There are different types of treatment for patients with adult Hodgkin's lymphoma.

Different types of treatment are available for patients with adult Hodgkin's lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. 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.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Patients with Hodgkin's lymphoma should have their treatment planned by a team of doctors with expertise in treating lymphomas.

Treatment will be overseen by a medical oncologist, a doctor who specializes in treating cancer. The medical oncologist may refer you to other doctors who have experience and expertise in treating adult Hodgkin's lymphoma and who specialize in certain areas of medicine. These may include the following specialists:

• Neurosurgeon.
• Neurologist.
• Rehabilitation specialist.
• Radiation oncologist.
• Endocrinologist.
• Hematologist.
• Other oncology specialists.

Three types of standard treatment are used:

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. 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 chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment with more than one anticancer drug.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Surgery

Laparotomy is a procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken for biopsy. If cancer is found, the tissue or organ is removed during the laparotomy.

Other types of treatment are being tested in clinical trials. These include the following:

High-dose chemotherapy and radiation therapy with stem cell transplantation

High-dose chemotherapy and radiation therapy with stem cell transplantation is a method of giving high doses of chemotherapy and radiation therapy and replacing blood-forming cells destroyed by the cancer treatment. 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 therapy is completed, 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.

Clinical trials comparing new methods of treatment

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

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Treatment Options by Stage

Stage I Adult Hodgkin's Lymphoma

Treatment of stage I depends on whether the patient has stage IA (without symptoms) or stage IB (with symptoms) and where the cancer is.

• Stage IAIf the cancer is above the diaphragm and does not involve a large part of the chest, treatment may include the following:
  • Combination chemotherapy with or without radiation therapy.
  • Radiation therapy to lymph nodes in the mantle field (neck, chest, and armpits), including those near the aorta, with radiation therapy to the spleen if laparotomy is not done.
  • Radiation therapy to the mantle field, with or without laparotomy.
  • A clinical trial of combination chemotherapy with or without radiation therapy.

  If the cancer is above the diaphragm and does involve a large part of the chest, treatment may include the following:

  • Combination chemotherapy and radiation therapy to the mantle field (neck, chest, and armpits).
  • A clinical trial of combination chemotherapy with or without radiation therapy.

  If the cancer is below the diaphragm, treatment may include the following:

  • Radiation therapy to the groin.
  • Combination chemotherapy with radiation therapy to involved areas.
  • A clinical trial of chemotherapy.

• Stage IB. Treatment of stage IB is usually combination chemotherapy with or without radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Stage II Adult Hodgkin's Lymphoma

Treatment of stage II depends on whether the patient has stage IIA (without symptoms) or stage IIB (with symptoms) and where the cancer is.

• Stage IIA If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may include the following:
  • Combination chemotherapy with or without radiation therapy.
  • Radiation therapy to lymph nodes in the mantle field (neck, chest, and armpits), including those near the aorta, with radiation to the spleen if laparotomy is not done.
  • Radiation therapy to the mantle field with or without laparotomy.
  • A clinical trial of combination chemotherapy with or without radiation therapy.

  If the cancer is above the diaphragm and does involve a large part of the chest, treatment may include the following:

  • Combination chemotherapy and radiation therapy to the mantle field.
  • A clinical trial of combination chemotherapy with or without radiation therapy.
• Stage IIB. Treatment of stage IIB may include the following:
  • Combination chemotherapy with or without radiation therapy.
  • A clinical trial of combination chemotherapy with or without radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Stage III Adult Hodgkin's Lymphoma

Treatment of stage III depends on whether the patient has stage IIIA (without symptoms) or stage IIIB (with symptoms) and where the cancer is.

• Stage IIIA If the cancer does not involve a large part of the chest, treatment may include the following:
  • Combination chemotherapy with or without radiation therapy.
  • A clinical trial of combination chemotherapy with or without radiation therapy.

  If the cancer does involve a large part of the chest, treatment may include the following:

  • Combination chemotherapy with radiation therapy.
  • A clinical trial of combination chemotherapy with or without radiation therapy.
  • A clinical trial of combination chemotherapy and stem cell transplantation.

• Stage IIIB. Treatment of stage IIIB may include the following:
  • Combination chemotherapy with or without radiation therapy.
  • A clinical trial of combination chemotherapy with or without radiation therapy.
  • A clinical trial of combination chemotherapy and stem cell transplantation.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Stage IV Adult Hodgkin's Lymphoma

Treatment of stage IV may include the following:

• Combination chemotherapy.
• A clinical trial of combination chemotherapy with or without radiation therapy.
• A clinical trial of chemotherapy and stem cell transplantation.
• A clinical trial of new treatment options.