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 (the location of the lymphoma and the extent of its spread)
- 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. A health care team closely watches the individual. 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.
A combination of chemotherapy, biological therapy, and sometimes radiation therapy may be necessary for an aggressive type of lymphoma.
If treatment is required, there are several options used alone or in combination:
Chemotherapy: Health care professionals administer this drug treatment either as an injection or oral form that kills cancer cells. This treatment can involve one medication or multiple medications, and health care professionals may give it 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 kill cancer cells and shrink tumors. Health care professionals use this modality 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 survive standard levels of therapy. Physicians use this therapy if the lymphoma returns after treatment. For this therapy, one needs to be admitted to the hospital. After the therapy, a doctor injects healthy stem cells (that were either taken from you before the therapy or from a donor) to form a new immune system.
Biological drugs: These medications enhance the immune system's ability to fight cancers. Monoclonal antibodies treat NHL. Health care professionals administer the therapy 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. R-CHOP therapy or regimen is an example of a common regimen used to treat NHL. It involves a combination of chemotherapy and biological therapy drugs (rituximab; cyclophosphamide; doxorubicin hydrochloride; vincristine sulfate) and prednisone.
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, the cancer cell absorbs more radiation. 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, researchers linked vitamin deficiencies (especially vitamin D) 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 due to 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.