Hodgkin lymphoma

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Hodgkin lymphoma at a glance

Hodgkin lymphoma is a cancer of lymphocytes, a type of white blood cell. It most often appears in lymph nodes, small structures that are part of the immune system, but can involve other organs. Many people can be cured, including some with disease in several parts of the body. Treatment is planned to control the lymphoma while reducing avoidable long-term effects on the heart, lungs, fertility and other organs.

Lymphoma is an umbrella term for two broad groups: Hodgkin and non-Hodgkin lymphoma. This guide covers Hodgkin lymphoma; non-Hodgkin lymphoma has a separate guide. The exact diagnosis on your biopsy report, which describes a tissue sample examined in the laboratory, helps identify which guide and treatment pathway apply.

The most important first distinction is between classical Hodgkin lymphoma and nodular lymphocyte-predominant disease. They have different biology and may need different treatment. A specialist pathology review is valuable before choosing a programme. The word Hodgkin on an old or incomplete report should not replace an exact diagnosis.

This guide mainly describes adult care and relevant adolescent principles. Children and younger adolescents need an age-specific paediatric programme. Treatment intensity and radiotherapy decisions should not be copied directly from an adult plan.

Symptoms and when to seek help

A persistent, often painless lump in the neck, armpit or groin is a common presentation. Other symptoms can include drenching night sweats, unexplained fever, weight loss, itching or fatigue. A chest mass may cause cough, breathlessness or pressure. These symptoms can have non-cancer causes, so biopsy and assessment are needed.

Severe breathlessness, swelling of the face or neck, chest pain, fainting or a new neurological symptom needs urgent care. Fever during treatment, particularly when infection-fighting white cells called neutrophils are low, also needs prompt assessment. Do not wait for the next infusion visit if a symptom is rapidly worsening.

What treatment aims to achieve

For most newly diagnosed classical Hodgkin lymphoma, the aim is cure. The number of treatment cycles, meaning repeated periods of treatment and recovery, and the need for radiotherapy depend on stage, risk features and response. Some people need a different plan after an interim scan. That adjustment is often built into the protocol rather than being an unexpected failure of care.

Making this information useful to you

A cancer diagnosis can arrive before you have had time to understand the tests. You do not need to learn every treatment name at once. Begin with the exact diagnosis, where the cancer is, and what the team recommends next. A relative or friend can join the appointment if you would find that helpful. Ask for an interpreter when language makes a discussion harder; important decisions should not depend on guessing unfamiliar words.

This guide explains possibilities, not a prescription for your situation. Your blood and tissue test results, scan findings, general health, previous treatment and priorities determine which possibilities apply. Two people with the same cancer name may appropriately receive different treatment. If a recommendation differs from something you have read, ask the team to explain the reason and the evidence behind it.

Keep a list of medicines, allergies and other health conditions, including non-prescription products, vitamins and herbal remedies. Tell the team about previous cancer treatment, pregnancy or breastfeeding, and anything that could affect attending appointments. Do not stop an established medicine without advice. Bring your questions in the order that matters most to you, so that the most important concern is discussed first.

Understand

Classical Hodgkin lymphoma

Classical Hodgkin lymphoma has a characteristic pattern of malignant cells within a larger background of immune cells. The pathology report may describe nodular sclerosis, mixed cellularity, lymphocyte-rich or lymphocyte-depleted classical disease. These names help describe the tissue, but treatment is usually driven more by the overall clinical risk and response than by the classical subtype alone.

Cell-marker testing helps distinguish it from non-Hodgkin lymphomas and other conditions. A cell-surface protein called CD30 is commonly important and provides a target for brentuximab vedotin, an antibody carrying a cell-killing medicine. The diagnosis requires the whole pathology pattern; the presence of one marker by itself is not sufficient.

Nodular lymphocyte-predominant disease

Nodular lymphocyte-predominant Hodgkin lymphoma is also described in newer classifications as nodular lymphocyte-predominant B-cell lymphoma. It usually grows more slowly than classical disease and often has a cell-surface protein called CD20. Treatment may involve observation in selected circumstances, local radiotherapy or rituximab-containing treatment, depending on extent and symptoms.

This disease can sometimes transform into an aggressive large B-cell lymphoma. A new rapidly growing node may therefore need repeat biopsy. It should not automatically be treated using the same medicines as classical Hodgkin lymphoma or as the original indolent disease.

Stage, bulk and B symptoms

B symptoms mean defined unexplained fever, drenching night sweats or significant unintentional weight loss. Bulky disease means a large mass according to the treatment framework being used. Early-stage disease may be described as favourable or unfavourable using several risk factors. Different protocols define these categories somewhat differently, so ask which definition applies to your plan.

Stage IV Hodgkin lymphoma is not equivalent to incurable stage IV disease in many solid cancers. It can still be treated with curative intent. Stage is one part of the discussion, alongside age, health, disease burden and treatment response.

Why it develops

Usually there is no single cause. Epstein-Barr virus is associated with some cases, and immune suppression or family factors can influence risk. Most people exposed to common viruses never develop lymphoma. Hodgkin lymphoma itself is not contagious, and ordinary contact does not transmit it to family members.

Tests and diagnosis

Obtaining enough tissue

A cancer in a lymph node is not automatically lymphoma: other cancers can spread to lymph nodes. Examining a tissue sample helps establish the type of cancer.

An excision biopsy, which removes a lymph node or substantial tissue sample, is often helpful because the pathologist needs to see the architecture of the tissue. A core biopsy may be appropriate when excision is difficult. Fine-needle aspiration alone may not provide enough information to establish and classify lymphoma.

Ask whether the sample has been reviewed by a haematopathologist, a doctor specialising in the laboratory diagnosis of blood and lymphatic disorders, and whether more tissue is needed before treatment. If symptoms require urgent steroids or another intervention, the team balances immediate safety with preserving the ability to make a reliable diagnosis. Steroids can affect biopsy findings, so tell the team if you have already taken them. Do not take unprescribed steroids before a planned biopsy or stop prescribed medicines without advice.

PET-CT and other assessments

Positron emission tomography combined with computed tomography (PET-CT) is commonly used to map classical Hodgkin lymphoma and check its response. It combines detailed body images with a small amount of radioactive tracer that highlights active cells. Infection and inflammation can also take up this tracer. A suspicious result does not always prove that living lymphoma cells remain. Sometimes repeat imaging, comparison with timing or biopsy is needed before changing to a more intensive treatment.

Blood tests assess counts, kidney and liver function and other baseline markers. A bone marrow biopsy is not routinely necessary in every patient when an informative PET-CT has been performed, but it may be needed for specific questions. The investigation plan should be tailored rather than assuming that every possible test is required.

Heart, lung and fertility assessment

Heart function may be checked before doxorubicin-containing treatment. Lung assessment is relevant if bleomycin is being considered or if there are respiratory problems. Infection screening, including hepatitis and human immunodeficiency virus (HIV) when appropriate, informs treatment safety. Pregnancy testing and fertility-preservation discussion should take place before treatment when relevant.

Discuss sperm storage, egg or embryo preservation and other options early enough to consider them. The likelihood of infertility differs between regimens and is generally greater with more intensive treatment with certain chemotherapy drugs, called alkylating agents, and with transplant. It cannot be inferred simply from the fact that chemotherapy is being given.

Interpreting response scans

Interim and end-of-treatment PET scans are read using a structured approach, often including the Deauville score, a five-point scale comparing tracer uptake with reference areas in the chest and liver. The meaning of a score depends on when the scan was performed and which protocol is being used. Do not change treatment based on a score without the clinical interpretation.

A remaining lump on CT may be scar tissue when the PET part of the scan shows no active lymphoma, called metabolic remission. Conversely, a new active area may need further investigation even if other masses have shrunk. Ask whether the scan result is clearly reassuring, clearly concerning or uncertain, and what the next step is in each case.

Preparing for your appointment

If scans have been performed, bring a CD containing your scan images in Digital Imaging and Communications in Medicine (DICOM) format, the standard used for medical images, together with the software needed to view them, along with the written scan reports. Bring your biopsy report and ask whether the pathology slides or tissue blocks are needed for specialist review or additional tests. Keep originals safe and agree how borrowed material will be returned. Having the actual images allows the team to compare changes and plan treatment accurately.

A repeat test is sometimes needed because an earlier sample was too small, a scan did not cover the necessary area, or a new result will change treatment. Ask what question the test will answer, how it may affect the plan, and when you should expect the result. A result described as uncertain does not automatically mean the cancer is worse. Sometimes discussion between the scan specialist (radiologist), tissue specialist (pathologist) and treating team resolves the uncertainty without another procedure.

Before a scan or procedure, mention kidney problems, previous contrast reactions, implanted devices, diabetes medicines, blood-thinning medicines and the possibility of pregnancy. Follow the testing centre's instructions about food, drink and medicines. If you have not received those instructions, contact the centre rather than making changes yourself.

Planning your treatment

Balancing cure and late effects

Treatment aims to maximise the chance of cure while avoiding unnecessary exposure. For early disease, this may involve a shorter chemotherapy programme with involved-site radiotherapy, which targets the areas affected by lymphoma, or a carefully selected chemotherapy-only approach. Omitting radiotherapy can reduce radiation exposure but may change relapse risk, so the trade-off should be explained individually.

For more extensive disease, medicines that work throughout the body are central. Newer antibody and immune combinations may reduce the need for bleomycin or other components in some settings, but they introduce their own risks. The choice depends on stage, age, health, evidence and the team's experience with the complete regimen.

Making a practical plan

Ask about the expected number of cycles, the timing of scans, whether radiotherapy is anticipated and what might change the plan. Discuss work, study, transport and caregiving. A treatment calendar is useful, but delays can occur when recovery or side effects require them.

Before treatment, review other medicines, smoking, cardiovascular risks and vaccination. A central line, a thin tube placed in a large vein, may help with repeated intravenous treatment, meaning treatment given into a vein. The team will explain how to recognise line infection or a clot and how treatment is arranged if an urgent problem develops between visits.

When specialist review is particularly useful

Atypical pathology, nodular lymphocyte-predominant disease, pregnancy, significant heart or lung disease, older frail patients and relapsed disease may need additional specialist input. A second opinion can clarify the balance between reasonable options. It should not delay emergency care for a rapidly threatening mass or serious infection.

Questions to ask your care team

• What is the exact cancer type and stage, and are any important results still pending?
• Is the aim to cure the cancer, reduce the chance of recurrence, control it, or relieve a particular symptom?
• What benefit do you expect from this option, and what are the reasonable alternatives for me?
• How will treatment affect everyday activities, fertility, sexual health and the things I most value?
• How will we know whether it is working, and when will we review the plan?
• Who should I contact between visits, including at night or over a weekend?

Clinical trials and newer treatments

A clinical trial can be worth considering at diagnosis or when treatment needs to change. Trials ask a defined question; some compare established treatments and others study a newer approach. Eligibility depends on the cancer, previous treatment, test results and health. Taking part is voluntary, and choosing not to participate does not remove your right to standard care. Ask about extra visits, possible randomisation (allocation to a treatment group by chance), travel, side effects and what happens when the study ends.

Newer treatments are considered using the clinical evidence, recognised guidelines and the exact cancer type, biomarkers (features found by laboratory tests) and previous treatment. Some options have less mature evidence than established treatments. Ask what is known, what remains uncertain and whether a clinical trial would be appropriate.

Your priorities and supportive care

Tell the team what you are hoping treatment will make possible: returning to work, caring for family, keeping independence, reducing pain or attending an important event. These priorities can influence a choice between reasonable options. If the likely benefit is small and the burden is substantial, discussing a less intensive approach is appropriate. Decisions can be revisited when your health or circumstances change.

Supportive and palliative care help with symptoms, sleep, mood, family concerns and planning. They can be provided alongside treatment intended to cure or control cancer. A referral does not mean that active treatment is ending. If the cancer cannot be cured, ask what treatments may help you live longer or more comfortably and how their burdens compare with their likely benefits.

Treatment options

Early-stage classical Hodgkin lymphoma

ABVD combines doxorubicin, bleomycin, vinblastine and dacarbazine. It remains part of established early-stage strategies, with the number of cycles and use of involved-site radiotherapy adapted to risk and response. Some protocols reduce bleomycin exposure after an appropriate PET response. Decisions about which drugs to omit must follow the actual protocol rather than a general assumption that a good scan permits stopping treatment.

Radiotherapy uses a carefully planned field around the involved sites. Modern treatment aims to limit exposure to nearby organs. Discuss expected benefit and late risks, including the heart, breast tissue, thyroid or lungs according to the area treated. These risks depend on field, dose, age and other treatment, not simply on whether any radiation is used.

Advanced classical Hodgkin lymphoma

Nivolumab with AVD (doxorubicin, vinblastine and dacarbazine, without bleomycin) is an established option for previously untreated stage III or IV classical Hodgkin lymphoma in adults and adolescents aged 12 years or older. Nivolumab helps the immune system recognise the lymphoma, while AVD supplies chemotherapy. The combination needs monitoring for immune-related inflammation as well as ordinary chemotherapy effects.

Brentuximab vedotin with AVD is another established option for appropriate advanced disease. Brentuximab targets CD30 and carries a cell-killing medicine into the lymphoma cell. Nerve symptoms and low neutrophils are important considerations, and medicine to help the marrow make neutrophils, called growth-factor support, is often part of the plan.

PET-adapted ABVD-based approaches remain relevant in suitable circumstances. More intensive programmes, including BrECADD (brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine and dexamethasone) in selected fit patients, may be considered in experienced centres using an established protocol. These programmes have different toxicity and fertility implications and should not be presented as necessary for everyone with advanced disease.

Brentuximab vedotin must not be given together with bleomycin because this combination can cause serious lung toxicity. The complete regimen matters; treatment names should not be mixed and matched from different schedules.

Nodular lymphocyte-predominant disease

For limited disease, local radiotherapy may provide effective control, and carefully selected patients may be monitored after appropriate assessment. More extensive or symptomatic disease may be treated with rituximab alone or a rituximab-containing combination, depending on risk and clinical circumstances.

Because this disease can recur after long intervals, follow-up remains important. A suspected transformation requires biopsy and a different treatment discussion. Classical Hodgkin immune regimens should not automatically be assumed to apply to this CD20-positive B-cell condition.

If classical Hodgkin lymphoma returns or does not respond

Relapsed classical Hodgkin lymphoma means it has come back after a period of remission, when there were no signs of active disease. Refractory lymphoma means it has not responded adequately to treatment or has grown during treatment. Hearing either term can be frightening. Further treatment can still work, and for some people the aim remains cure. The next plan depends on your previous treatment, response and overall health.

Confirming what has changed

A repeat biopsy is recommended whenever possible to confirm that this is classical Hodgkin lymphoma. PET-CT scans help show where it is active, but infection or inflammation can also appear on a scan. An uncertain result may need further assessment before treatment changes.

The team considers how soon the lymphoma returned, where it is, your symptoms and how well your heart, lungs and other organs are working. Bring your previous treatment summary, including immune medicines, radiotherapy and any serious side effects. A lymphoma specialist and transplant team may discuss the plan together.

Choosing treatment to bring the lymphoma under control

You may hear the term salvage treatment. This means further treatment after the first approach has not worked well enough or the lymphoma has returned; it does not mean there is no realistic hope of benefit.

Options include:

• Different chemotherapy medicines: these may be used to shrink the lymphoma before a transplant or to control it when transplant is unsuitable.
• Pembrolizumab or nivolumab: these are immune checkpoint inhibitors. They block a protein called programmed cell death protein 1 (PD-1), releasing a brake on immune cells so they can attack the lymphoma. Depending on previous treatment and the plan, a specialist may use an immune medicine alone, with chemotherapy, or followed by chemotherapy if the response is insufficient.
• Brentuximab vedotin: this targets the CD30 protein on lymphoma cells and delivers a cell-killing medicine. It may be used alone or in a selected combination. Previous exposure and nerve problems, such as numbness or tingling, affect whether it is a suitable choice.

Nivolumab with brentuximab vedotin is also an option for selected children, adolescents and young adults aged 5 to 30 years whose classical Hodgkin lymphoma has returned or not responded after one previous treatment programme. Children need a specialist paediatric plan. This age-specific option should not be assumed to apply to everyone.

Previous treatment matters: a medicine that did not control the lymphoma may not be the best next choice. Immune medicines can cause inflammation in healthy organs, and brentuximab can damage nerves. Your team should explain the benefit and main risks of the complete programme.

When an autologous transplant may help

For people who are suitable, treatment often aims to achieve a strong response before high-dose chemotherapy and an autologous stem cell transplant. Autologous means using your own blood-forming stem cells, collected beforehand. The high-dose chemotherapy treats the lymphoma; returning the cells helps restore blood production afterwards.

A response scan helps the team decide whether to proceed, use another treatment first or consider radiotherapy to a remaining active area. A good response is encouraging, but it does not guarantee cure. Discuss fertility preservation, time in hospital and support during recovery before treatment begins.

After transplant, some people at higher risk of another relapse may be offered brentuximab vedotin to help maintain the response. This additional treatment is called consolidation or maintenance. It is not needed by everyone; previous brentuximab treatment, response and side effects matter.

If lymphoma returns after an autologous transplant

Pembrolizumab, nivolumab, brentuximab vedotin or other treatment may still help, depending on what has already been used. For selected people, an allogeneic transplant, using a donor’s blood stem cells, offers another possible route to lasting control or cure.

A donor transplant has substantial risks, including graft-versus-host disease, in which donor immune cells attack healthy tissues. Previous PD-1 treatment can increase transplant-related immune complications, so the transplant team must plan the timing and preventive care carefully. It is a separate decision, not an automatic next step for everyone who responds to immunotherapy.

When transplant is unsuitable

You still have treatment and support options if intensive treatment is unsuitable or you decide against it. Immune or targeted medicines, chemotherapy, or radiotherapy to a troublesome area may control the lymphoma and relieve symptoms. Supportive care can help with symptoms, worry and everyday life alongside these treatments.

A clinical trial may offer another option, particularly after several treatments. Ask what is established, what remains uncertain and how participation compares with the other choices. Taking part is voluntary.

Ask your team: “Are we aiming for cure or longer-term control?”, “What would a good response mean for my next step?” and “What support will I and my caregiver need?” You do not need to absorb every option in one conversation.

Managing side effects

Lung and heart symptoms

Bleomycin can cause lung injury. New cough, breathlessness or reduced exercise tolerance needs prompt assessment, even if symptoms seem mild. Tell future anaesthetic and respiratory teams about past bleomycin exposure. Do not assume that a normal earlier lung test excludes later toxicity.

Doxorubicin and radiation involving the chest can affect long-term heart health. During treatment, chest pain, palpitations, fainting or significant breathlessness should be assessed promptly. After treatment, management of blood pressure, cholesterol, diabetes and smoking helps reduce additional risk.

Nerves, bowel function and fatigue

Vinblastine and brentuximab can cause peripheral neuropathy, damage to nerves outside the brain and spinal cord. Report numbness, burning, weakness or difficulty with fine tasks early. Constipation can also be significant and may need preventive treatment. Severe abdominal pain or inability to pass stool or gas requires medical advice rather than simply increasing laxatives at home.

Fatigue, altered taste, nausea and hair loss can affect daily life. Anti-sickness medicines, mouth care, nutrition support and paced activity can help. A major deterioration in energy should still be assessed for anaemia, infection, hormone problems or other causes.

Immune-related effects

Nivolumab and pembrolizumab can cause inflammation in organs including lungs, bowel, liver, skin and hormone-producing glands. Persistent diarrhoea, a new cough, severe rash, jaundice, marked headache, dizziness or unusual thirst should be reported. These effects can arise during treatment or after it ends.

Do not assume that an immune medicine is free of serious side effects because it is not chemotherapy. The team may need to pause treatment and use steroids or other medicines. Carry information about the immune treatment when attending another hospital.

Fertility and hormonal health

Periods may change or stop during treatment, and sperm production can be affected. Fertility recovery is variable and depends on the regimen and age. Lack of periods does not reliably prevent pregnancy. Discuss contraception and the safe timing of pregnancy after treatment.

Radiotherapy involving the neck may lead to thyroid problems later. Fatigue, cold intolerance or weight changes may need thyroid testing rather than being attributed only to recovery. Treatment-related menopause and sexual-health concerns deserve practical support.

Keeping treatment manageable

Keep the team's contact details available and know where to go outside clinic hours. Report side effects early rather than waiting until the next appointment. A short record of symptoms, temperature, fluid intake and medicines can help the team decide what is needed. Do not change cancer medicine doses, restart a stopped treatment, or use leftover antibiotics without instructions. A planned delay or dose adjustment can be an important part of safe treatment.

If you receive treatment that can lower white blood cells, a temperature of 38°C (100.4°F) or higher needs urgent advice. Follow any lower threshold or additional instructions your team gives you. Chills, sudden weakness, confusion or feeling very unwell also need urgent assessment, even without a fever. Do not wait for a blood test appointment or try to hide the fever with medicine before speaking to the team.

Severe breathlessness, chest pain, a new seizure, sudden weakness, heavy bleeding or collapse require emergency care. New severe back pain with leg weakness, numbness around the bottom, or loss of bladder or bowel control also needs immediate assessment. Contact the nearest emergency service when necessary; a website contact form or routine messaging service is not an emergency pathway.

Eating, drinking and energy

Treatment may change appetite, taste, bowel habits and energy. Small, frequent meals and foods containing protein can be easier than large meals. Ask for dietitian support if weight is falling, swallowing is difficult, or you are avoiding many foods. There is no single diet that treats cancer, and severe restriction or prolonged fasting can make it harder to tolerate treatment. Check supplements with your team because some interact with medicines.

Take anti-sickness medicine as prescribed and report vomiting that prevents you keeping down fluids or essential medicines. Seek advice for persistent diarrhoea, dizziness, very little urine or increasing weakness. Fluid recommendations may need adjustment if you have heart or kidney disease. Mouth ulcers, pain or infection that interferes with eating should be treated promptly rather than accepted as unavoidable.

Gentle movement, short walks and planned rest may help fatigue, but activity should match your condition and any surgical or bone-safety restrictions. Fatigue can also reflect anaemia, infection, hormone changes, pain, poor sleep or low mood. Let the team assess a marked or persistent change. Accepting help with shopping, transport or meals can conserve energy for the activities that matter to you.

Live well

Follow-up after remission

Follow-up focuses on symptoms, examination, recovery and treatment-related effects. Routine PET scans are not generally used indefinitely in a person who is well in remission. A new symptom may lead to targeted investigation. Ask for a clear plan so that fewer scans do not feel like a loss of care.

Report persistent new lumps, unexplained fever, sweats, weight loss or itching that is unusual for you. These symptoms do not necessarily mean relapse, but the team should decide whether assessment is needed. Keep your treatment summary, including radiation fields and chemotherapy or immune medicines.

Long-term health after cure

Survivorship care may include heart-risk assessment, thyroid testing, fertility or hormone support and screening adapted to earlier radiation exposure. For example, chest radiation at a young age may change future breast-screening recommendations. Your individual plan should specify timing rather than relying on a general website schedule.

Vaccination, dental health, exercise and avoiding tobacco remain worthwhile. Recovery of stamina can take time, and returning to work or study gradually may be more manageable. Late effects can appear years later, so informing future clinicians about the treatment history matters even after routine lymphoma follow-up becomes less frequent.

Confidence and life after treatment

Finishing treatment can bring relief and uncertainty at the same time. Fear before appointments, changes in body image and concerns about fertility or relationships are common reasons to ask for support. You do not need to wait until distress is severe before speaking with a counsellor or the care team.

For people living with recurrent disease, periods of treatment and recovery may alternate. The goals can change over time, but symptom control, independence and the things that matter to you remain central. Ask for a review whenever the burdens of treatment no longer match the expected benefit.

Emotional and practical support

Feeling frightened, angry, sad or uncertain is understandable. You do not have to appear positive all the time. Ask about counselling, psycho-oncology (support for the emotional effects of cancer), support groups or a social worker if worry is affecting sleep, relationships or daily life. Persistent depression, panic or thoughts of self-harm need prompt professional help. Caregivers may need their own support and breaks; one person should not have to manage every appointment and household task alone.

It can help to agree who will update relatives and how much information you want shared. Children usually benefit from honest, age-appropriate explanations and reassurance about who will care for them. Ask permission before discussing private medical information with others. If concentration or memory is difficult, use reminders, a calendar and a trusted companion at important consultations.

Relationships, fertility and sexual health

Cancer and treatment can affect desire, comfort, fertility, body image and confidence. These are valid medical concerns. Raise fertility questions before treatment when possible, because some protective options need to be arranged early. The right approach depends on age, the treatment and how urgently it must start. Do not assume that absent periods or reduced fertility means pregnancy is impossible. Ask about contraception and the safe timing of pregnancy for your specific medicines.

Explain any pain, dryness, erection difficulties or changes in intimacy to the team. Appropriate treatments, rehabilitation and counselling can help. You can choose how much to involve a partner. Advice about hormone-containing treatments needs to take the cancer type and treatment into account; do not start them without discussing suitability.

Planning ahead while living well

Ask for a clear follow-up plan and know which symptoms should be reported between visits. Continue care for other conditions and discuss vaccinations with your oncology team; the timing and suitability of live vaccines can change during treatment. Avoid tobacco and ask for practical cessation support if needed. Activity, food and sleep plans should be realistic for your health rather than another source of pressure.

If treatment is long term, arrange periodic discussions about what is helping, what is difficult and what you want next. Planning for future care can protect your preferences and reduce uncertainty for family. You can discuss who should help with decisions if you become too unwell to speak for yourself, while continuing treatment and everyday life now.

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