Watch and wait for Non-Hodgkin Lymphoma (NHL)

Watch and wait means delaying treatment until it is needed. For some people with non-Hodgkin lymphoma, this is an option.

What is watch and wait (active monitoring)?

If you have low-grade non-Hodgkin lymphoma (NHL), your doctor may suggest you do not need to start treatment straight away.

Instead, you have regular tests and appointments to monitor the lymphoma and check for signs that you need to start treatment. This is called watch and wait. It may also be called active surveillance or active monitoring. It is a way of delaying treatment until it is needed.

Your doctor may suggest watch and wait if:

  • you have low-grade lymphoma and do not have symptoms
  • low-grade lymphoma has come back after treatment but is not causing problems.

Low-grade lymphoma often develops slowly and you may not need treatment for a long time.

Sometimes people worry about not having treatment straight away immediately. But there can be advantages to delaying treatment.

Advantages of watch and wait

  • Studies have shown that people who delay treatment until it is needed often live as long as people who start treatment straight away. They also respond just as well to treatment.
  • You will avoid the risk of treatment side effects, for as long as possible.
  • Effective treatments can be kept in reserve for you until they are needed.
  • Low-grade lymphoma can go through periods when it is more active and others when it is stable or even shrinks. In some people, the lymphoma shrinks without any treatment. This is called spontaneous regression.

Monitoring lymphoma

Even when you are not having any treatment for lymphoma, you will still see your cancer specialist regularly. At each appointment, they will check you for signs that you may need to start treatment. These signs might include:

  • unexplained weight loss, severe night sweats or unexplained fever (B-symptoms)
  • a lower than normal number of red blood cells (anaemia), white blood cells or platelets in your blood
  • the lymphoma starting to grow quickly
  • the lymphoma starting to affect an important organ, such as a kidney
  • the lymph nodes getting bigger and bulky
  • a build-up of fluid in the tummy area (ascites) or in the lining of lungs (pleural effusion).

 

Coping with watch and wait

If you are worried about delaying treatment, here are some helpful tips:

  • Make sure you understand why watch and wait is recommended and what other treatment options there may be. If you have any concerns, talk to your doctor.
  • Think of your time without treatment as an opportunity to make the most of a good quality of life. Use it to do things you enjoy and to get as fit and healthy as you can. We have more information about maintaining a healthy lifestyle.
  • Try to focus on the present rather than what might happen in the future.
  • Express your feelings – you can do this by talking to family and friends, joining a support group or online forum, or by keeping a journal.

Although watch and wait can be difficult to adjust to at first, many people find it gets easier with time.

About our information

  • References

    Below is a sample of the sources used in our non-Hodgkin lymphoma (NHL) information. If you would like more information about the sources we use, please contact us at  cancerinformationteam@macmillan.org.uk

    National Institute of Health and Care Excellence (NICE). Blood and bone marrow cancers. NICE Pathways. Last accessed 3 December 2020.

    Non-Hodgkin’s lymphoma: diagnosis and management; NICE Guideline (July 2016).

    Newly Diagnosed and Relapsed Follicular Lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up; European Society for Medical Oncology (2020).


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Rajnish Gupta, Macmillan Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.