Frequently Asked Questions:

Hodgkin Lymphoma

If Hodgkin lymphoma spreads from one lymph node to the next, why can’t it just be cut out?

While that seems like it should certainly be the case, operations done at the turn of the last century showed that despite often times very meticulous and extensive surgeries, removal of all obviously involved lymph nodes failed to cure the patient. That is because the naked eye can only see large accumulations of cancer cells, and not single cells, or even aggregates of thousands of cells. For that reason, while chemotherapy for Hodgkin lymphoma is considered highly effective and safe, it shrinks not just the obviously enlarged lymph nodes, but those microscopic cells that escaped the surgeon’s scalpel. In fact, it was the use of chemotherapy, and treating these less obvious sites of disease, that have had such a dramatic impact on our ability to cure the disease.

What is a PET scan, and why does my doctor want me to get one instead of a routine CT scan?

PET scans have completely revolutionized how we see lymphoma in the body, and how we determine response to treatment. PET stands for Positron Emission Tomography. The scan essentially measures how much radioactive glucose (or sugar) is taken up by the lymphoma cells. It is largely based on the fact that many lymphomas have a much higher rate of metabolism than normal cells, which can be directly measured by the amount of sugar they take up. The units of this sugar uptake are measured in SUV’s. Those diseases with higher SUVs are considered to be more metabolically active, and possibly more aggressive. The lower the SUV numbers, the lower the metabolic activity, and likely the more slowly growing the disease. Many patients worry, appropriately, about the exposure to radiation from imaging studies, and indeed, PET scans expose patients to more radiation than routine CT scans. However, recent data from many lymphoma groups around the world have shown that the ability to convert a patient’s PET scan from positive (that is, the measurement of the radioactive glucose in a tumor seen on the CT scan) to negative is one of the strongest prognostic factors known for the disease. That is, patients who convert from PET positive to PET negative do better. That does not mean that all patients who convert do well, nor that all patient who do not convert, do poorly. The information can be used to help the doctor determine if a change of treatment is warranted, and is now being used to individualize the amount of chemotherapy a patient may need to receive. Importantly, not all that glows is lymphoma on a PET scan, and it’s critical to know that many infections or inflammatory reactions can produce PET positive findings.

Can the chemotherapy used to cure my Hodgkin lymphoma impact my ability to have children?

The earliest regimens used to treat Hodgkin lymphoma, namely a regimen called MOPP chemotherapy, left many women sterile. The newer regimens, in particular ABVD, are typically less sterilizing. However, any patients’ risk of sterility is mostly a function of their age. Woman typically older than age 30 are felt to have a greater risk of sterility from chemotherapy than woman under age 30. For woman interested in preserving their sterility, it is usually recommended they see a fertility specialist prior to starting chemotherapy. Fertility specialists can usually harvest a woman’s eggs or a piece of the ovary within 2 to 3 weeks, without jeopardizing their lymphoma treatment. These eggs can be fertilized in the future, implanted into a uterus, and can result in a normal pregnancy. The process is obviously a bit easier for men, and often times, these same fertility specialists, or centers that specialize in fertility, will collect a series of samples over a few days, and store the sperm until you’re ready to have children. We routinely help patients address these important life issues before commencing with their treatment.