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Cancer Types Non-Hodgkin Lymphoma

 
Non-Hodgkin Lymphoma: Treatment
Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat non-

Hodgkin lymphoma include hematologists, medical oncologists, and radiation oncologists. Your doctor may suggest that you choose an oncologist who specializes in the treatment of lymphoma. Often, such doctors are associated with major academic centers. Your health care team may also include an oncology nurse and a registered dietitian.

The choice of treatment depends mainly on the following:

  • The type of non-Hodgkin lymphoma (for example, follicular lymphoma)
  • Its stage (where the lymphoma is found)
  • How quickly the cancer is growing (whether it is indolent or aggressive lymphoma)
  • Your age
  • Whether you have other health problems

If you have indolent non-Hodgkin lymphoma without symptoms, you may not need treatment for the cancer right away. The doctor watches your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting. If you have indolent lymphoma with symptoms, you will probably receive chemotherapy and biological therapy. Radiation therapy may be used for people with Stage I or Stage II lymphoma.

If you have aggressive lymphoma, the treatment is usually chemotherapy and biological therapy. Radiation therapy also may be used. If non-Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People whose lymphoma comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.

You may want to know about side effects and how treatment may change your normal activities. Because chemotherapy and radiation therapy often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them. At any stage of the disease, you can have supportive care. Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring.

You may want to ask the doctor these questions before you begin treatment:

  • What type of lymphoma do I have? May I have a copy of the report from the pathologist?
  • What is the stage of my disease? Where are the tumors?
  • What are my treatment choices? Which do you recommend for me? Why?
  • Will I have more than one kind of treatment?
  • What are the expected benefits of each kind of treatment? How will we know the treatment is working? What tests will be used to check its effectiveness? How often will I get these tests?
  • What are the risks and possible side effects of each treatment?
  • What can we do to control the side effects?
  • How long will treatment last?
  • Will I have to stay in the hospital? If so, for how long? What can I do to take care of myself during treatment?
  • What is the treatment likely to cost? Will my insurance cover the cost?
  • How will treatment affect my normal activities?
  • Would a clinical trial be right for me?
  • How often will I need checkups?


Watchful Waiting

People who choose watchful waiting put off having cancer treatment until they have symptoms. Doctors sometimes suggest watchful waiting for people with indolent lymphoma. People with indolent lymphoma may not have problems that require cancer treatment for a long time. Sometimes the tumor may even shrink for a while without therapy. By putting off treatment, they can avoid the side effects of chemotherapy or radiation therapy. If you and your doctor agree that watchful waiting is a good idea, the doctor will check you regularly (every 3 months). You will receive treatment if symptoms occur or get worse.

Some people do not choose watchful waiting because they don’t want to worry about having cancer that is not treated. Those who choose watchful waiting but later become worried should discuss their feelings with the doctor.

You may want to ask the doctor these questions before choosing watchful waiting:

  • If I choose watchful waiting, can I change my mind later on?
  • Will the disease be harder to treat later?
  • How often will I have checkups?
  • Between checkups, what problems should I report?


Chemotherapy

Chemotherapy for lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body. You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually in an outpatient part of the hospital, at the doctor’s office, or at home. Some people need to stay in the hospital during treatment. Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of cycles depend on the stage of your disease and on the anticancer drugs used.

If you have lymphoma in the stomach caused by H. pylori infection, your doctor may treat this lymphoma with antibiotics. After the drug cures the infection, the lymphoma also may go away.

The side effects of chemotherapy depend mainly on which drugs are given and how much. The drugs can harm normal cells that divide rapidly:

  • Blood cells: When chemotherapy lowers your levels of healthy blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team gives you blood tests to check for low levels of blood cells. If levels are low, there are medicines that can help your body make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may be somewhat different in color and texture.
  • Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, trouble swallowing, or mouth and lip sores.

Ask your health care team about medicines or other treatments that help with these problems. The drugs used for non-Hodgkin lymphoma also may cause skin rashes or blisters, and headaches or other aches. Your skin may become darker. Your nails may develop ridges or dark bands. Your doctor can suggest ways to control many of these side effects.

You may want to ask the doctor these questions before having chemotherapy:
  • Which drug or drugs will I have?
  • When will treatment start? When will it end? How often will I have treatments?
  • What side effects should I tell you about? Can I prevent or treat any of these side effects?
  • Will there be lasting side effects?


Biological Therapy

People with certain types of non-Hodgkin lymphoma may have biological therapy. This type of treatment helps the immune system fight cancer. Monoclonal antibodies are the type of biological therapy used for lymphoma. They are proteins made in the lab that can bind to cancer cells. They help the immune system kill lymphoma cells. People receive this treatment through a vein at the doctor’s office, clinic, or hospital.

Flu-like symptoms such as fever, chills, headache, weakness, and nausea may occur. Most side effects are easy to treat. Rarely, a person may have more serious side effects, such as breathing problems, low blood pressure, or severe skin rashes. Your doctor or nurse can tell you about the side effects that you can expect and how to manage them.

You may want to ask the doctor these questions before having biological therapy:

  • What will the treatment do?
  • Will I have to stay in the hospital?
  • How will we know if the treatment is working?
  • How long will I be on biological therapy?
  • Will I have side effects during treatment? How long will they last? What can we do about them?


Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill non-Hodgkin lymphoma cells. It can shrink tumors and help control pain. Two types of radiation therapy are used for people with lymphoma:

  • External radiation: A large machine aims the rays at the part of the body where lymphoma cells have collected. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.
  • Systemic radiation: Some people with lymphoma receive an injection of radioactive material that travels throughout the body. The radioactive material is bound to monoclonal antibodies that seek out lymphoma cells. The radiation destroys the lymphoma cells.

The side effects of radiation therapy depend mainly on the type of radiation therapy, the dose of radiation, and the part of the body that is treated. For example, external radiation to your abdomen can cause nausea, vomiting, and diarrhea. When your chest and neck are treated, you may have a dry, sore throat and some trouble swallowing. In addition, your skin in the treated area may become red, dry, and tender. You also may lose your hair in the treated area.

You are likely to become very tired during external radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise people to try to stay as active as they can.

People who get systemic radiation also may feel very tired. They may be more likely to get infections.

If you have radiation therapy and chemotherapy at the same time, your side effects may be worse. The side effects can be distressing. You can talk with your doctor about ways to relieve them.

You may want to ask the doctor these questions before starting radiation therapy:

  • Why do I need this treatment?
  • When will the treatments begin? When will they end?
  • What are the risks and side effects of this treatment? What can we do about them?
  • How will I feel during treatment?
  • How will treatment affect my normal activities?
  • Are there any lasting effects?


Stem Cell Transplantation

If lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of blood forming stem cells allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in your bone marrow.

Stem cell transplants take place in the hospital. After you receive high-dose treatment, healthy blood forming stem cells are given to you through a flexible tube placed in a large vein in your neck or chest area.

New blood cells develop from the transplanted stem cells. The stem cells may come from your own body or from a donor:

  • Autologous stem cell transplantation: This type of transplant uses your own stem cells. Your stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After you receive high-dose treatment, the stored stem cells are thawed and returned to you.
  • Allogeneic stem cell transplantation: Sometimes healthy stem cells from a donor are available. Your brother, sister, or parent may be the donor. Or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor’s cells match your cells.
  • Syngeneic stem cell transplantation: This type of transplant uses stem cells from a patient’s healthy identical twin.

You may want to ask the doctor these questions before having a stem cell transplant:

  • What are the possible benefits and risks of different types of transplants?
  • What kind of stem cell transplant will I have? If I need a donor, how will we find one?
  • How long will I need to be in the hospital? Will I need special care? How will I be protected from germs?
  • How will we know if the treatment is working?
  • What can we do about side effects?
  • How will treatment affect my normal activities?
  • What is my chance of a full recovery?


Supportive Care

Non-Hodgkin lymphoma and its treatment can lead to other health problems. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment. You may receive antibiotics and other drugs to help protect you from infections. Your health care team may advise you to stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it can be serious, and you will need treatment right away.

Non-Hodgkin lymphoma and its treatment also can lead to anemia, which may make you feel very tired. Drugs or blood transfusions can help with this problem.


Nutrition and Physical Activity

It’s important for you to take care of yourself by eating well and staying as active as you can.

You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.

Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems.

Many people find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress.

Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it.


Follow-up Care

You’ll need regular checkups after treatment for non-Hodgkin lymphoma. Your doctor will watch your recovery closely and check for recurrence of the lymphoma. Checkups help make sure that any changes in your health are noted and treated as needed.

Checkups may include a physical exam, lab tests, chest x-rays, and other procedures. Between scheduled visits, you should contact the doctor right away if you have any health problems.

You may want to ask your doctor these questions after you have finished treatment:

  • How often will I need checkups?
  • Which follow-up tests do you suggest for me?
  • Between checkups, what health problems or symptoms should I tell you about?