Hodgkin's Disease: Treatment Options

How is it treated?

Treatment options for Hodgkin's Disease (like all cancers) can vary with the stage of development that the disease is in. Radiation therapy and/or chemotherapy are almost always a part of the treatment plan. Bone marrow transplants are also now being included as part of the treatment plan for certain cases. Other than for a biopsy, surgery is rarely a part of treatment for Hodgkin's Disease that has not spread to other organs. Treatment options are different for each individual case, but there are several common procedures listed below. The information presented is intended to provide patients with treatment information that they can use when discussing treatment options with their physician.

Radiation Therapy for Hodgkin's Disease

In some cases X-rays can be used to destroy or shrink cancer cells at the site of the tumor. External beam radiation is the type of radiation normally used in the treatment of Hodgkin's Disease. External beam radiation therapy uses radiation from outside the body to focus on the cancer and is, therefore, not the primary treatment for cancer that may have spread. A machine such as a linear accelerator or cobalt apparatus may administer this type of radiation. Radiation therapy is a type of localized treatment, which means that it affects only a specific area of the body. The radiation can be focused just on the site of the tumor (involved field radiation) or it can also be directed to the surrounding lymph nodes (extended field radiation). Radiation therapy can be curative for Stage I and some Stage II cases of Hodgkin's Disease.

Chemotherapy for Hodgkin's Disease

Chemotherapy drugs are administered by mouth or injection to destroy the cancer cells. The drugs enter the blood stream and can, therefore, reach areas of the body where the cancer may have spread. Chemotherapy for Hodgkin's Disease always involves the use of a number of different drugs. This allows several different types of cancer cells to be destroyed at the same time. Chemotherapy is a type of systemic treatment, which means that it affects all areas of the body. Multiple drug chemotherapy has been exceptionally effective for most cases of Hodgkin's Disease.

Other Treatments

• Autologous Bone Marrow Transplant - This type of treatment is sometimes used if the cancer becomes resistant to regular chemotherapy or radiation therapy. Some of the patient's own bone marrow is first taken out using a special needle. Very high doses of chemotherapy or radiation therapy are then administered to destroy the cancer cells that have become resistant to regular doses. These high doses are more lethal than regular doses, but also destroy bone marrow that has not been removed from the body. After the chemotherapy or radiation therapy, the bone marrow that was removed is returned to the patient unharmed. This preserved bone marrow allows the body to continue to fight infections and carry oxygen in the blood. Autologous bone marrow transplants have proven very effective in fighting cancers that were once thought to be incurable. They require anesthetic and may require a short hospital visit. However, the procedure itself lasts only two hours.
  
  
• Peripheral Blood Stem Cell Transplant (PBSCT) - This treatment is also normally used when the cancer becomes resistant to chemotherapy or radiation therapy. The blood is slowly run through a machine that filters out the stem cells. Stem cells are special cells that can develop into a number of different blood cells, including those that fight infections. These stem cells are frozen and then returned to the body after a treatment of high dose chemotherapy or radiation therapy. PBSCT can be performed on an outpatient basis and does not require anesthetic. However, it is a slow process and may require a period of weeks to be completed.
  
  
• Clinical Trials - There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end-stage cancer patients. Consult your physician or the Rhode Island Cancer Council to find out what clinical trials are going on near you and if you are eligible.
  

What are the side effects of the treatments?

Certain side effects have been associated with different types of treatments. Each patient's response to treatment will be different but there are some common effects that have been reported by patients. Most side effects are temporary and can often be relieved with medication.

• Radiation Therapy (Side effects depend on area of the body being treated.)
  
  • Nausea, vomiting, diarrhea
    
  • Sexual dysfunction
    
  • Irritation to the skin near the radiation site
    
• Chemotherapy
  
  • Nausea and vomiting - loss of appetite
    
  • Loss of hair
    
  • Mouth sores
    
  • Increased susceptibility to infection
    
  • Premature menopause (permanent)
    
  • Infertility (permanent)
    
• Autologous Bone Marrow Transplant
  
  • Higher risk of infection
    
  • Possible toxicity to heart, lungs, liver, kidney, and other organs
    
• Peripheral Blood Stem Cell Transplant
  
  • Higher risk of infection
    
  • Possible toxicity to heart, lungs, liver, kidney, and other organs
    

The vast majority of Hodgkin's patients live a long and comfortable life after treatment. However, since most patients with Hodgkin's Disease are young and will be cured, the possibility of late effects of treatment can occur in a small, but real, number of cured patients. These include:

• Growth changes in very young patients
  
• Leukemia
  
• Second Cancers
  

**Close monitoring by a physician is important long after treatment so that if any of these effects develop they can be treated or controlled.**

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