What is the treatment for non-Hodgkin's lymphoma?
A doctor will usually refer a patient to an oncologist for evaluation and treatment. Some large academic medical centers have oncologists who specialize in lymphomas.
The treatment plan depends mainly on the following:
- The type of non-Hodgkin's lymphoma
- Its stage (where the lymphoma is found)
- How quickly the cancer is growing
- The patient's age
- Whether the patient has other health problems
- If there are symptoms present such as fever and night sweats (see above)
If one has a slow-growing non-Hodgkin's lymphoma without symptoms, one may not require treatment for the cancer right away. The individual will be watched closely by a health care team. These cancers might not require treatment for years, although close follow-up is necessary. If the indolent lymphoma produces symptoms, therapy will usually consist of chemotherapy and biological therapy. Stage I and II often require radiation therapy.
For an aggressive type of lymphoma, a combination of chemotherapy and biological therapy is usually indicated, and sometimes radiation therapy will be added.
If treatment is required, there are several options that are utilized alone or in combination:
Chemotherapy: This is a drug treatment either as an injection or oral form that kills cancer cells. This treatment can involve one medication or multiple medications and be given alone or in conjunction with other therapies. This therapy is given in cycles, alternating treatment periods and non-treatment periods. The repetition of these cycles and the number of cycles will be determined by an oncologist based on the staging of the cancer and the medications used. Chemotherapy also harms normal cells that divide rapidly. This can lead to hair loss, GI symptoms, and difficulty with the immune system.
Radiation therapy: High doses of radiation are used to kill cancer cells and shrink tumors. This modality can be used alone or in conjunction with other therapies. Side effects usually depend on the type and dosage of the therapy as well as the area undergoing radiation therapy. Universally, patients tend to get tired during radiation therapy, especially toward the later stages of treatment.
Stem cell transplant: This procedure allows a patient to receive large doses of chemotherapy or radiation therapy to kill the lymphoma cells that might not be killed with standard levels of therapy. This therapy is used if the lymphoma returns after treatment. For this therapy, one needs to be admitted to the hospital. After the therapy, healthy stem cells (that were either taken from you before the therapy or from a donor) are injected to form a new immune system.
Biological drugs: These are medications that enhance the immune system's ability to fight cancers. In NHL, monoclonal antibodies are used for treatment. The therapy is administered via an IV, and the monoclonal antibodies bind to the cancer cells and augment the immune system's ability to destroy cancer cells. Rituximab (Rituxan) is such a drug used in the treatment of B-cell lymphoma. Side effects for this treatment are usually flu-like symptoms. Rarely, a person can have a severe reaction, including a drop in blood pressure or difficulty breathing.
Radio immunotherapy medications: These are made of monoclonal antibodies that transport radioactive materials directly to cancer cells. Because the radioactive material is traveling and binding directly to the cancer cell, more radiation is delivered to the cancer cell and less to the normal tissue. Ibritumomab (Zevalin) and tositumomab (Bexxar) are two drugs approved for this use in lymphomas. Side effects usually include getting very tired or experiencing flu-like symptoms.
Additional aspects of cancer treatments
In addition to medical therapies, patients will also require supportive care. One should have the opportunity to learn about the disease and the treatment options and discuss this with a care team. Most cancer centers will have support groups where one can share concerns with other patients and learn from their experiences.
Some patients find moderate physical activity helpful. Discuss with a doctor what kind of activities are appropriate.
Eating the appropriate amounts of foods, as well as the right foods, is an important part of treatment. Speaking with a nutritionist can be very helpful.
In addition, vitamin deficiencies (especially vitamin D) have recently been linked to worse survival in some subgroups of cancer patients. Patients should discuss their nutritional requirements with their health care team.
Appropriate caloric intake is important especially if nausea is present as a result of your treatments. Some people find that exercise can help their nausea during therapy. Acupuncture has also shown to decrease the side effects of cancer treatments.
What is the prognosis and survival rate for non-Hodgkin's lymphoma?
The prognosis of NHL can be good but is linked to the type of lymphoma, the extent of spread (staging), and response to therapy. Prognosis should be discussed with the patient's health care provider.
The National Cancer Institute reports the following average five-year survival:
NHL Five-Year Survival
|Stage at diagnosis||Stage distribution (%)||Five-year relative survival (%)|
|Localized (confined to primary site)||28||81.6|
|Regional (spread to regional lymph nodes)||15||72.9|
|Distant (cancer has metastasized)||49||61.6|
Five-year survival is a measure used to predict and gauge the severity of the cancer. Patients should discuss risk factors, staging, and classifications with their health care team as none of these numbers should be applied to an individual patient without considering all the circumstances of the patient's illness.