Surgical Procedures: Surgery and Staging for Adult Hodgkin Lymphoma

Your lymphatic system is made up of:

• Lymph fluid, lymph vessels, and lymph nodes.
• Your spleen, thymus, and tonsils.
• Your bone marrow.
• Lymphatic tissue is also found in organs such as the stomach, thyroid, brain, and skin. 

Your lymph system helps manage fluid volume and fight disease.

When there are malignant (cancer) cells in your lymphatic system, it is called “lymphoma.” There are many types of lymphoma. Hodgkin lymphoma is diagnosed based on certain traits in the cells.

What is staging and how is it done?

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may include:

• Physical Exam:  This is an exam to look at your body and to talk about past health issues.
• Blood Work: Your provider may have you get your blood drawn to check a complete blood count (CBC), blood chemistries, and sedimentation rate.
• Radiologic Imaging: Radiology tests look inside your body to see if the cancer has spread. These tests can include: 
  • CAT scan (CT scan).
  • Positron emission tomography scan (PET scan).
  • Magnetic resonance imaging (MRI).
  • Ultrasound.
• Procedures, such as:
  • Biopsy:  A biopsy takes cells from the cancer to see what type of cancer it is and how it behaves. A doctor called a pathologist looks at the sample under a microscope.
    • Incisional biopsy: A small part of the lymph node is removed for testing.
    • Core biopsy:  A larger part of the lymph node tissue is removed using a thick needle.
    • Excisional biopsy: The whole lymph node is removed.
    • Bone marrow aspiration & biopsy: A hollow needle is inserted into the breastbone or hipbone to remove (aspirate) bone marrow, blood, and bone for testing.

Hodgkin lymphoma spreads to other parts of the body through the tissue, lymph, and blood systems. These lymphomas are described as stages I-IV, A, B, E, and S based on clinical and physical findings. Your care team will talk to you about your stage and treatment plan.

Part of your treatment plan may include surgery. Surgery is not often used to treat Hodgkin lymphoma itself, but may be used to look for cancer or to remove organs that are affected:

• Exploratory Laparotomy:  This is surgery to look at the organs inside your belly. Biopsy and/or removal of organs may be needed.
• Splenectomy: Removal of the spleen. Read more about  splenectomy here.

For Hodgkin Lymphoma that comes back (recurrence), surgery may be used after chemotherapy (called neoadjuvant therapy). This is still being studied.

What are the risks of surgery to treat Hodgkin Lymphoma?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions may be wheezing, rash, swelling and low blood pressure).
• Damage to other organs.
• Bleeding.
• Blood clots.
• Infection.
• Urinary retention (not being able to pee on your own).
• Scar tissue.
• Belly pain.

What is recovery like?                                 

Recovery from surgery to treat Hodgkin lymphoma depends on the extent and type of the procedure you have had. A hospital stay may be needed.

You will be told how to care for your incision (surgical cut) before leaving the hospital.

Your medical team will go over the medications you will be taking, such as those for pain, blood clot prevention and/or other conditions.

You may have to make changes to your activity level. Your provider will talk about these with you.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.