adults, there are two main divisions of HL (limited and advanced disease) and four stages designated by Roman numerals I through IV. Stages I and II are considered limited disease, although Stage II may be considered advanced in patients with bulky disease (tumors greater than 10 centimeters [~four inches] wide). Stages III and IV are considered advanced disease. Although some patients have advanced HL at the time they are diagnosed, their disease can often be successfully treated. The Ann Arbor staging system has traditionally been used for staging HL. Although this older staging system is still in use, a modification of the Ann Arbor staging system called the Lugano Classification was proposed in 2014. This system is shown in the figure on the following page. Learning the Basics 38 Part 1 STAGING OF HL (LUGANO CLASSIFICATION) Stage I: • Involvement of a single lymph node or group of adjacent nodes Stage III: • Involvement of lymph nodes on both sides of the diaphragm (muscle that separates the chest from the abdomen), or • Involvement of lymph nodes above the diaphragm plus spleen involvement Stage II: • Involvement of two or more groups of lymph nodes on the same side of the diaphragm Stage IV: • Widespread disease in lymph nodes and organ involvement St III St IV 39 Understanding Hodgkin Lymphoma Stage I–IV HL can be further classified based on whether “B symptoms” (fever, unexplained weight loss of greater than 10 percent of body weight, and drenching night sweats) are present. An “A” designation means that the patient does not have “B symptoms,” while the “B” designation means that the patient does have “B symptoms” (see Chapter 2 for additional discussion of “B symptoms”). In children, HL is staged using a different system in which the lymphoma is classified as low-, intermediate-, or high-risk. Treatment of Hodgkin Lymphoma 40 Part 2 Chapter 5: What to Know Before Starting Treatment Receiving a cancer diagnosis can be overwhelming. It is perfectly normal to be shocked by the diagnosis, anxious about the future, and confused about the decisions that need to be made. This chapter will help patients and caregivers prepare for the start of treatment by explaining the next steps and providing tips for talking with doctors about any questions or concerns. Patients can also call the Lymphoma Research Foundation’s (LRF’s) Helpline at (800) 500-9976 or email helpline@lymphoma.org. Part 2 — Treatment of Hodgkin Lymphoma PATIENT T First Steps to Take PI After Receiving a Diagnosis ■ Take care of yourself (eat, sleep, rest, and exercise). ■ Seek the support of family, friends, and others you trust. ■ Learn about the disease and treatment options. ■ Find medical care that meets your needs. ■ Seek out additional sources of emotional and social support for people with cancer, such as LRF’s Lymphoma Support Network that connects patients and caregivers with volunteers who have experience with Hodgkin lymphoma, similar treatments, or challenges. ■ Research the cost of care, what your insurance will cover, and what financial assistance programs may be available to you. ■ Maintain a copy of your medical records (paperwork, test results, and your own notes). ■ Download and start using LRF’s Focus On Lymphoma app on your mobile device to learn about and manage HL. 41 Understanding Hodgkin Lymphoma Who Plans and Carries Out the Treatment? Treatment is usually overseen by a medical oncologist, hematologist, or hematologist/oncologist. Oncologists are physicians who specialize in diagnosing and treating patients with cancer. Hematologists are physicians who specialize in diagnosing and treating patients with disorders of the blood and lymphatic system. Physicians who treat lymphoma may be certified in one or both specialties. Depending on the patient’s healthcare needs, the primary doctor may refer the patient to other specialists, such as a surgical oncologist or a radiation oncologist. The doctor may also suggest a second opinion at a cancer center with particular expertise in managing patients with a specific type of Hodgkin lymphoma (HL) or for participation in a clinical trial. For more information about clinical trials, contact LRF’s Helpline at (800) 500-9976 or