Last Modified : 2005-09-15
Hodgkin’s lymphoma is a cancer that develops in the lymph system, part of the body’s immune system. The lymph system is made up of the following:
Because lymph tissue is found throughout the body, Hodgkin’s lymphoma can begin in almost any part of the body and spread to almost any tissue or organ in the body.
Lymphomas are divided into two general types: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. This summary is about Hodgkin’s lymphoma during pregnancy. Refer to the following PDQ summaries for more information:
Hodgkin's lymphoma in pregnant women is the same as the disease in nonpregnant women of childbearing age. However, treatment is different for pregnant women.
Age and Epstein-Barr infection can affect the risk of developing Hodgkin's lymphoma during pregnancy.Risk factors for Hodgkin's lymphoma include the following:
Pregnancy is not a risk factor for Hodgkin's lymphoma.
Possible signs of Hodgkin's lymphoma include swollen lymph nodes, fever, and night sweats.These and other symptoms may be caused by Hodgkin's lymphoma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems do not go away:
The following tests and procedures may be used:
The prognosis (chance of recovery) depends on the stage of the cancer (the number of lymph node groups affected and the number of places outside of the lymph nodes to which the cancer has spread). Most pregnant patients with newly diagnosed Hodgkin’s lymphoma can be cured.
Treatment options depend on the following:
The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
To protect the fetus from the harms of radiation, tests that do not use radiation are used in the staging process. These include:
Hodgkin's lymphoma during pregnancy may be described as follows:
Stage I is divided into stage I and stage IE:
Stage II is divided into stage II and stage IIE:
Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIS+E:
Stage III is also divided into stage III(1) and stage III(2) as follows:
In stage IV, the cancer either:
Different types of treatment are available for pregnant patients with Hodgkin’s lymphoma. Treatment is carefully chosen to protect the fetus. Treatment decisions are based on the mother’s wishes, the stage of the Hodgkin’s lymphoma, and the age of the fetus. The treatment plan may change as the symptoms, cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Four types of standard treatment are used:Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
To avoid any risk to the fetus, radiation therapy should be postponed until after delivery, if possible. If immediate treatment is needed, pregnant women with Hodgkin’s lymphoma may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the fetus may not protect it from scattered radiation that could possibly cause cancer in the future.
ChemotherapyChemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
The fetus cannot be protected from being exposed to chemotherapy when the mother is treated. Some chemotherapy regimens may cause birth defects when given in the first trimester. Vinblastine is an anticancer drug that has not been linked with birth defects in the second half of pregnancy.
Watchful waitingWatchful waiting is closely monitoring a patient’s condition without giving any treatment unless symptoms appear or change. Delivery may be induced when the fetus is 32 to 36 weeks old, so that the mother can begin treatment.
Steroid therapySteroids are hormones naturally produced in the body by the adrenal glands and by reproductive organs. Some types of steroids are made in a laboratory. Certain steroid drugs have been found to help chemotherapy work better and help stop the growth of cancer cells. Steroids can also help the lungs of the fetus develop faster than normal. This is important when delivery is induced early.
When Hodgkin’s lymphoma is diagnosed in the first trimester of pregnancy, it does not necessarily mean that the patient will be advised to end the pregnancy. Each patient's treatment will depend on the stage of the lymphoma, how fast it is growing, and the patient's wishes. For women who choose to continue the pregnancy, treatment of Hodgkin’s lymphoma during the first trimester of pregnancy may include the following:
When Hodgkin’s lymphoma is diagnosed in the second half of pregnancy, most patients can delay treatment until after the baby is born. Treatment of Hodgkin’s lymphoma during the second half of pregnancy may include the following: