Stages and Treatment of Hodgkin's Lymphoma During Pregnancy

by National Cancer Institute

(Page 2 of 2)

Stages of Hodgkin's Lymphoma During Pregnancy

After Hodgkin's lymphoma during pregnancy has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.

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:

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

Stages of Hodgkin's lymphoma during pregnancy may include A, B, E, and S.

Hodgkin's lymphoma during pregnancy may be described as follows:

A: The patient has no symptoms.

B: The patient has symptoms such as fever, weight loss, or night sweats.

E: "Ev stands for extranodal and means the cancer is found in an area or organ other than the lymph nodes or has spread to tissues beyond, but near, the major lymphatic areas.

S: "S" stands for spleen and means the cancer is found in the spleen.

The following stages are used for Hodgkin's lymphoma during pregnancy:

Stage I

Stage I is divided into stage I and stage IE:

Stage I: Cancer is found in one lymph node group.

Stage IE: Cancer is found in an area or organ other than the lymph nodes.

Stage II

Stage II is divided into stage II and stage IIE:

Stage II: Cancer is found in two or more lymph node groups on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).

Stage IIE: Cancer is found in an area or organ other than the lymph nodes and in lymph nodes near that area or organ, and may have spread to other lymph node groups on the same side of the diaphragm.

Stage III

Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIS+E:

Stage III: Cancer is found in lymph node groups on both sides of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).

Stage IIIE: Cancer is found in lymph node groups on both sides of the diaphragm and in an area or organ other than the lymph nodes.

Stage IIIS: Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen.

Stage IIIS+E: Cancer is found in lymph node groups on both sides of the diaphragm, in an area or organ other than the lymph nodes, and in the spleen.

Stage III is also divided into stage III(1) and stage III(2) as follows:

Stage III(1): Cancer is found only in the upper abdomen above the renal vein.

Stage III(2): Cancer is found in lymph nodes in the pelvis and/or near the aorta.

Stage IV

In stage IV, the cancer either: is found throughout one or more organs other than the lymph nodes and may be in lymph nodes near those organs; or is found in one organ other than the lymph nodes and has spread to lymph nodes far away from that organ.

Treatment Option Overview

There are different types of treatment for pregnant patients with Hodgkin's lymphoma.

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

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.

Chemotherapy

Chemotherapy 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 waiting

Watchful 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 therapy

Steroids 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.

Treatment of Hodgkin's Lymphoma During Pregnancy

Hodgkin's Lymphoma During the First Trimester of Pregnancy

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:

• Watchful waiting when the cancer is above the diaphragm and is slow-growing. Delivery may be induced when the fetus is 32 to 36 weeks old so the mother can begin treatment.
• Radiation therapy above the diaphragm, with the fetus shielded.
• Systemic chemotherapy using one or more drugs.

Hodgkin's Lymphoma During the Second Half of Pregnancy

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:

• Watchful waiting, with plans to induce delivery when the fetus is 32 to 36 weeks old.
• Systemic chemotherapy using one or more drugs.
• Steroid therapy.
• Radiation therapy to relieve breathing problems caused by a large tumor in the chest.

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