The main types of treatment for Hodgkin lymphoma are chemotherapy and radiotherapy. You may need to have either of these, or a combination of both.

Many people with Hodgkin lymphoma can be cured, even when the lymphoma has spread to different areas of the body.

Your doctor will plan your treatment based on the results of the staging tests (see page 16). Other factors will also be taken into account when planning your treatment,  These include:

• your age
• your general health (including any other medical conditions)
• the specific type of Hodgkin lymphoma you have
• which parts of your body are affected
• the size of affected lymph nodes and whether the lymphoma is involving other organs
• whether or not you have symptoms such as high temperatures, night sweats or weight loss.

Your doctor will explain your treatment to you and the reasons why a particular treatment has been chosen.

Radiotherapy is sometimes used on its own to treat early-stage lymphoma. Early stage means that only one or two groups of lymph nodes are affected. However, chemotherapy is now often given instead of radiotherapy in early-stage lymphoma. When Hodgkin lymphoma is more widespread, chemotherapy is nearly always the main treatment.

If Hodgkin lymphoma does not respond well to standard chemotherapy, or comes back after standard treatment, high-dose chemotherapy with stem cell support may be used.

Treatments for Hodgkin lymphoma may occasionally cause serious long-term side effects. Some chemotherapy drugs can cause permanent infertility. However, this is less likely with some newer treatments. Treatment with chemotherapy and radiotherapy can lead to a slightly increased risk of developing another cancer later in life. However, modern treatments and approaches to treating Hodgkin lymphoma are designed to limit these risks as much as possible.

In most hospitals, a team of specialists will decide the treatment that is best for you. This multidisciplinary team will include:

• chemotherapy and radiotherapy specialists (medical and clinical oncologists)
• a doctor who specialises in treating blood disorders (haematologist)
• a doctor who helps to analyse scans and x-rays (a radiologist).

The team will often also include a number of other healthcare professionals, such as a:

• nurse specialist
• pathologist (a doctor who specialises in how disease affects the body)
• dietitian
• physiotherapist
• occupational therapist
• psychologist or counsellor.

Together they will be able to advise you on the best course of action and plan your treatment.

If two treatments are equally effective for your type and stage of lymphoma, your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the side effects you might get, so that you can decide what is the right treatment for you.

Remember to ask questions about any aspects that you do not understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your doctor or specialist nurse. You can also talk to the nurses at Cancerbackup.

Before you have any treatment, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other possible other treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is important to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Many people are frightened at the idea of having cancer treatments, because of the side effects that can occur. Some people ask what would happen if they did not have any treatment.

Although the treatments can cause side effects, these can usually be well-controlled with medicines.

Treatment can be given for different reasons, and the potential benefits will vary depending upon the individual situation. Many people with Hodgkin lymphoma will be cured with treatment. However, sometimes, if the lymphoma has come back after initial treatment, any further treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some people in this situation the treatment will have no effect upon the cancer and they will get the side effects without any of the benefits.

If you have been offered treatment that aims to cure your lymphoma, deciding whether to accept the treatment may not be difficult. However, if a cure is not possible and the treatment is to control the lymphoma for a period of time, it may be more difficult to decide whether to go ahead with treatment.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.

Even though a number of cancer specialists work together as part of a team to decide on the most suitable treatment, you may want to have another medical opinion. Most doctors will be willing to refer you to another specialist for a second opinion, if you feel that it will be helpful. The second opinion can take some time to organise and may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will be helpful.

If you do go for a second opinion, it may be a good idea to take a friend or relative with you, and have a list of questions ready so that you can make sure your concerns are covered during the discussion.