Once your Hodgkin lymphoma is in remission, you'll need to visit your doctor for regular follow-up care. He or she monitors your health and looks for signs that you may need more treatment. You'll likely undergo chest X-rays and computed tomography (CT) scans of the abdomen to detect relapsed disease. Some treatments can cause long-term effects or late effects.
Not everyone suffers from long-term and late effects of treatment, but for some patients the effects can range from mild to severe. Your risk for developing long-term or late effects can be influenced by:
- your treatment type and duration
- your age at the time of treatment
- your gender
- your overall health
Your doctor will let you know how often you need physical exams and other tests. Hodgkin lymphoma survivors are advised to follow these guidelines:
- Keep a record of treatments received.
- Get a blood test every five years to measure your cholesterol levels if you were treated with chest radiation.
- Get regular screenings for heart disease.
- Get regular screenings for cancer.
- Get an early baseline mammogram (within 10 years after therapy or by age 25) and then regular mammograms every two to three years if you were treated with chest radiation. Perform monthly breast self-exams.
- Get regular lung cancer screenings if you were treated with chest radiation. If you smoke, quit; besides increasing your chances of lung cancer, smoking after radiation therapy raises your risk of developing acute myeloid leukemia and myelodysplastic syndromes.
- Get your thyroid function checked regularly.
- Seek medical and psychosocial support for fatigue, depression and other long-term effects if you need it.
If you continue to show no signs of Hodgkin lymphoma and long-term or late effects, your doctor may suggest longer periods between visits.
The National Comprehensive Cancer Network (NCCN) produces Clinical Practice Guidelines in Oncology for most cancers, which many doctors follow. Their guidelines are among the most comprehensive and most frequently updated clinical practice guidelines available in any area of medicine. You can download guidelines at the NCCN website for helpful information about Hodgkin lymphoma to discuss with your doctor.
Some treatment centers have comprehensive follow-up care clinics for cancer survivors. To find a long-term survival clinic near you, visit The National Coalition for Cancer Survivorship.
Long-Term and Late Effects of Radiation Therapy
Patients treated for Hodgkin lymphoma 15 to 20 years ago received aggressive radiation therapy even in stages I and II. Doctors have monitored the treatment's long-term and late effects and linked the therapy to a risk of developing a second cancer. Fortunately, patients are no longer exposed as often to the extended field radiation they were years ago so the risk of developing another cancer isn't as high as it once was. However, it's still considered a serious risk.
The degree of the risk depends on the radiation's extent and dose. Second cancers, especially cancers of the breast, lung, stomach, bone and soft tissues, have appeared as soon as five years and as late as 30 years after radiation therapy.
The following are known risks to people treated with radiation therapy for Hodgkin lymphoma:
- Girls and women under age 30 who had radiation to the breast area are at risk for developing breast cancer 15 to 20 years after treatment.
- Patients who had chest radiation have a higher chance of developing lung cancer, especially when the treatment followed chemotherapy with the drug bleomycin (the "B" in ABVD). Nonsmokers who received chest radiation have four times the risk of lung cancer than the general population; smokers have as much as 25 to 40 times increased risk.
- Radiation therapy has been linked to heart disease, including inflammation of the sac surrounding the heart (pericardium) and heart attack.
- Radiation therapy can injure the thyroid gland, causing decreased thyroid function (hypothyroidism).
Long-Term and Late Effects of Chemotherapy
Some side effects of chemotherapy, such as fatigue and depression, can linger for months or years after treatment. Other medical conditions like heart disease and other cancers may not appear until years after treatment ends.
Long-term and late effects can impact your physical, mental and cognitive (brain function) health in several ways, including:
- heart or thyroid problems
- a secondary cancer
- a low energy level
- hearing loss
- posttraumatic stress disorder
- an inability to concentrate or focus
Researchers are working to improve their understanding of long-term and late effects and create guidelines for follow-up care. If you'd like to contribute to this important research, you can take part in a clinical trial that collects data on long-term and late effects.