Coping with cancer? Speak to a health professional or someone who has been there, or find a support group or forum. Looking for transport, accommodation or home help? Practical advice and support during and after treatment. Making cancer treatment decisions Decision-making steps, consent and second opinions.
Chemotherapy common questions Addresses chemotherapy concerns such as pain, time and pregnancy. We are conducting a research study about the support needed by people affected by cancer, including anyone with a current or past cancer diagnosis, and anyone caring for someone affected by cancer.
This information will be used to plan CCNSW services and to campaign for broader health system changes to improve the quality of life of people affected by cancer. Learn more about: Having chemotherapy Side effects of chemotherapy Common side effects of chemotherapy Taking care with infections Video: What is chemotherapy? It typically starts with chemotherapy usually with the ABVD regimen for 4 to 6 cycles or other regimens such as 3 cycles of Stanford V.
This is often followed by more, and maybe different, chemo. Radiation therapy involved field radiation therapy, or IFRT is usually given to the sites of the tumor at this point, especially if it was bulky disease. Doctors generally treat these stages with chemotherapy using more intense regimens than that used for earlier stages. The ABVD regimen for at least 6 cycles is often used, but some doctors favor more intense treatment with the Stanford V regimen for 3 cycles, or up to 8 cycles of the BEACOPP regimen if there are several unfavorable prognostic factors.
Another option for some people might be chemo plus the drug brentuximab vedotin Adcetris. Depending on the results of the scans, more chemo may be given. Radiation therapy may be given after chemo, especially if there were any large tumor areas. Treatment for HL should remove all traces of the lymphoma. If HL is still there, most experts think that more of the same treatment is unlikely to cure it.
However, some people who received these treatments developed serious side effects later in life, including infertility the inability to have children , heart problems such as heart failure, leaky heart valves, and heart attacks , and secondary cancers, such as lung cancer and breast cancer.
These long-term problems were partly caused by the types of chemotherapy and high doses of radiation therapy delivered to large areas of the body used at that time. Learn more about the late effects of treatment for Hodgkin lymphoma. To avoid or reduce the risk of these problems, current treatment plans for Hodgkin lymphoma are aimed at achieving the best chance of curing the Hodgkin lymphoma while avoiding causing long-term side effects as much as possible.
Newer types and doses of chemotherapy and new technologies that allow directing radiation therapy to smaller areas of the body have reduced these risks. For some people, this is followed by radiation therapy to the affected lymph node areas.
It may be possible to treat some people with early-stage disease stage I or II with a relatively short course of chemotherapy with or without radiation therapy.
For stage III or stage IV disease, chemotherapy is the primary treatment, although additional radiation therapy may be recommended, especially to areas of large lymph nodes. Descriptions of the common types of treatments used for Hodgkin lymphoma are listed below.
Your care plan also includes treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and ask about anything that is unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment, including any potential side effects.
Shared decision making is particularly important for Hodgkin lymphoma because there are different treatment options. Learn more about making treatment decisions. Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are given by a medical oncologist, a doctor who specializes in treating cancer with medication, or a hematologist, a doctor who specializes in treating blood disorders.
Common ways to give systemic therapies include an intravenous IV tube placed into a vein using a needle or by taking a pill or capsule by mouth. Each of these types of therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes radiation therapy.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications.
Learn more about your prescriptions by using searchable drug databases. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. Many people with Hodgkin lymphoma receive chemotherapy through a port-a-cath placed under the skin. Learn more about catheters and ports in cancer treatment.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles of treatment given over a set number of weeks or months. There are many different types of chemotherapy that may be used to treat Hodgkin lymphoma. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. Newly diagnosed Hodgkin lymphoma is often treated with regimens that use a combination of chemotherapy drugs given at 1 time.
The drugs that make up common combinations of chemotherapy are listed below. There are other combinations that are less commonly used; not all combinations are listed here. ABVD: Doxorubicin available as a generic drug , bleomycin available as a generic drug , vinblastine Velban , and dacarbazine available as a generic drug. ABVD chemotherapy is usually given every 2 weeks for 2 to 8 months. AAVD is given every 2 weeks for 6 months. Brentuximab vedotin is an antibody-drug conjugate.
This means it delivers chemotherapy only to cells that have a special protein on the surface called CD There are several different treatment schedules, but different drugs are usually given every 2 to 3 weeks. If this happens, recent research suggests that gemcitabine Gemzar combined with other drugs may be a good alternative. The type of chemotherapy, number of cycles of chemotherapy, and the additional use of radiation therapy are based on the stage of the Hodgkin lymphoma and the type and number of prognostic factors see Stages.
Talk with your doctor about the specifics of your treatment plan. Usually, doctors choose to monitor how well these treatments are working with repeat PET-CT scans after 2 to 3 months of treatment. If the PET scans show that the treatment is not working, the chemotherapy may be changed.
If the PET scans show that treatment is working, then the doctor may decide to lower the subsequent number of drugs used or the total number of treatment cycles. There are several second-line treatments available for Hodgkin lymphoma. ICE: Ifosfamide Ifex , carboplatin available as a generic drug , and etoposide. ICE is usually given every 2 or 3 weeks for 2 to 3 cycles.
DHAP is dexamethasone available as a generic drug , high-dose cytarabine, and cisplatin. Gem-Ox is gemcitabine and oxaliplatin Eloxatin. GDP is gemcitabine, dexamethasone, and cisplatin. Gemcitabine-based regimens are either given 2 weeks in a row followed by an off-week or every other week. Brentuximab vedotin: This drug is an option if previous chemotherapy stops working. The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging.
The information gathered from the staging process determines the stage of the disease. It is important to know the stage to plan treatment. The results of the tests and procedures done to diagnose and stage Hodgkin lymphoma are used to help make decisions about treatment.
Cancer can spread through tissue , the lymph system , and the blood :. In stage II, the term bulky disease refers to a larger tumor mass. The size of the tumor mass that is referred to as bulky disease varies based on the type of lymphoma. In stage III adult Hodgkin lymphoma , cancer is found:.
In stage IV adult Hodgkin lymphoma , cancer :. Early favorable adult Hodgkin lymphoma is stage I or stage II , without risk factors that increase the chance that the cancer will come back after it is treated. Early unfavorable adult Hodgkin lymphoma is stage I or stage II with one or more of the following risk factors that increase the chance that the cancer will come back after it is treated:.
Advanced favorable Hodgkin lymphoma means that the patient has 0—3 of the risk factors below. Advanced unfavorable Hodgkin lymphoma means that the patient has 4 or more of the risk factors below. The more risk factors a patient has, the more likely it is that the cancer will come back after it is treated:.
The cancer may come back in the lymph system or in other parts of the body. Different types of treatment are available for patients with adult Hodgkin lymphoma.
Some treatments are standard currently used treatment , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
For pregnant women with Hodgkin lymphoma, treatment is carefully chosen to protect the unborn baby. The treatment plan may change as the signs and symptoms , cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Treatment will be overseen by a medical oncologist , a doctor who specializes in treating cancer. The medical oncologist may refer you to other health care providers who have experience and expertise in treating adult Hodgkin lymphoma and who specialize in certain areas of medicine.
These may include the following specialists :. For information about side effects that begin during treatment for cancer, see our Side Effects page.
Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. These late effects depend on the type of treatment and the patient's age when treated, and may include the following:. Regular follow-up by doctors who are experts in finding and treating late effects is important for the long-term health of patients treated for Hodgkin lymphoma.
Chemotherapy is a cancer treatment that uses one or more drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Cancer treatment using more than one chemotherapy drug is called combination chemotherapy.
When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body systemic chemotherapy. When a pregnant woman is treated with chemotherapy for Hodgkin lymphoma, it isn't possible to protect the unborn baby from being exposed to the chemotherapy.
Some chemotherapy regimens may cause birth defects if given in the first trimester. Vinblastine is an anticancer drug that has not been linked with birth defects when given in the second or third trimester of pregnancy. See Drugs Approved for Hodgkin Lymphoma for more information. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Sometimes total-body irradiation is given before a stem cell transplant. Proton beam radiation therapy is a type of high-energy, external radiation therapy that uses streams of protons tiny particles with a positive charge to kill tumor cells.
This type of treatment can lower the amount of radiation damage to healthy tissue near a tumor such as the heart or breast. External radiation therapy is used to treat adult Hodgkin lymphoma and may also be used as palliative therapy to relieve symptoms and improve quality of life. For a pregnant woman with Hodgkin lymphoma, radiation therapy should be postponed until after delivery, if possible, to avoid any risk of radiation exposure to the unborn baby.
If treatment is needed right away, the woman may decide to continue the pregnancy and receive radiation therapy. A lead shield is used to cover the pregnant woman's abdomen to help protect the unborn baby from radiation as much as possible.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Immunotherapy is a treatment that uses the patient's immune system to fight cancer.
Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biologic therapy. Labor may be induced when the unborn baby is 32 to 36 weeks old so that the mother can begin treatment. Steroids are hormones made naturally in the body by the adrenal glands and by reproductive organs. Some types of steroids are made in a laboratory.
Certain steroid drugs have been found to help chemotherapy work better and help stop the growth of cancer cells. When an early delivery is likely, steroids can also help the lungs of the unborn baby develop faster than normal. This gives babies who are born early a better chance of survival. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied.
Information about clinical trials is available from the NCI website. High doses of chemotherapy are given to kill cancer cells. Healthy cells, including blood-forming cells, are also destroyed by the cancer treatment. Stem cell transplant is a treatment to replace the blood-forming cells. Stem cells immature blood cells are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the patient completes chemotherapy and radiation therapy, the stored stem cells are thawed and given back to the patient through an infusion.
These reinfused stem cells grow into and restore the body's blood cells. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Some clinical trials only include patients who have not yet received treatment.
Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring coming back or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country.
Clinical trials supported by other organizations can be found on the ClinicalTrials. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition has changed or if the cancer has recurred come back. These tests are sometimes called follow-up tests or check-ups. For information about the treatments listed below, see the Treatment Option Overview section. Treatment of early favorable classic Hodgkin lymphoma in adults may include the following:. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done.
General information about clinical trials is also available. Treatment of early unfavorable classic Hodgkin lymphoma in adults may include the following:. Treatment of advanced classic Hodgkin lymphoma in adults may include the following:. Treatment of recurrent classic Hodgkin lymphoma in adults may include the following:.
Treatment of nodular lymphocyte—predominant Hodgkin lymphoma in adults may include the following:. When Hodgkin lymphoma is diagnosed in the first trimester of pregnancy , it does not necessarily mean that the woman will be advised to end the pregnancy. Each woman's treatment will depend on the stage of the lymphoma , how fast it is growing, and her wishes.
Treatment of Hodgkin lymphoma during the first trimester of pregnancy may include the following:. When Hodgkin lymphoma is diagnosed in the second half of pregnancy , most women can delay treatment until after the baby is born. Treatment of Hodgkin lymphoma during the second or third trimester of pregnancy may include the following:. For more information from the National Cancer Institute about adult Hodgkin lymphoma, see the following:.
For general cancer information and other resources from the National Cancer Institute, see the following:. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language.
Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
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