|
Table of Contents General Information About Adult Hodgkin Lymphoma
Stages of Adult Hodgkin Lymphoma
Recurrent Adult Hodgkin Lymphoma
Treatment Option Overview
Treatment Options for Adult Hodgkin Lymphoma
To Learn More About Adult Hodgkin Lymphoma
Get More Information From NCI
Changes to This Summary (08/26/2008)
About PDQ
General Information About Adult Hodgkin Lymphoma
| Key Points for This Section
|
|
Adult Hodgkin lymphoma is a disease in which malignant
(cancer) cells form in the lymph system.
Adult Hodgkin lymphoma is a type of cancer that develops in the lymph system, part of the body's immune system.
The lymph system is made up of the following:
- Lymph: Colorless,
watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the
body against infections and the
growth of tumors.
- Lymph vessels: A network of thin tubes that collect lymph
from different parts of the body and return it to the bloodstream.
- Lymph nodes:
Small, bean-shaped structures that filter lymph and store white blood cells that help fight
infection and disease. Lymph nodes are located along the network of lymph vessels
found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
- Spleen: An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys
old blood cells. It is located on the left side of the abdomen near the stomach.
- Thymus: An organ
in which lymphocytes grow and multiply. The thymus is in the chest behind the
breastbone.
- Tonsils: Two small
masses of lymph tissue at the
back of the throat. The tonsils produce lymphocytes.
- Bone marrow: The
soft, spongy tissue in the center of large bones. Bone marrow produces white
blood cells, red blood cells, and platelets.
|
Enlarge
|
|
|
|
|
| Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart. |
Because lymph tissue is found throughout the body, Hodgkin
lymphoma can begin in almost any part of the body and spread to almost any
tissue or organ in the body.
Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. This summary is about the treatment of adult Hodgkin lymphoma. (See the PDQ summary on Adult Non-Hodgkin Lymphoma Treatment for more information.)
Hodgkin lymphoma can occur in both adults and children; however,
treatment for adults may be different than treatment for children. Hodgkin lymphoma may also occur in patients who have acquired immunodeficiency syndrome (AIDS); these
patients require special treatment.
See
the following PDQ summaries for more information:
Hodgkin lymphoma in pregnant women is the same as the disease in nonpregnant women of childbearing age. However, treatment is different for pregnant women. This summary includes information about treating Hodgkin lymphoma during pregnancy.
There are two main types of Hodgkin lymphoma: classical and nodular lymphocyte-predominant.
Most Hodgkin lymphomas are the classical type. The classical type is broken down into the following four subtypes:
- Nodular sclerosing Hodgkin lymphoma.
- Mixed cellularity Hodgkin lymphoma.
- Lymphocyte depletion Hodgkin lymphoma.
- Lymphocyte-rich classical Hodgkin lymphoma.
Age, gender, and Epstein-Barr infection can affect
the risk of developing adult Hodgkin lymphoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for adult
Hodgkin lymphoma include the following:
- Being in young or late adulthood.
- Being male.
- Being infected with the Epstein-Barr
virus.
- Having a first-degree relative (parent, brother, or sister) with Hodgkin lymphoma.
Pregnancy is not a risk factor for Hodgkin lymphoma.
Possible signs of adult Hodgkin lymphoma include swollen lymph
nodes, fever, night sweats, and weight loss.
These and other symptoms may be caused by adult Hodgkin lymphoma.
Other conditions may cause the same symptoms. A doctor should be consulted if any of the following
problems do not go away:
- Painless, swollen lymph nodes in the neck, underarm, or
groin.
- Fever for no known reason.
- Drenching night sweats.
- Weight loss for no known reason.
- Itchy skin.
- Feeling very tired.
Tests that examine the lymph nodes are used to detect (find)
and diagnose adult Hodgkin lymphoma.
The following tests and procedures may be used:
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The patient's symptoms.
- The stage of the cancer.
- The type of Hodgkin lymphoma.
- Blood test results.
- The patient's age, gender, and general health.
- Whether the cancer is recurrent or progressive.
For Hodgkin lymphoma during pregnancy, treatment options also depend on:
- The wishes of the patient.
- The age of the fetus.
Adult Hodgkin lymphoma can usually be cured if found and treated early.
Back to Top Stages of Adult Hodgkin Lymphoma
| Key Points for This Section
|
|
|
After adult Hodgkin lymphoma has been diagnosed, tests are
done to find out if cancer cells have spread within the lymph system or to
other parts of the body.
The process used to find out if cancer has spread within the lymph
system or to other parts of the body is called staging. The information gathered from the staging
process determines the stage of the
disease. It is important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the
body, taken from different angles. The pictures are made by a computer
linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This
procedure is also called computed tomography, computerized tomography, or
computerized axial tomography. For adult Hodgkin
lymphoma, CT scans of the chest, abdomen, and pelvis are taken.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
| Enlarge | | | | Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope. |
- Laparotomy: A surgical procedure in which an incision (cut) is made in the wall
of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease. This procedure is done only if it is needed to make decisions about treatment.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Surgical biopsy: The removal of tissue using a scalpel. A pathologist views the tissue under a microscope to look for cancer cells.
- Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
For pregnant women with Hodgkin lymphoma, staging tests that protect the fetus from the harms of radiation are used. These include:
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Stages of adult Hodgkin lymphoma may include
A, B, E, and S.
Adult Hodgkin lymphoma may be described as
follows:
- A: The patient has no symptoms.
- B: The patient has symptoms such as fever, weight loss, or night
sweats.
- E: "E" stands for extranodal and means the cancer is found in an area or organ other than the lymph
nodes or has spread to tissues beyond, but near, the major lymphatic areas.
- S: "S" stands for spleen and means the cancer is found in the spleen.
The following stages are used for adult Hodgkin
lymphoma:
Stage I
Stage I is divided
into stage I and stage IE.
Stage II
Stage II is divided
into stage II and stage IIE.
Stage III
Stage III is divided
into stage III, stage IIIE, Stage IIIS, and stage
IIIS+E.
Stage III is also divided into stage III(1) and stage
III(2) as follows:
Stage IV
In stage IV, the cancer either:
- is found throughout one or more organs other than the lymph nodes and may be in lymph nodes near those organs; or
- is found in one organ other than the lymph nodes and has
spread to lymph nodes far away from that organ.
Adult Hodgkin lymphoma may be grouped for treatment as follows:
Early Favorable
Early favorable adult Hodgkin lymphoma is stage I or stage II, without risk factors.
Early Unfavorable
Early unfavorable adult Hodgkin lymphoma is stage I or stage II with one or more of the following risk factors:
Advanced Favorable
Advanced favorable adult Hodgkin lymphoma is stage III or stage IV with three or fewer of the following risk factors:
- Being male.
- Being aged 45 years or older.
- Having stage IV disease.
- Having a low blood albumin (protein) level (below 4).
- Having a low hemoglobin level (below 10.5).
- Having a high white blood cell count (15,000 or higher).
- Having a low lymphocyte count (below 600 or less than 8% of the white blood cell count).
Advanced Unfavorable
Advanced unfavorable Hodgkin lymphoma is stage III or stage IV with four or more of the following risk factors:
- Being male.
- Being aged 45 years or older.
- Having stage IV disease.
- Having a low blood albumin (protein) level (below 4).
- Having a low hemoglobin level (below 10.5).
- Having a high white blood cell count (15,000 or higher).
- Having a low lymphocyte count (below 600 or less than 8% of the white blood cell count).
Back to Top Recurrent Adult Hodgkin Lymphoma
Recurrent adult Hodgkin lymphoma is cancer that has recurred (come back)
after it has been treated. The cancer may come back in the lymph system or in other parts of the body.
Back to Top Treatment Option Overview
| Key Points for This Section
|
|
|
There are different types of treatment for patients with adult
Hodgkin lymphoma.
Different types of treatment are available for patients with adult Hodgkin lymphoma. Some treatments
are standard (the currently used treatment), and some are being tested in clinical trials. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the new treatment may
become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
For pregnant patients with Hodgkin lymphoma, treatment is carefully chosen to protect the fetus. Treatment decisions are based on the mother’s wishes, the stage of the Hodgkin lymphoma, and the age of the fetus. The treatment plan may change as the symptoms, cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Patients with Hodgkin lymphoma should have their treatment
planned by a team of health care providers with expertise in treating lymphomas.
Treatment will be overseen by a medical
oncologist, a doctor who specializes in treating cancer. The
medical oncologist may refer you to other health care providers who have experience and
expertise in treating adult Hodgkin lymphoma and who specialize in certain
areas of medicine. These may include the following specialists:
Patients may develop late effects that appear months or years after their treatment for Hodgkin lymphoma.
Treatment with chemotherapy and/or radiation therapy for Hodgkin lymphoma may increase the risk of second cancers and other health problems for many months or years after treatment. These late effects depend on the type of treatment and the patient's age when treated, and may include:
Regular follow-up by doctors who are expert in finding and treating late effects is important for the long-term health of patients treated for Hodgkin lymphoma.
Three types of standard treatment are used:
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment with more than one anticancer drug.
When a pregnant woman is treated with chemotherapy for Hodgkin lymphoma, it isn't possible to protect the fetus from being exposed to the chemotherapy. Some chemotherapy regimens may cause birth defects if given in the first trimester. Vinblastine is an anticancer drug that has not been linked with birth defects when given in the second half of pregnancy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
For pregnant patients with Hodgkin lymphoma, radiation therapy should be postponed until after delivery, if possible, to avoid any risk to the fetus. If immediate treatment is needed, patients may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the fetus may not protect it from scattered radiation that could possibly cause cancer in the future.
Surgery
Laparotomy is a procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease. If cancer is found, the tissue or organ is removed during the laparotomy.
For pregnant patients with Hodgkin lymphoma, treatment options also include:
Watchful waiting
Watchful waiting is closely monitoring a patient’s condition without giving any treatment unless symptoms appear or change. Delivery may be induced when the fetus is 32 to 36 weeks old, so that the mother can begin treatment.
Steroid therapy
Steroids are hormones naturally produced in the body by the adrenal glands and by reproductive organs. Some types of steroids are made in a laboratory. Certain steroid drugs have been found to help chemotherapy work better and help stop the growth of cancer cells. Steroids can also help the lungs of the fetus develop faster than normal. This is important when delivery is induced early.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in
clinical trials. It may not mention every new treatment being studied.
Information about clinical trials is available from the
NCI Web
site.
High-dose chemotherapy and radiation therapy with stem cell transplant
High-dose chemotherapy and radiation therapy with stem cell transplant is a way of giving high doses of chemotherapy and radiation therapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Back to Top Treatment Options for Adult Hodgkin Lymphoma
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Early Favorable Hodgkin Lymphoma
Treatment of early favorable Hodgkin lymphoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I adult Hodgkin lymphoma and stage II adult Hodgkin lymphoma.
Early Unfavorable Hodgkin Lymphoma
Treatment of early unfavorable Hodgkin lymphoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I adult Hodgkin lymphoma and stage II adult Hodgkin lymphoma.
Advanced Favorable Hodgkin Lymphoma
Treatment of advanced favorable Hodgkin lymphoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III adult Hodgkin lymphoma and stage IV adult Hodgkin lymphoma.
Advanced Unfavorable Hodgkin Lymphoma
Treatment of advanced unfavorable Hodgkin lymphoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III adult Hodgkin lymphoma and stage IV adult Hodgkin lymphoma.
Hodgkin Lymphoma During Pregnancy
Hodgkin Lymphoma During the First Trimester of Pregnancy
When Hodgkin lymphoma is diagnosed in the first trimester of pregnancy, it does not necessarily mean that the patient will be advised to end the pregnancy. Each patient's treatment will depend on the stage of the lymphoma, how fast it is growing, and the patient's wishes. For women who choose to continue the pregnancy, treatment of Hodgkin lymphoma during the first trimester of pregnancy may include the following:
Hodgkin Lymphoma During the Second Half of Pregnancy
When Hodgkin lymphoma is diagnosed in the second half of pregnancy, most patients can delay treatment until after the baby is born. Treatment of Hodgkin lymphoma during the second half of pregnancy may include the following:
Recurrent Adult Hodgkin Lymphoma
Treatment of recurrent Hodgkin lymphoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent adult Hodgkin lymphoma.
Back to Top To Learn More About Adult Hodgkin Lymphoma
For more information from the National Cancer Institute about adult Hodgkin lymphoma, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (08/26/2008)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Back to Top |
 and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart.','popup','width=780,height=630,scrollbars=1,resizable=1,menubar=0,location=0,status=0,toolbar=0'))
. Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.','popup','width=780,height=630,scrollbars=1,resizable=1,menubar=0,location=0,status=0,toolbar=0'))
)
 is inserted into the patient\'s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.','popup','width=780,height=630,scrollbars=1,resizable=1,menubar=0,location=0,status=0,toolbar=0'))