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. (Treatment for children with Hodgkin's disease is not discussed here. The Cancer Information Service and the other resources listed under "National Cancer Institute Information Resources" can provide up-to-date information about Hodgkin's disease in children). Patients with Hodgkin's disease may be vaccinated against the flu, pneumonia, and meningitis. They should discuss a vaccination plan with their health care provider. 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. For more information, see the "Clinical Trials" section. Getting a Second Opinion Before starting treatment, patients may want a second opinion to confirm their diagnosis and treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it. There are a number of ways to find a doctor who can give a second opinion: The patient's doctor may be able to suggest specialists to consult. The Cancer Information Service, at 1-800-4-CANCER, can tell callers about cancer treatment facilities, including cancer centers and other programs supported by the National Cancer Institute. Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school. The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries.

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: What is my exact diagnosis? What is the stage of the disease? What are my treatment choices? Which do you recommend for me? Why? What are the risks and possible side effects of each treatment? What side effects should I report to you? How long will treatment last? What are the chances that the treatment will be successful? Will treatment affect my normal activities? If so, for how long? Are new treatments under study? Would a clinical trial be appropriate for me? What is the treatment likely to cost?

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: What is the goal of this treatment? What are its risks and possible side effects? What side effects should I report to you? How will the radiation be given? When will the treatments begin? When will they end? How will I feel during therapy? What can I do to take care of myself during therapy? How will we know if the radiation therapy is working? How will treatment affect my normal activities?

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: What is the goal of this treatment? What drugs will I be taking? Will the drugs cause side effects? What can I do about them? What side effects should I report to you? How long will I need to take this treatment? What can I do to take care of myself during treatment? How will we know if the drugs are working?

Clinical Trials

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. They may also want to read the National Cancer Institute booklet Taking Part in Clinical Trials: What Cancer Patients Need to Know, which describes how studies are carried out and explains their possible benefits and risks. The NCI Web site at http://www.cancer.gov/ provides detailed information about ongoing studies for Hodgkin's disease. Another way to learn about clinical trials is through the Cancer Information Service.
Side Effects of Treatment

Treatments for Hodgkin's disease are very powerful. It is hard to limit the effects of therapy so that only cancer cells are destroyed. Because treatment also damages healthy cells and tissues, it often causes side effects.

The side effects of cancer treatment depend mainly on the type and extent of the therapy. Side effects may not be the same for everyone, and they may even change from one treatment to the next. Doctors and nurses can explain the possible side effects of treatment. They can also lessen or control many of the side effects that may occur during and after treatment.
Radiation Therapy

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 "Followup 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 National Cancer Institute booklet Radiation Therapy and You has helpful information about radiation therapy and managing its side effects.
Chemotherapy

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. Sometimes, however, chemotherapy results in a permanent loss of fertility. The National Cancer Institute booklet Chemotherapy and You has helpful information about chemotherapy and coping with side effects.

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. Patients and their families also may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful suggestions.