How treatment is planned

A group of specialists with expert knowledge in non-Hodgkin lymphoma will manage your treatment. This is called a multidisciplinary team (MDT).

The MDT will meet to discuss your test results and plan your treatment. One of the most important things they will take into account is whether the lymphoma is:

  • indolent (slow-growing)
  • aggressive (fast-growing). 

Because indolent lymphomas tend to be slow growing, some people don’t always need to start treatment straight away. This is called watch and wait.

Early-stage indolent lymphoma is usually treated with radiotherapy. This may cure the lymphoma.

The most common treatment for advanced-stage indolent lymphoma is chemotherapy. This often shrinks the lymphoma and stops symptoms, known as remission. Some indolent lymphomas become more aggressive with time. If this happens, they are treated in the same way as aggressive lymphomas.

Aggressive lymphomas need immediate treatment, usually with chemotherapy. This aims to make the lymphoma disappear (complete remission) – and many people are cured.  If the lymphoma comes back it can sometimes be put back into remission with further treatment, which may be more intensive.

You will need to give permission (consent) for the hospital staff to give you the treatment.

Multidisciplinary team

Usually, a team of specialists have a meeting to discuss your case and agree on the most helpful treatment options for you. This is called a multidisciplinary team (MDT) meeting

The MDT will include a:

  • cancer specialists with experience in treating lymphoma – these might be haematologists (doctors who specialise in treating blood cell disorders) and/or oncologists (doctors who specialise in treating cancer)
  • a radiologist (a doctor who interprets the results of scans and x-rays)
  • a pathologist (a doctor who examines tissue for lymphoma cells and tests them to find the type of lymphoma).

It may also include other specialists, such as a nurse specialist, pharmacist, dietitian, physiotherapist, occupational therapist, psychologist or counsellor.

The MDT will take into account several things when deciding which treatment is best for you, including:

  • the type of lymphoma you have
  • its stage
  • which part(s) of your body are affected
  • your general health
  • your preferences.

Planning your treatment

There are several types of treatment for NHL. You may need just one type of treatment or a combination of different types. Chemotherapy is the most common treatment for NHL and is usually given with steroids. Monoclonal antibody therapy is also often given with chemotherapy. This is called chemoimmunotherapy. Other treatments that may be used include radiotherapy and stem cell transplant.

One of the most important things your doctors will take into account when planning your treatment is whether you have an indolent or aggressive lymphoma.

Treating indolent lymphomas

Early-stage indolent lymphoma

Up to 1 in 5 people with indolent NHL have early-stage or localised disease (stage 1–2) when they are diagnosed.

The most common treatment is radiotherapy to the affected lymph nodes. This usually makes the lymphoma disappear completely and many people are cured. If the lymphoma comes back, it can be treated with chemotherapy and can often be controlled for many years.

Advanced-stage indolent lymphoma

Most people with indolent NHL have advanced stage lymphoma (stage 3 or 4) when they are diagnosed.

Because indolent lymphoma is often very slow-growing, some people don’t need to start treatment straight away.

If you’re not having problems with symptoms, your specialist may suggest it’s best to keep a close eye on you with regular check-ups instead of starting treatment. This is called ‘watch and wait’ or active surveillance. It means you can avoid the inconvenience and side effects of treatment until you really need it. It also means your doctors can keep effective treatments in reserve for you until the disease is starting to cause you problems.

When you have treatment, this is most likely to be with chemotherapy, either on its own or usually with a monoclonal antibody. This is often very successful at shrinking the lymphoma so you feel well and don’t have any symptoms (known as remission). After the lymphoma has gone into remission, some people have a further course of treatment with a monoclonal antibody. This is called maintenance treatment.

After a period of remission, which may last for years, indolent lymphoma eventually comes back. But, with more treatment, it often shrinks back down again, giving another period of remission. In this way, lymphoma may be controlled for years, even decades, and most people have a good quality of life.

Transforming from indolent to aggressive lymphoma

Over time, about 1 in 3 indolent lymphomas become more aggressive. If this happens, the transformed lymphoma is treated in the same way as an aggressive lymphoma.

Sometimes it’s possible for both indolent and aggressive NHL to be diagnosed in the same person, at the same time. If this happens, the NHL is treated as an aggressive lymphoma.

Treating aggressive lymphomas

Aggressive lymphomas are usually fast-growing and need treatment soon after they’re diagnosed. The aim is to make the lymphoma disappear completely (complete remission) and many people are cured. The most common treatment is chemotherapy given into a vein.

This is often given in combination with a monoclonal antibody. Most people have their treatment as outpatients. Chemotherapy can often shrink aggressive lymphoma very quickly.

Sometimes, radiotherapy is used after chemotherapy. It’s most likely to be used if the lymphoma was in just one area of the body, or if the lymph nodes were very enlarged (bulky) before chemotherapy was given.

Some types of aggressive lymphoma may spread to the brain. If there is lymphoma in your brain or a high risk of it spreading there, you may be given additional treatments. This may include having chemotherapy directly into the fluid in the spine, called intrathecal chemotherapy.

Many people with aggressive NHL are cured. But in some people, the lymphoma comes back. If this happens, the lymphoma can sometimes be put back into remission with further treatment. Some people are offered a more intensive treatment than they had for their first treatment. This may involve high-dose chemotherapy with stem cell support (autologous) or a donor (allogeneic) stem cell transplant.

Giving your consent

Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment.

No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:

  • the type and extent of the treatment
  • its advantages and disadvantages
  • any significant risks or side effects
  • any other treatments that may be available.

If you don't understand what you've been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it's not unusual to need repeated explanations.

It's a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.

People sometimes feel that hospital staff are too busy to answer their questions, but it's important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.

You can always ask for more time if you feel that you can't make a decision when your treatment 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 essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don't have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.

Back to Who will be involved in your decision

Getting a second opinion

There are many reasons for wanting a second opinion about your treatment. Speak to your specialist or GP.