Hodgkin lymphoma - Treating Hodgkin lymphoma

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

Your treatment plan

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

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

Your MDT will recommend the best treatment options for you. However, you should not be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner.

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

Surgery is not generally used to treat the condition, except for the biopsy used to diagnose it.

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

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

Chemotherapy

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

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

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

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

fatigue
breathlessness
increased vulnerability to infection
bleeding and bruising more easily

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

Other possible side effects of chemotherapy include:

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

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

Read more about the side effects of chemotherapy.

High-dose chemotherapy

If regular chemotherapy is unsuccessful or Hodgkin lymphoma returns after treatment, you may have a course of chemotherapy at a higher dose.

However, this intensive chemotherapy will destroy your bone marrow, leading to the problems mentioned above. You will therefore require a stem cell or bone marrow transplant to replace the damaged bone marrow.

Radiotherapy

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

Treatment is normally given in short daily sessions, Monday to Friday, over the space of several weeks. You should not have to stay in hospital between appointments.

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

Other common side effects include:

tiredness
nausea and vomiting
dry mouth
loss of appetite

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

Steroid medication

Steroid medication is sometimes used in combination with chemotherapy as a more intensive treatment for advanced cases of Hodgkin lymphoma, or where initial treatment has been ineffective.

The steroid medication is given intravenously, usually at the same time as your chemotherapy.

Common side effects of steroid medication include:

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

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

Rituximab

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

Rituximab is a type of biological therapy called a monoclonal antibody. It attaches itself to the surface of cancerous cells and stimulates the immune system to attack and kill the cell.

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

Side effects of the drug can include:

flu-like symptoms, such as headaches, fever and muscle pain
tiredness
nausea
diarrhoea

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

Follow-up

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

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

Want to know more?

For more information, see:

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