Types of treatment

Treatment planning

The treatment of non-Hodgkin’s lymphomas has greatly improved over the past few years, even when they have spread to different areas of the body. Many people can now either be cured or stay in remission for many years.

Complete remission is where there is no sign of the lymphoma.

Partial remission is where the lymphoma shrinks down so that the person is well, does not have symptoms and does not need further treatment at that time.

For many people in the early stages of some types of low-grade lymphoma, no treatment may be needed at first. Where treatment is needed, the main types are radiotherapy and chemotherapy. You may need either of these treatments, or a combination of both. Monoclonal antibodies may sometimes be given with chemotherapy.

Your doctor will plan your treatment by taking into consideration a number of things, including:

• the specific type of lymphoma you have
• your age
• your general health (including any other medical conditions)
• which parts of your body it is affecting
• the number of affected lymph nodes and whether other organs are affected

Low-grade lymphomas

Low-grade lymphomas often grow very slowly and there may be long periods where there is very little, or no, change in the disease. For many people, regular check-ups are all that is needed and treatment may be postponed for a long time – this is known as active surveillance or watchful waiting. Usually the first treatment given is chemotherapy. If you have low-grade NHL in only one group of lymph nodes, you may just be given radiotherapy to that area.

After treatment, many people with low-grade lymphoma have a time with no signs of active disease (known as remission). If the disease then comes back, it can be treated again with chemotherapy, radiotherapy or with monoclonal antibodies and another period of remission may follow. Low-grade non-Hodgkin’s lymphoma can often be controlled in this way for many years.

Many people with low grade non-Hodgkin’s lymphoma can have the illness controlled for many years and can live an almost normal life for much of that time.

Some people worry about having chemotherapy or radiotherapy because of the side effects, although there are now very good ways of controlling or reducing these. Some people ask what would happen if they did not have treatment.

NHL is usually very sensitive to chemotherapy and radiotherapy and treatment can reduce the amount of lymphoma or even get rid of it for a time. Treatment can improve symptoms and increase life expectancy for most people.

In a small number of people the treatment may not work and they will not have any benefit. If this happens then another type of treatment may be tried, and the second treatment may be more successful. Whether or not to have treatment is always your own choice, but it is helpful to discuss the benefits and possible side effects with your cancer specialist, a specialist nurse at the hospital, or one of the nurses at CancerBACUP.

High-grade lymphomas

These are faster growing and need more intensive chemotherapy, usually given into a vein by drip, often in combination with a monoclonal antibody. Most chemotherapy for high-grade lymphomas is given in the outpatients department, although sometimes you may have to stay in hospital. If there is a risk that the nervous system may be affected by the lymphoma, an anti-cancer drug may be injected into the fluid around the spinal cord in a procedure similar to a lumbar puncture. This is known as intrathecal chemotherapy. CancerBACUP has further information on lumbar puncture and intrathecal chemotherapy.

Chemotherapy can often shrink high-grade NHL very quickly. If there is a high risk of the disease coming back after standard treatment, other treatments such as high-dose chemotherapy may be recommended. Sometimes radiotherapy may be used after chemotherapy, especially if the lymphoma is in just one area of the body or was very large before chemotherapy was given.

Some people who have been advised to have chemotherapy or radiotherapy worry about the side effects of treatment and wonder what would happen if they did not have it.

Without treatment, high-grade lymphomas would usually get bigger and spread quite quickly and for most people life expectancy would be short. Most of the side effects of treatment can be well controlled and the results are usually very good. A complete cure is possible for many people. Some people will find that their initial treatment does not work, and then another type of treatment will be used.

Whether or not to have treatment is always your own decision, but if you have worries about treatment it can be helpful to discuss them with your cancer specialist, a specialist nurse at the hospital, or one of the nurses at CancerBACUP.

Your treatment

If you have any questions about your treatment don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions for your doctor and to take a close friend or relative with you. You may also be able to speak to a nurse specialist at the hospital.

Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion if you feel this will be helpful.

Children

Children with non-Hodgkin’s lymphoma nearly always have high-grade tumours and the main form of treatment is with intensive chemotherapy. Radiotherapy may sometimes be necessary as well. CancerBACUP has a section on children’s cancers, which has detailed information about non-Hodgkin’s lymphoma in children and its treatment.