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Hodgkin's Lymphoma During Pregnancy
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.
- Night sweats.
- 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.
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
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.
To Learn More
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer
Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday
from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call
1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to
answer your questions.
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