Hodgkin's Lymphoma During Pregnancy
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General Information
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.
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What is Hodgkin's lymphoma?
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.)
A doctor should be seen if any of the following symptoms persist for longer
than 2 weeks:
- Painless swelling of the lymph nodes in the neck, underarm, or
groin.
- Fever.
- Night sweats.
- Tiredness.
- Weight loss without dieting.
- Itchy
skin.
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.
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Description
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.
This information is provided from the PDQ® database in collaboration with the NCI.
