. Treatments and ways of dealing with cancer that work for one person may not be right for another – even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the health care provider.
People living with cancer may worry about what the future holds. They may worry about holding their jobs, caring for their families, personal relationships, or continuing with daily activities. Concerns about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, psychologist, or member of the clergy can be helpful to people who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest groups that can help with rehabilitation, emotional support, financial aid, transportation, or home care.