Treatment for NHL
Treatment for non-Hodgkin lymphoma has a very good success rate and many people are cured. If the tests you’ve had show you have non-Hodgkin lymphoma, your team of specialists will discuss your treatment options with you.
The main treatment for non-Hodgkin lymphoma (NHL) is chemotherapy (chemo), which uses anti-cancer drugs to kill the lymphoma cells. Sometimes older teenagers and young adults are given a drug called rituximab along with chemo. Rituximab is a type of targeted treatment called a monoclonal antibody. Some people also have radiotherapy after their chemo is finished. Radiotherapy uses high-energy rays to kill cancer cells.
The type of treatment you have depends on which type of NHL you have, and on how much lymphoma you have in your body (the stage of the lymphoma). Your doctors will know the stage of your lymphoma from scans, such as CT and PET/CT scans.
The scans will tell you doctors that your NHL is at one of these stages:
Stage 1 - One group of lymph nodes is affected.
Stage 2 - Two or more groups of lymph nodes are affected on the same side of the diaphragm (the sheet of muscle under the lungs).
Stage 3 - Lymph nodes above and below the diaphragm are affected.
Stage 4 - The lymphoma has spread outside the lymph nodes to organs such as the liver, lungs or bone marrow.
Waiting to hear about the stage of the cancer can feel pretty scary, but it’s important to find out this information, as it helps your doctors plan the right treatment.
Chemo can reach lymphoma cells wherever they are in your body. It’s usually given into a vein (intravenously) through a central line, an implantable port or a PICC line. Your bloodstream carries the chemo drugs around your body to wherever they’re needed. You’ll be given a combination of chemo drugs over a few days, followed by a gap of a few weeks. This is known as a cycle of treatment. During the gap between treatments your body (and blood cells) have time to recover from any side effects before the next lot of treatment is given. Your whole treatment will probably last for several months in total. You’re most likely to have your treatment as an outpatient (day patient), but sometimes you might have to stay in hospital for a few days.
You’ll usually be given a combination of chemo drugs.
Different chemo drugs cause different side effects. Some people just have a few side effects and others have more. It's hard to know how they will affect you, as everyone’s different.
Most side effects are short-term (temporary) and gradually disappear once treatment stops. The most common temporary side effects are being more at risk of getting an infection, losing your hair, feeling sick and tiredness.
There’s lots more information in the chemotherapy section.
Sometimes side effects can be long-term. For example, although chemo usually only temporarily affects fertility (being able to have children), sometimes it’s permanent. If you’re having chemo that might affect your fertility, your doctor or nurse should tell you about this. If there is a chance that your fertility will be affected, your doctor will talk to you about things that can be done to help you to be able to have children in the future. For example, guys may be able to store sperm before treatment starts - see our fertility section.
Sometimes there can be other effects of the treatment that happen years later, which are called late effects. Your specialist can talk to you about this.
This treatment is sometimes used for older teenagers and young adults.
Our bodies make antibodies naturally to help us fight infections. Specially designed antibodies (called monoclonal antibodies) can also be made in a lab and used to treat cancer. These monoclonal antibodies work by locking onto a protein on the surface of the cancer cell so that it’s destroyed.
The monoclonal antibody that’s most often used to treat NHL is called rituximab.
Rituximab is used to treat some types of B-cell NHL. It’s given as a drip into a vein. It can be given to you as an outpatient and is usually given with chemotherapy. Rituximab locks on to a protein called CD20, which is found on the surface of white blood cells called B-lymphocytes or B-cells. When the rituximab locks on, this triggers the body’s immune system to attack the cells and destroy them. As well as destroying the abnormal lymphoma cells, the rituximab also destroys your body’s normal B-cells. But your body can replace the normal B-cells once the treatment is over.
You might feel mild pain in the parts of your body where the lymphoma is when rituximab is being given. If this happens, your nurses can give you painkillers to relieve it.
Sometimes people have a reaction to rituximab, especially with the first dose. So the first time you have rituximab it’ll be given slowly over a few hours. You’ll also be given medicines before each treatment that help prevent a reaction.
Signs of a reaction can include having a headache, feeling itchy, or feeling a bit shaky and shivery. Occasionally people have a more serious reaction and feel very breathless. It’s really important that you let the nurses looking after you know if you don’t feel well when you’re having rituximab. This can sound a bit scary, but most people are fine. The drip can also be stopped if you don’t feel well and started again when you feel better.
Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells. Radiotherapy is targeted carefully to only treat the part of the body where the lymphoma is. It may be used when the lymphoma cells are contained in one or two areas of lymph nodes in the same part of the body (for example, in stage 1 or 2 NHL).
For some people, both chemo and radiotherapy are needed.
You’ll go to the hospital radiotherapy department for your treatment. Radiotherapy is usually given Monday-Friday, with a rest at the weekend. The length of your treatment depends on the type and stage of the lymphoma, but a course of radiotherapy treatment is normally given over a few weeks. Each individual treatment only takes a few minutes.
Before your treatment starts you’ll go to the radiotherapy department to have your treatment planned using a CT scan. This helps them make sure your radiotherapy is really accurate. However, you may not need a CT scan if the area being treated is in the skin or near the surface of the skin.
During treatment, you need to lie really still. You'll be left on your own in the room, but it's only for a few minutes and you can talk to the radiographer through an intercom. Some hospitals have music playing while you have your treatment.
Radiotherapy isn't painful, but you’ll probably feel tired after you’ve had a few treatments. It can also make your skin over the areas being treated red and sore. Other side effects depend on the part of your body being treated, for example radiotherapy near your neck might give you a sore throat.
Always tell your doctor or nurse specialist about any side effects you’re having – there’s usually something they can do to make things easier.
If you smoke it’s best to give up because of the effect smoking has on your lungs, especially if you’re having radiotherapy to the chest. To find out more have a look in the radiotherapy section.
We’ve got more information about chemotherapy, rituximab and radiotherapy. This information is written for people of all ages, not just for young people with non-Hodgkin lymphoma.
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