• ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens): The chemotherapy recipes that cure most Hodgkin lymphoma: ABVD (four drugs, the long-standing standard), the more intensive German BEACOPP, and newer versions that replace bleomycin with brentuximab vedotin (A+AVD) or add nivolumab (N-AVD).
• Reed-Sternberg cell: The Reed-Sternberg cell is the giant, often two-nucleus cancer cell of Hodgkin lymphoma; it makes up only about 1% of the tumour, and the rest is immune cells it has recruited.
• After Hodgkin lymphoma: the late effects, and the screening that follows them: Most people treated for Hodgkin lymphoma are cured, and the long follow-up cohorts show that the treatment leaves a raised risk of heart disease, of a second cancer and of an underactive thyroid for decades.
• Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them: Hodgkin lymphoma is usually cured, and the problems that follow arrive twenty and thirty years later: heart disease, an underactive thyroid, and second cancers, especially breast cancer in women irradiated to the chest when young.
• Cardiotoxicity (LVEF decline, cardiomyopathy): Heart damage from cancer treatment: anthracyclines weaken the heart muscle permanently in a dose-related way, trastuzumab does so reversibly, and some kinase inhibitors raise blood pressure or disturb rhythm.
• British and American lymphoma practice: where they differ, and why: The same trials are read in both countries and reach different conclusions, because the British system asks what a treatment costs for the benefit it gives and the American one asks whether it is better at all.
• Deauville five-point scale: A 1-to-5 score for how bright a lymphoma looks on PET compared with the liver; 1-3 is considered a complete metabolic response.
• Fertility before lymphoma treatment: what to ask for, and when: Several lymphoma treatments can end fertility, and the chance to preserve it exists only before the first dose.
• Fertility preservation before lymphoma treatment: a decision with a deadline in days: Most of the ways of preserving fertility have to happen before the first dose of chemotherapy, and two of them take about a fortnight.
• Secondary malignancy (therapy-related cancer): A new, different cancer caused by the treatment of the first one: leukaemia after alkylating chemotherapy or PARP inhibitors, solid tumours in irradiated tissue decades later, and rarely T-cell lymphoma after CAR-T.

Staging: FDG-PET/CT with Lugano staging; bone marrow biopsy no longer needed when PET is used; fertility counselling and cardiac baseline.

Biomarker results to ask for: Interim FDG-PET after two cycles (Deauville score; guides omission of radiotherapy), CD30 and CD15 on Hodgkin and Reed-Sternberg cells; CD20 usually negative, Bulky disease, erythrocyte sedimentation rate, B symptoms and number of sites (GHSG and EORTC risk factors), EBV status (EBER) in mixed cellularity disease, Baseline metabolic tumour volume (prognostic, research), Circulating tumour DNA (research; PhasED-seq).

Scans and tests linked to this cancer: FDG PET, Mammography & tomosynthesis, Multidisciplinary tumour boards, PET-adapted (response-adapted) therapy, ctDNA monitoring in lymphoma (PhasED-seq, clonoSEQ).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• Early favourable disease: Two cycles of ABVD with 20 Gy involved-site radiotherapy (HD10); or PET-adapted chemotherapy alone (three ABVD if PET-negative after two, RAPID and H10) accepting a small increase in relapse. (Doxorubicin, Vinblastine, Dacarbazine, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), IMRT / IGRT (modern external beam), PET-adapted (response-adapted) therapy, Deauville five-point scale)
• Early unfavourable disease: Four cycles of ABVD (or two escalated BEACOPP plus two ABVD) with 30 Gy involved-site radiotherapy; radiotherapy omitted in PET-negative patients after HD17. (Doxorubicin, Vinblastine, Dacarbazine, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), IMRT / IGRT (modern external beam), PET-adapted (response-adapted) therapy)
• Children and adolescents: Response-adapted Children's Oncology Group regimens with radiotherapy for slow responders; AHOD2131 tests brentuximab vedotin with nivolumab. (AHOD2131 (COG / NCTN), Brentuximab vedotin, Nivolumab, Children's Oncology Group (COG))
• Early favourable Hodgkin lymphoma: two cycles of ABVD and 20 Gy, and the argument about leaving the radiotherapy out: GHSG HD10 established the smallest combined-modality treatment that works: two cycles of ABVD followed by 20 Gy involved-field radiotherapy gave five-year freedom from treatment failure of about 93 per cent and overall survival of about 97 per cent, with no advantage from four cycles or from 30 Gy, and fewer acute adverse events at the lower intensity. Four visits of chemotherapy and a fortnight of radiotherapy cure the great majority. Whether the radiotherapy can be dropped in patients whose PET is negative has been asked twice, and both answers were the same. HD16 randomised 1,150 patients: among 628 who were PET-negative after two cycles, five-year progression-free survival was 93.4 per cent with combined-modality treatment against 86.1 per cent with ABVD alone (difference 7.3 percentage points, hazard ratio 1.78), with five-year overall survival of 98.1 and 98.4 per cent. RAPID randomised patients whose PET was negative after three cycles and found three-year progression-free survival of 94.6 per cent with radiotherapy against 90.8 per cent without, with no difference in overall survival and non-inferiority not formally shown. So omitting radiotherapy costs a few percentage points of disease control and costs nothing in survival, while avoiding a field over the heart, breasts, thyroid and lungs in a person who will live another fifty years. It is a genuine choice and it is made differently by different patients and different countries. A Deauville score of 4 on the interim PET predicts a much higher risk of failure than a score of 3, and those patients keep the radiotherapy. (GHSG HD10: reduced treatment intensity in early-stage favourable Hodgkin lymphoma, RAPID: PET-directed therapy for early-stage Hodgkin lymphoma, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Doxorubicin, Bleomycin, Vinblastine, Dacarbazine, IMRT / IGRT (modern external beam), Deauville score and PET-adapted therapy, FDG PET, Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy, Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them)
• Early unfavourable Hodgkin lymphoma: more chemotherapy, and PET-guided intensification: Early-stage disease with risk factors (a large mediastinal mass, extranodal involvement, a raised erythrocyte sedimentation rate, three or four or more nodal areas, or age 50 or over depending on the criteria used) is treated with four cycles of chemotherapy and involved-site radiotherapy at 30 Gy, or with more intensive chemotherapy in place of some of it. EORTC/LYSA/FIL H10 randomised 1,950 patients and settled the PET-adapted question in both directions. In the 18.8 per cent whose PET after two cycles of ABVD was positive, switching to two cycles of escalated BEACOPP with involved-node radiotherapy raised five-year progression-free survival from 77.4 to 90.6 per cent (hazard ratio 0.42). In PET-negative patients, non-inferiority of ABVD alone could not be demonstrated in either the favourable group (99.0 against 87.1 per cent for combined-modality treatment) or the unfavourable group (92.1 against 89.6 per cent), so omitting radiotherapy again costs disease control. Brentuximab vedotin with AVD is an option for unfavourable early-stage disease in some guidelines, and AHOD2131, an international trial in patients aged 5 to 60 with stage I to II disease, is testing response-adapted brentuximab vedotin with nivolumab against standard therapy with or without radiation. That trial is the one most likely to change this row next. (AHOD2131 (COG / NCTN), ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Brentuximab vedotin, Nivolumab, Doxorubicin, Bleomycin, Vinblastine, Dacarbazine, Etoposide, Cyclophosphamide, Procarbazine, IMRT / IGRT (modern external beam), FDG PET, Deauville score and PET-adapted therapy, Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy)
• Children, adolescents and young adults with early-stage Hodgkin lymphoma: Paediatric protocols differ from adult ones in two ways that matter: they use response-adapted designs to remove radiotherapy from as many children as possible, and they avoid or limit the agents with the worst late effects in a growing body, particularly alkylating agents and chest radiotherapy. Children's Oncology Group and EuroNet protocols give a short course of multi-agent chemotherapy, assess response with PET after two cycles, and give involved-site radiotherapy only to sites that have not responded adequately. The aim is to cure more than 95 per cent of children with the smallest cumulative dose of anthracycline, alkylator and radiation they can be cured with. AHOD1331 showed the direction of travel in high-risk paediatric disease: replacing bleomycin with brentuximab vedotin gave three-year event-free survival of 92.1 per cent against 82.5 per cent (hazard ratio 0.41), with three-year overall survival of 99.3 against 98.5 per cent, similar toxicity and a similar proportion receiving radiotherapy (53.4 against 56.8 per cent). AHOD2131 is now testing brentuximab vedotin with nivolumab against standard therapy in early-stage disease across the ages of 5 to 60, which is unusual and deliberate: adolescents and young adults have historically fallen between paediatric and adult trials and done worse for it. Growth, fertility, thyroid function, cardiac function and psychological support are part of the treatment plan from the first appointment, not the end of it. (AHOD1331: brentuximab vedotin with chemotherapy in paediatric high-risk Hodgkin lymphoma, AHOD2131 (COG / NCTN), Brentuximab vedotin, Nivolumab, Bleomycin, Doxorubicin, IMRT / IGRT (modern external beam), FDG PET, Fertility before lymphoma treatment: what to ask for, and when, Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them)
• Survivorship: Cardiac surveillance, breast screening from eight years after chest radiotherapy in women, thyroid checks and second-cancer awareness for life. (Cardio-oncology, Mammography & tomosynthesis, Late effects and survivorship toxicity)

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.