Hodgkin's Disease

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Questions to Ask Your Doctor About Your Cancer
(Free Handout)

Treatment

Early-stage HD
If Hodgkin's disease (HD) is in its early stages and disease is contained above the diaphragm, the large abdominal muscle that controls breathing, radiation therapy typically has been the treatment of choice (see Radiation). External beam radiation (delivered outside of the body by a machine) usually is aimed at the mantle field - the neck, chest, and lymph nodes under the arms. Occasionally, the patient's condition calls for total nodal irradiation - that is, radiation is directed at the nodes in the upper abdomen, lower pelvis, and the spleen.

In general, the radiation dose depends upon the stage of HD. However, if early stage cancer is found below the diaphragm, treatment may involve chemotherapy, with or without radiation therapy.

Late-stage HD
Late-stage HD (e.g., Stage 3) in adults who do not have much involvement of the chest may be managed by total nodal irradiation, with/without liver irradiation, or chemotherapy, with/without radiation therapy to areas of bulky disease.

Widespread HD
Adults with more extensive HD (e.g., Stage 4) often will be treated with chemotherapy alone or in combination with total nodal irradiation or radiation to areas of bulky disease, or bone marrow transplantation.

Recurrent HD
If the patient experiences a relapse (the disease comes back), treatment is determined by two things: (1) the previous form of therapy, and (2) the new location of disease. If the patient was first treated with radiation therapy, usually appearing within 2 years of treatment, then chemotherapy usually is given.

Adults who were first treated with chemotherapy usually will receive radiation therapy to the lymph nodes with/without more chemotherapy. HD recurrence at more that one site may warrant higher doses of chemotherapy and consideration of bone marrow transplantation.

Children
Radiation doses are kept to a minimum in children, because radiation can impair the growth of bones, muscles, and other tissues within the treatment field. Areas with "bulky" disease (large amount of tumor) are the focus of radiation treatment. The ovaries of girls and young women are protected from radiation to avoid damage and infertility.

Children with HD or other lymphomas have special concerns. Children's cancer centers are better equipped to address these concerns and to provide optimal care and treatment of children with cancer. If your child has HD and lives in the United States, he or she should be treated at a children's hospital. There your child will be attended by specialists in childhood cancer, child psychology, pediatric nutrition, and other health professionals who cater to the unique needs of children.

Children who initially were treated with chemotherapy and have a recurrence may receive another course of chemotherapy with different drugs.

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