Director, Maimonides Cancer Center
Vice Chair & Clinical Director, Radiation Oncology
Radiation Therapy for Hodgkin's Lymphoma
Facts About Hodgkin's Lymphoma
The lymphatic system is a network of thin tubular vessels that branches out to almost all parts of the body. Scattered in between these vessels are lymph nodes. The job of the lymphatic system is to fight infection and disease. Cancer of the lymphatic system is called lymphoma. Hodgkin's is one of two main types of lymphoma with non-Hodgkin's being the other.
- Hodgkin's lymphoma (Hodgkin's disease) commonly affects lymph nodes in the neck or in the area between the lungs behind the breastbone. It can also begin in groups of lymph nodes under the arms, in the abdomen or in the groin.
- It's named after the British doctor Thomas Hodgkin who first described the disease in 1832. According to the American Cancer Society, nearly 64,000 new cases of lymphoma will be diagnosed this year. This includes 7,350 cases of Hodgkin's lymphoma.
- Hodgkin's lymphoma is very treatable and often curable. Eighty-five percent of patients with Hodgkin's live longer than five years after diagnosis.
Risk Factors for Hodgkin's Lymphoma
The cause of Hodgkin's lymphoma is unknown. However, doctors believe immune system problems as well as age may increase a person's chance of developing this disease.
- Hodgkin's lymphoma has two peak time frames: between the ages of 15 and 40 and in people over age 55. However, the disease can affect anyone.
- Males are typically more at risk of developing Hodgkin's lymphoma.
- Those who have been infected with the Epstein-Barr virus are more likely to develop Hodgkin's lymphoma.
- Having a parent or sibling with Hodgkin's lymphoma also increases risk of the disease.
Signs and Symptoms of Hodgkin's Lymphoma
The signs and symptoms of lymphoma are not specific and may also be associated with other, noncancerous conditions. Talk to your doctor if you have any of these problems.
- Swollen lymph nodes in the neck, underarm or groin.
- Unexplained fevers.
- Drenching night sweats.
- Unexplained weight loss.
- Constant fatigue.
- Skin rash or itchy skin.
Unexplained fevers, night sweats and weight loss are known as “B” symptoms. Ask your doctor about their significance in your case.
Diagnosing Hodgkin's Lymphoma
To see if you have Hodgkin's lymphoma, your doctor will first examine you to assess your overall health and look for anything unusual. He or she may also perform some or all of the following tests.
- The doctor will order blood tests to evaluate a variety of factors, including the number of blood cells in your blood and how well your liver and kidneys are working.
- During a lymph node biopsy, your doctor will perform surgery to take out a lymph node. It will then be examined under a microscope to look for cancer.
- Several imaging tests will be performed to see if lymphoma has spread to other organs. These tests may include CT, PET or gallium scans.
Staging of Hodgkin's Lymphoma
The stage of cancer is a term used to describe its size and whether it has spread. Knowing this helps doctors plan the best treatment.
- Stage I: Single lymph node or non-lymph node region is affected.
- Stage II: Two or more lymph node or non-lymph node regions are affected on the same side of the diaphragm (the muscle under the lungs).
- Stage III: Lymph node or non-lymph node regions above and below the diaphragm are affected.
- Stage IV: The cancer has spread outside the lymph nodes to organs such as the liver, bones or lungs. Stage IV can also refer to a tumor in another organ and/or tumors in distant lymph nodes.
Treatment Options for Hodgkin's Lymphoma
Treatment options depend on the type of lymphoma, its stage and your overall health. Treatment may include chemotherapy or radiation therapy, either alone or in combination. It may help to talk to several cancer specialists before deciding on the best course of treatment for you, your cancer and your lifestyle.
- A radiation oncologist is a doctor who specializes in destroying cancer cells with high energy X-rays or other types of radiation.
- A medical oncologist is a doctor who is an expert at prescribing special drugs (chemotherapy) to treat cancer. Some medical oncologists are also hematologists, meaning they have experience treating blood problems.
Understanding Radiation Therapy
Radiation therapy, also called radiotherapy, is the careful use of radiation to safely and effectively kill cancer cells while avoiding nearby healthy tissue.
- Radiation oncologists use radiation therapy to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
- Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells are destroyed by the radiation, the body naturally eliminates them.
- Healthy tissues can also be affected by radiation, but they are usually able to repair themselves in a way cancer cells cannot.
External Beam Radiation Therapy
External beam radiation therapy is a series of outpatient treatments to accurately deliver radiation to the cancer cells. Radiation therapy has been proven to be very successful at treating and curing Hodgkins lymphoma.
- Radiation oncologists deliver external beam radiation therapy to the lymphoma from a machine called a linear accelerator.
- Each treatment is painless and is similar to getting an X-ray. Treatments last less than 30 minutes each, every day except for Saturday and Sunday, for three to four weeks.
- Involved field radiation is when your doctor delivers radiation only to the parts of your body known to have cancer. It is often combined with chemotherapy. Radiation above the diaphragm to the neck, chest and/or underarms is called mantle field radiation. Treatment below the diaphragm to the abdomen, spleen and/or pelvis is called inverted-Y field radiation.
- Your radiation oncologist may deliver radiation to all the lymph nodes in the body to destroy cancer cells that may have spread to other lymph nodes. This is called total nodal irradiation.
- Your radiation oncologist may also deliver radiation to the entire body. This is called total body irradiation. It is often done before chemotherapy and a stem cell or bone marrow transplant to eliminate any remaining cancer cells and create space for the new stem cells.
Potential Side Effects
The side effects you may experience will depend on the part of the body being treated, the dose of radiation given and if you also receive chemotherapy. Ask your doctor before treatment begins about possible side effects, and how best to manage them.
- You may experience very few or no side effects and can continue your normal routine during treatment.
- You may experience mild skin irritation, hair loss, sore throat, upset stomach, loose bowel movements, nausea and/or fatigue. Most side effects will go away after treatment ends.
- Tell your doctor or nurse if you experience any discomfort. They may be able to prescribe medication or change your diet to help.
- Hodgkins lymphoma is often curable, allowing many people with the disease to live long lives after treatment. In some very rare cases, the treatments that cured the cancer may lead to significant after effects. Talk to your doctor about the risks of your treatment.