Posted Date: Jan 9, 2003
Note: A separate PDQ® summary on Adult Hodgkin's Lymphoma Treatment is also available.
This summary discusses the treatment of Hodgkin's lymphoma during pregnancy.
Hodgkin's lymphoma is a type of lymphoma. Lymphomas are cancers that develop in the lymph system, part of the body's immune system.
The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains white blood cells called lymphocytes. Along the network of vessels are groups of small organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen. The lymph nodes make and store infection-fighting cells. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat) are also part of the lymph system.
Because there is lymph tissue in many parts of the body, Hodgkin's lymphoma can start to grow in almost any part of the body. The cancer can spread to almost any organ or tissue in the body, including the liver, bone marrow (the spongy tissue inside the large bones of the body that makes blood cells), and spleen.
Lymphomas are divided into 2 general types: Hodgkin's lymphoma and non-Hodgkin's lymphomas. The cancer cells in Hodgkin's lymphoma look a certain way under a microscope. (Refer to the PDQ® summaries on Adult Non-Hodgkin's Lymphoma Treatment and Childhood Non-Hodgkin's Lymphoma Treatment for more information.)
If symptoms are present, a doctor will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes do not feel normal, a doctor may need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy.
The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is in just one area or has spread throughout the body), the size of the swollen areas, the results of blood tests, the type of symptoms, and the patient's age, sex, and overall condition.
Hodgkin's lymphoma most commonly affects young adults and, therefore, young women may be diagnosed with the disease when they are pregnant. Treatment for Hodgkin's lymphoma during pregnancy is chosen carefully so that the fetus is put in as little danger as possible. When treatment is being planned, the wishes of the patient, the seriousness and aggressiveness of the disease, and the number of months remaining in the pregnancy are also considered. The treatment plan may change as the symptoms, cancer, and pregnancy change.
Women who are in the first trimester of pregnancy are usually advised to end the pregnancy. Women who choose to continue pregnancy may delay treatment until the baby is delivered if the disease is slow growing and located above the diaphragm (above the stomach). If immediate treatment is needed for Hodgkin's lymphoma, women may choose to receive radiation therapy or chemotherapy. Both radiation therapy and chemotherapy can cause harm to the fetus. In most cases, the fetus can be protected from exposure to radiation therapy with proper shielding. The fetus can not be protected against exposure to chemotherapy (using drugs to kill cancer cells), and some chemotherapy regimens may cause birth defects.
Most patients in the second half of pregnancy can delay treatment until the baby is induced at 32 to 36 weeks. Treatment for Hodgkin's lymphoma can begin shortly after the baby is born. Patients with advanced Hodgkin's lymphoma may require treatment before the baby is delivered. These patients may receive steroids (designed to fight tumor growth and help lung development in the fetus), radiation therapy, and/or chemotherapy. Because some chemotherapy regimens may cause birth defects, single-drug chemotherapy regimens are usually given. More extensive chemotherapy is usually given once the baby has been delivered. If the patient's breathing is being affected by a large tumor in the chest, a short course of radiation therapy can be given before delivery.
Women who have been treated for Hodgkin's lymphoma during pregnancy appear to have survival rates similar to women who were treated while not pregnant. The long-term effects of anticancer treatment on the children of these women is not yet known; however, the risk does not appear to be significant.
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