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Young man, interrupted

James Sherwood was furious when his life was put on hold by Hodgkin's disease. Now recovered, he has some advice for the singer Delta Goodrem, who has just received the same diagnosis

Monday 21 July 2003 00:00 BST
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As cancers go, Hodgkin's disease is a two-faced fiend. This lymphatic cancer has a 91 per cent survival rate, so the odds are favourably stacked for those newly-diagnosed such as Delta Goodrem, the Australian pop princess and Neighbours actress. Though this cancer of the lymphatic system is relatively rare, treatment for itis the success story of oncology. Seen from this perspective, Hodgkin's is the My Little Pony of cancers compared to the Four Horsemen of the Apocalypse that are lung, liver, bowel and breast cancers.

Hodgkin's probably won't kill you but that's pretty cold comfort for 18-year-old Goodrem - or me. I was treated for the disease in 1999. Hodgkin's is not cancer-lite. It still demands radiotherapy, chemotherapy or both to kill it off. It is most commonly diagnosed in the 25- to 30-year-old age bracket, and men are more likely to develop it than women so Delta has been doubly unlucky to encounter Hodgkin's.

My heart went out to this sunny Aussie when I heard she'd been Tango-ed by Hodgkin's. It would take a lot not to seethe with rage that instead of going on tour in the US, she will be at Sydney's St Vincent's Hospital fighting the rogue cells proliferating in her lymphatic system. If Delta is anything like me, the resentment that fate had interrupted her at such a moment will by now outweigh the gratitude that Hodgkin's is unlikely to be terminal.

Hodgkin's may be eminently curable but it's still a vicious cancer that can leave men and women bald, infertile and with an increased chance of developing another form of cancer in later life. There is no known genetic, dietary or environmental trigger but there are tentative suggestions that those exposed to the Epstein-Barr or HIV virus could have an increased chance of developing it. The lack of triggers only increases feelings of resentment. It's as if you've lost some sick biological lottery.

The giveaway symptom for Hodgkin's is a painless swelling in the lymph nodes (under the arms, in the neck and groin), night sweats, weight loss, fatigue and itching skin. I discovered the lump in my throat and dismissed it as a swollen gland. It was months later, when having jabs for a foreign assignment, that I mentioned it to the nurse at my local practice. She made an immediate appointment with the doctor and the dance with cancer began.

At the time I was a fashion columnist for The Independent on Sunday. It was the first sustained period in a previously erratic career, and life was sweet. Having never been in a hospital bed since birth, the parallel universe of underfunded institutions with faded Monet prints was a rude awakening.

I've never had much truck with the colloquialism of cancer - "chemo" for chemotherapy or "Tommy's" for St Thomas's but no one even said the "c" word in the first month of tests. A biopsy (an operation to take tissue from the lump for lab analysis) preceded scans and, eventually, an operation to remove the lump.

It's hard to keep hold of your identity once you become a number on a plastic wristband. The nurse on my ward at Guy's Hospital, who'd read my Independent column and told me it was "quite good", did more for my morale than flowers, fruit or a filthy Jackie Collins.

Coming round in a corridor after the op was the first time I took what was happening seriously. Before Guy's I'd adopted a benign indifference to consultants, nurses and well-wishers. Bandaging a weeping wound on my neck instead of dressing it with a silk Ferragamo tie felt grotesque. Little did I know this was merely the tenor clearing his throat. The overture hadn't even started.

The diagnosis was swift and brusque. I rattled out my three questions - "Is it cancer? Is it curable? Is it chemotherapy?" - and received three affirmative answers. I had a glass of wine, a ciggie and a brief cry before telling the inner circle. I had not planned a strategy for outfoxing cancer but it came quickly: the family must tell no one until I say so, keep their distance and, if I holler, be there for me. I don't ask for much.

A negative HIV test made the cancer diagnosis a sweeter pill to swallow. The consultants had demanded the test before any treatment began. As my local GP said, "nobody could be that unlucky".

The first day at St Thomas's presented me with perhaps the most unpalatable aspect of cancer care: the Hickman line. It may sound like a charming stretch of railway between Devon and Cornwall but is in fact a piece of plastic that is inserted into a main vein and dangles from a hole in the chest, shooting those drugs straight to the lymphatic system. It needs daily cleaning with saline solution. The wound bleeds and gets infected. You can't bathe properly and it does what a blind date with Jim Davidson would do for one's libido. I looked and felt like a sick person.

My oncology consultant at St Thomas's, Dr Adrian Timothy, made the process of eight courses of chemotherapy with fortnightly intervals and radiotherapy as smooth as he could. "Not a lot has changed in terms of how we deal with Hodgkin's," he says. "If it is a localised disease confined to one or two gland areas then we can treat it with three or four courses of chemotherapy and radiotherapy. If it's more advanced we treat it with chemotherapy on its own. If the disease does relapse we have the option of giving higher doses of chemotherapy or stem cell transplant - when we take stem cells, store them, and give the patient high doses of chemotherapy."

The chemotherapy room looks not dissimilar to a suburban old people's home with plastic-covered armchairs, back copies of Woman's Realm and towelling turbans for sale on manky mannequins. Nurse Dawn told me the chances of temporarily losing my hair would lessen if I wore a sort of chilled boxer's helmet. It worked. Fake tan, hair dye and weight loss meant that I looked rather well all things considered. It was a small victory but it helped.

Another nasty shock came a week after my first chemotherapy. My immune system wasn't happy and I had daily injections of god-knows-what to pep me up. If there's one thing cancer has done for me it's to obliterate any needle phobia.

And once the chemotherapy was under way I looked forward to it. It was my quiet time to sit in the chemotherapy room and read while a cocktail of toxic drugs that sounded like pantomime dames (Adriamycin, Bleomycin and Vinblastine) seeped down the Hickman line. For three days afterwards I felt as if I had chronic flu, then gradually the body would recover. My pattern was to go clubbing the night before chemotherapy and drink myself half-blind. No, it probably didn't help, but that ice cap made for a marvellous hangover cure.

As chemotherapy gave way to radiotherapy, and radiotherapy to scans, the cancer was apparently cleared. Eventually the Hickman line was pulled out of my body like a reluctant tapeworm.

That whole period of my life (six months all told) had a dreamlike quality. When it was all over I blinked, yawned and realised I'd lost a boyfriend, pushed my parents too far away and kept up with my work but not my friends. It makes you selfish, cancer.

Dr Timothy told me that if Hodgkin's was going to come back, it would put in an appearance within the first two years of remission. (It didn't, although I've had a couple of biopsies and a scare or two.) And anyway, he says, even in its advanced stages, Hodgkin's can be cured. If there was a piece of advice I could give to Delta Goodrem it would be this: be selfish and take your time. The world can, and will, wait for you.

UNDERSTANDING HODGKIN'S DISEASE

* Hodgkin's disease is a lymphoma - a cancer of the lymphatic system.

* Around 1,400 new cases are diagnosed each year in Britain. The cause of lymphoma remains unknown.It affects more men than women.

* The lymphatic system is a complex network of lymphatic vessels and glands used to transport lymph throughout the body. Lymph is a fluid containing nutrients, waste products and, most importantly white blood cells: lymphocytes.

* In lymphomas some lymphocytes divide abnormally, or do not die off when they should. These abnormal lymphocytes can collect in the lymph nodes, which then enlarge to form tumours.

* Non-Hodgkin's lymphoma is also a cancer of the lymphatic system. It is more common than Hodgkin's (around 8,000 new cases a year), and more difficult to treat. The cells of non-Hodgkin's lymphoma look different to Hodgkin's under the microscope, and behave differently.

* Hodgkin's is treated with radiotherapy or chemotherapy, or a combination of the two. Treatment depends upon what part of the body is affected, and how large the tumours are.

* Hodgkin's is now very successfully treated: the majority of people affected by the condition will be completely cured.

* The Lymphoma Association runs a helpline for those affected by Hodgkin's diseaseon 0808 808 5555.

Catherine Nixey

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