Non-Hodgkin lymphoma is usually treated with cancer-killing medication or radiotherapy, although some people may not need treatment straight away.
In a few cases, if the initial cancer is very small and can be removed during a biopsy, no further treatment may be needed.
Your treatment plan
The recommended treatment plan will depend on your general health and age, as many of the treatments can put a tremendous strain on the body.
Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. This is known as a multidisciplinary team (MDT).
Your MDT will recommend the best treatment options for you. However, you shouldn't be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner.
You'll be invited back to see your care team for a full discussion about the risks and benefits of any treatments planned before treatment begins.
You can ask your care team if a clinical trial is available to take part in.
The main treatment options for non-Hodgkin lymphoma are described below.
If the disease is low-grade (slow developing) and you're well, a period of "watchful waiting" is often recommended. This is because some people take many years to develop troublesome symptoms and starting treatment immediately is often felt to be unnecessary.
If watchful waiting is recommended, you'll be seen regularly for reviews and invited to come back at any stage if you feel your symptoms are getting worse.
Chemotherapy is a widely used treatment for non-Hodgkin lymphoma, which involves using medicine to kill cancer cells. It may be used on its own, combined with biological therapy and/or combined with radiotherapy (see below).
The medication can be given in a number of different ways, depending on the stage of your cancer.
If doctors think your cancer is curable, you'll normally receive chemotherapy through a drip directly into a vein (intravenous chemotherapy). If a cure is unlikely, you may only need to take chemotherapy tablets to help relieve your symptoms.
If there's a risk of the cancer spreading to your brain, you may have chemotherapy injections directly into the cerebrospinal fluid around your spine.
Chemotherapy is usually given over a period of a few months on an outpatient basis, which means you shouldn't have to stay in hospital overnight. However, there may be times when your symptoms or the side effects of treatment become particularly troublesome, and a longer hospital stay may be needed.
Chemotherapy can have several side effects, the most significant of which is potential damage to your bone marrow. This can interfere with the production of healthy blood cells and cause the following problems:
- increased vulnerability to infection
- bleeding and bruising more easily
If you experience these problems, treatment may need to be delayed so you can produce more healthy blood cells. Growth factor medicines can also stimulate the production of blood cells.
Other possible side effects of chemotherapy include:
Most side effects should pass once your treatment has finished. Tell your care team if side effects become particularly troublesome, as there are treatments that can help.
Read more about the side effects of chemotherapy.
If non-Hodgkin lymphoma doesn't get better with initial treatment (known as "refractory" lymphoma), you may have a course of chemotherapy at a stronger dose.
However, this intensive chemotherapy destroys your bone marrow, leading to the problems mentioned above. You'll need a stem cell or bone marrow transplants to replace the damaged bone marrow.
Radiotherapy is most often used to treat early-stage non-Hodgkin lymphoma, where the cancer is only in one part of the body.
Treatment is normally given in short daily sessions, Monday to Friday, over several weeks. You should not have to stay in hospital between appointments.
Radiotherapy itself is painless, but it can have some significant side effects. These can vary, depending on which part of your body is being treated. For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss.
Other common side effects include:
- sore and red skin in the treatment area
- nausea and vomiting
- dry mouth
- loss of appetite
Most side effects are temporary, but there's a risk of long-term problems, including infertility and permanently darkened skin in the treatment area.
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Monoclonal antibody therapy
For some types of non-Hodgkin lymphoma, you may have a type of medication called a monoclonal antibody.
These medications attach themselves to the surface of cancerous cells and stimulate the immune system to attack and kill the cells. They're often given in combination with chemotherapy to make the treatment more effective.
For some types of non-Hodgkin lymphoma, you may continue having monoclonal antibody treatment regularly for up to two years after initial treatment, in combination with chemotherapy. This can reduce the chances of the cancer coming back in the future.
One of the main monoclonal antibody medications used to treat non-Hodgkin lymphoma is called rituximab. This medication is administered directly into your vein over the course of a few hours.
Side effects of rituximab can include:
- flu-like symptoms, such as headaches, fever and chills
- an itchy rash
You may be given additional medication to prevent or lessen these side effects. Side effects should improve over time, as your body gets used to rituximab.
As rituximab has been so successful in treating non-Hodgkin lymphoma, scientists are working hard to make more monoclonal antibody treatments for lymphoma, and some of these are already at an advanced stage in clinical trials. You may be asked if you want to participate in one of these trials during your treatment.
Steroid medication is commonly used in combination with chemotherapy to treat non-Hodgkin lymphoma. This is because research has shown that using steroids makes the chemotherapy more effective.
The steroid medication is normally given as tablets, usually at the same time as your chemotherapy. A short course of steroids, lasting no more than a few months, is usually recommended, as this limits the number of side effects you could have.
Common side effects of short-term steroid use include:
- increased appetite, which can lead to weight gain
- problems sleeping
- feeling agitated
On rare occasions, you may have to take steroids on a long-term basis. Side effects of long-term steroid use include weight gain and swelling in your hands, feet and eyelids.
The side effects of steroid medication usually start to improve once treatment finishes.
After your course of treatment ends, you may have a repeat scan to see how well the treatment has worked. Following this, you'll need regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning (known as a "relapse").
These appointments will start off being every few weeks or months, but become less frequent over time.
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