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Many people with non-Hodgkin lymphomas can 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.
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 are affected and the number of affected lymph nodes and whether other organs are affected.
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|, often in combination with a monoclonal antibody|. 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 lymphoma then comes back, it can be treated again with chemotherapy (with or without a monoclonal antibody), radiotherapy or with a monoclonal antibody given on its own. Often another period of remission may follow. Low-grade NHL can often be controlled in this way for many years.
These are faster growing and need treatment soon after the diagnosis. Treatment is usually with a combination of chemotherapy drugs and steroids. The chemotherapy is 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. Chemotherapy for high-grade NHL will vary depending on the type.
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 – this is called intrathecal chemotherapy|.
Chemotherapy can often shrink high-grade NHL very quickly. If there is a high risk of the lymphoma coming back after standard treatment, other treatments such as high-dose chemotherapy| may be recommended. Sometimes radiotherapy| is used after chemotherapy, especially if the lymphoma is in just one area of the body or was very large before chemotherapy was given.
Children with non-Hodgkin lymphoma nearly always have high-grade tumours and the main form of treatment is with intensive chemotherapy. Radiotherapy may sometimes be needed as well.
During the initial intensive period of a child’s chemotherapy, they will probably not be able to go to school. Many children worry quite a lot about missing school and getting behind with their work. It is important to reassure them that they will be able to catch up. Your doctor and the social worker at the hospital can help you to arrange a home tutor for your child during this time.
It may help to talk to your child’s head teacher, to see if the school can arrange to send work home for your child. There is also a teacher attached to the hospital ward who will help with your child’s education if they have to be in hospital for extended periods. The teacher will also keep in touch with your child’s school.
Our children's storybook, Peppermint Ward, covers many of the issues children face when having chemotherapy. You can order| a copy of this publication.
We have a section on children’s cancers, which has detailed information about non-Hodgkin lymphoma in children| and its treatment.
In most hospitals, a team of specialists will decide the treatment that is best for you. This multidisciplinary team will include:
It will often include a number of other healthcare professionals such as a nurse specialist, a pathologist (a doctor who specialises in identifying diseases by looking at cells in the laboratory), a dietitian, a physiotherapist, an occupational therapist and a psychologist or counsellor.
Together, the doctors will be able to advise you on the best course of action and plan your treatment.
If two treatments are equally effective for your type and stage of lymphoma, your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the side effects you might get, so that you can decide what the right treatment is for you.
Remember to ask questions about any aspects that you do not understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your doctor, specialist nurse, or our cancer support specialists|.
Before you have any treatment, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. Before you are asked to sign the consent form, you should be given full information about:
If you don't understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.
It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment. Patients can feel that hospital staff are too busy to answer questions, but it is important to know how treatment is likely to affect you. Staff should be willing to make time for your questions.
You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.
Many people are concerned about the side effects that may occur with cancer treatments. Although treatments can cause side effects, these can usually be controlled with medicines. Some people ask what would happen if they did not have any treatment.
Treatment can be given for different reasons, and the potential benefits will vary for each person. Low-grade NHL is usually very sensitive to chemotherapy and radiotherapy, and treatment can reduce the amount of lymphoma (partial remission) or get rid of it for a time (complete remission). Many people with low-grade NHL can have the illness controlled for many years and can live an almost normal life for a lot of that time. Treatment can reduce symptoms and increase life expectancy for most people.
Without treatment, high-grade NHL would usually get bigger and spread quite quickly, and most people would not live for much longer. Most of the side effects of treatment can be well controlled and the treatment is usually effective. A complete cure is possible for many people with high-grade NHL. Some people will find that their initial treatment does not work, and then another type of treatment will be used.
Sometimes, if the lymphoma has come back after initial treatment, the treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some people in this situation the treatment will have no effect upon the cancer and they will get the side effects with little benefit.
If you have been offered treatment that aims to cure your lymphoma or put it into remission, deciding whether to accept the treatment may not be difficult. However, if your lymphoma has come back and the treatment you have been offered is to control it for a period of time, it may be more difficult to decide whether to go ahead with treatment.
Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have further treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.
Even though a number of cancer specialists work together as part of a team to decide on the most suitable treatment, you may want to have another medical opinion. Most doctors will be willing to refer you to another specialist for a second opinion, if you feel that it will be helpful. The second opinion can take some time to organise and may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will be helpful.
If you go for a second opinion, it may be a good idea to take a friend or relative with you, and have a list of questions ready, so that you can make sure your concerns are covered.
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