Hodgkin's Disease - Staging and Treatment Guidelines

Treatment

Treatment options depend on:

• Type of Hodgkin’s disease
• Tumor stage, size, and location
• Patient’s age and overall health status
• Presence or absence of “B symptoms” (weight loss, persistent fever, night sweats)

Certain factors may determine whether more intensive treatment is required. For example, the presence of B symptoms and “bulky” (large mass) tumors usually indicates a more aggressive treatment approach.

Chemotherapy, radiation, or both (chemoradiation) are the main treatments for Hodgkin’s disease. Stem cell transplantation may be recommended for patients whose cancer has recurred.

Staging

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Hodgkin’s disease is staged (I through IV) depending on how far the cancer has spread. Staging is the primary method for determining both treatment options and prognosis.

Stage I. Disease is limited to a single node region (I) or has involved one neighboring area or a single nearby organ.

Stage II. Disease is limited to two or more lymph nodes on the same side of (above or below) the diaphragm or extends locally from the lymph node into a nearby organ.

Stage III. Disease is in lymph nodes on both sides of the diaphragm or has spread to nearby organs, the spleen, or both.

Stage IV. Disease has become widespread involving organs outside the lymph system, such as liver, lung, or bone marrow.

Treatment Options by Stage

Early Stages (I or II). For disease in stages I or II, the following treatments may be used:

• Treatment in Adults. Doctors usually recommend chemotherapy and sometimes radiation therapy as the first-line treatments for adults with Hoddkin's. Treatment provides excellent remission rates, although it may produce serious long-term complications in some patients. Select patients in early stages may also be candidates for radiation limited only to areas above the diaphragm (called the mantle field).
• Treatment in Children. Chemotherapy and low-dose radiation is the standard treatment for most children and adolescents who have not reached full growth. Specific chemotherapy combinations have been developed to reduce the risks for infertility, leukemia, and toxic effects on the heart and lungs.