What types of treatment are used?

Types of treatment

The main types of treatment for Hodgkin’s disease are chemotherapy and radiotherapy. You may need to have either of these, or a combination of both.

Many people with Hodgkin’s disease can be cured, even when the disease has spread to different areas of the body

Your treatment will be planned by a team of specialist doctors and will be based on the results of the staging tests. Many factors will be taken into account when planning your treatment. These include:

• your age
• your general health (including any other medical conditions)
• the specific type of Hodgkin’s disease you have
• which parts of your body it is affecting
• the size of affected lymph nodes and whether the lymphoma is involving other organs
• whether or not you have symptoms such as fevers, night sweats or weight loss.

Your doctor will explain your treatment to you and the reasons why a particular treatment has been chosen.

Radiotherapy can be used on its own to treat early-stage lymphoma (when only one or two groups of lymph nodes are affected). However, chemotherapy is now often given as well as radiotherapy in early-stage lymphoma. When Hodgkin’s disease is more widespread, chemotherapy is nearly always the main treatment.

If Hodgkin’s disease does not respond well to standard chemotherapy, or comes back after standard treatment, high dose chemotherapy with stem cell support.

Treatments for Hodgkin’s disease may occasionally result in serious long-term side effects. Some chemotherapy drugs can cause permanent infertility although newer treatments carry less risk of this. Treatment with chemotherapy and radiotherapy can lead to a slightly increased risk of developing another cancer later in life. However, modern treatments and approaches to treating Hodgkin’s disease are designed to limit these risks as much as possible.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment and to take some notes during the discussion.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.

It is essential to tell a doctor, or the nurse in charge, immediately so that he or she can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

If you have any questions about your own treatment, don’t be afraid to ask your doctor or the nurse looking after you.

Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion if you feel this will be helpful. However, a second medical opinion may take some time to arrange and could delay the start of your treatment, so you need to be sure that it will be helpful to you.

The benefits and disadvantages of treatment

Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. Some people ask what would happen if they did not have any treatment.

Although many of the treatments can cause side effects, knowledge about how these treatments affect people and improved ways of reducing or avoiding many of these side effects have made most of the treatments much easier to cope with.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. Nowadays most people with Hodgkin’s disease will be cured. Treatment usually involves chemotherapy (with or without radiotherapy), although some people with very early-stage Hodgkin’s disease may be treated by radiotherapy alone.

If the lymphoma has come back after treatment, further treatment may often lead to a cure. However, for some people with advanced Hodgkin’s disease treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. For some people in this situation the treatment will have no effect upon the lymphoma and they will get the side effects without any of the benefit.

If you have been offered treatment that aims to cure the lymphoma, deciding whether to accept the treatment may not be difficult. However, if the lymphoma has come back and a cure is not likely and the treatment is being given to control the lymphoma for a period of time, it may be more difficult to decide whether to go ahead with treatment.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms