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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:
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| using cytotoxic drugs, 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 often given 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.
In most hospitals, a team of specialists will decide the treatment that is best for you. This multidisciplinary team (MDT) will include:
The team will often also include a number of other healthcare professionals, such as:
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’re 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 choose the right treatment for you.
Remember to ask questions about anything you don’t 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|.
You may be asked to take part in a research trial.| There are a number of different trials for NHL. Your doctors will explain whether there are any that are suitable for you. You don’t have to take part in a trial. If you don’t take part, you will be given the standard treatment for your type of lymphoma.
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’s not unusual for people to need repeated explanations.
It’s 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’s 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 don’t have it. It’s important to tell a doctor or nurse if you decide not to have treatment so that they can record your decision in your medical notes. You don’t have to give a reason for not wanting to have treatment, but it can help 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 didn’t 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 a cure isn’t possible and the treatment is to control the lymphoma 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.
Usually a number of cancer specialists work together as a team and use national treatment guidelines to decide on the most suitable treatment for you. Even so, you may want to have another medical opinion. Either your specialist or GP should be willing to refer you to another specialist for a second opinion, if you feel it will be helpful. Having a second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
If you do 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 during the discussion.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.