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 a drug called rituximab is used 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 that divides the tummy (abdomen) from 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. It might help to talk to someone close to you about how you are feeling.
Chemo can reach lymphoma cells wherever they are in your body. It’s usually given into a vein (intravenously). For this you will need either a temporary needle called a cannula or a tube into the vein that can stay in for months called 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. These are called late effects. One important late effect is that some chemo can affect the heart. It is important to have a healthy lifestyle, including regular exercise after treatment, as this can reduce the risk of problems. Your doctor will talk to you about this.
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 of both some lymphoma cells and normal white blood cells (called B-lymphocytes or B-cells). When this happens, it 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.
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, and will be monitored while you are having the treatment.
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 can be used on its own or after chemo.
You’ll go to the hospital radiotherapy department for your treatment. Radiotherapy is usually given every day Monday-Friday, with a rest at the weekend. The length of your treatment depends on the type and stage of the lymphoma, but it is usually given over 3-4 weeks. Each individual treatment only takes a few minutes.
Before your treatment starts you’ll go to the radiotherapy department so that your treatment can be planned. The team will help you to lie down in a comfortable position for the radiotherapy and will usually do a CT scan. They will draw marks on you and possibly give you a tiny tattoo to make sure that they line up to the right spot every day.
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 You can bring your own music to play while you have your treatment. The radiographer will be watching you the whole time on CCTV to make sure you are ok. You cannot see or feel radiotherapy, and it does not hurt.
Straight after treatment you will not feel any different. But you’ll probably feel tired after you’ve had a few treatments. It can also make your skin a little red over the areas being treated. Other side effects depend on the part of your body being treated. For example, radiotherapy near your neck might give you a sore throat.
Your doctor will tell you about all of the possible effects of treatment, as some of them can happen some months or years after radiotherapy. They will also explain how you can reduce the chance of these things happening. For example, if you have radiotherapy to your heart you can be at increased risk of heart problems in later life, but this but this can be reduced with regular exercise and a healthy lifestyle.
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.
Always tell your doctor, radiographer or nurse specialist about any side effects you’re having – there’s usually something they can do to make things easier.
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.
We have more information about: