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Treating lymphoma

NHS Choices Medical Reference

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Once lymphoma has been diagnosed, you will need to discuss possible treatment plans. It is likely that the discussion will take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. These health professionals make up what is known as a multidisciplinary team (MDT).

An MDT�often includes the following professionals:

  • oncologist�-� a specialist in the non-surgical treatment of lymphoma, using techniques such as chemotherapy
  • pathologist -�a specialist in the study of cancerous blood cells
  • pharmacist
  • social worker
  • transplant specialist
  • radiographer -�a specialist in radiotherapy
  • microbiologist -�a specialist in infectious diseases
  • psychologist
  • specialist cancer nurse -�who will serve as the first point of contact between you and the members of the MDT
  • counsellor

Treatment for lymphoma may involve a visit to a specialist cancer centre or hospital.

The recommended treatment plan will depend on your general health and your age, because many of the treatments can cause serious side effects and complications, which can put a tremendous strain on the body.

There are several factors to take into account when deciding on your treatment. These include:

  • your age and general health
  • your symptoms
  • the likely progression of your lymphoma
  • specific subtype of your lymphoma
  • the stage of your lymphoma
  • possible side effects of treatment

Your MDT will recommend the best treatment options to you. However, you should not be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner.

Chemotherapy

Chemotherapy is a widely used treatment for lymphoma, often combined with radiotherapy. The type of chemotherapy you receive will depend on the type and stage of your lymphoma.

If it is thought that your lymphoma is curable, you will normally receive an aggressive treatment regimen of chemotherapy injections (intravenous chemotherapy), designed to kill all of the cancerous cells in your body. However, if a cure is unlikely, a more moderate treatment regimen involving taking chemotherapy tablets (oral chemotherapy) may be used, which can often provide long-term relief from symptoms.

Chemotherapy is usually given over a period of a few months on an outpatient basis, meaning you should not have to stay in hospital overnight. But 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 kills the cancerous cells but it can also damage healthy cells, which can lead to a number of common side effects. These include:

  • nausea
  • vomiting
  • diarrhoea
  • loss of appetite
  • mouth ulcers
  • tiredness
  • skin rashes
  • hair loss
  • infertility -�this may be temporary or permanent (see Lymphoma -complications for more details)

Side effects should pass once treatment has finished. Tell your MDT if side effects become particularly troublesome, as there are medicines that can help you cope better with some side effects. For example, creams and gels can treat mouth ulcers.

Aggressive chemotherapy can also damage your bone marrow. This can interfere with the production of healthy blood cells, which can lead to the following symptoms:

  • fatigue
  • breathlessness
  • increased vulnerability to infection
  • bleeding and bruising more easily

Treatment may need to be delayed so that you can produce more healthy blood cells. Growth factor medicines can also stimulate the production of blood cells.

If the damage to the bone marrow is extensive, you may require a stem cell transplant to replace the damaged bone marrow. See Lymphoma - complications�for more information.

Radiotherapy

Radiotherapy is often used to treat stage 1 and 2 lymphomas, when the cancer cells are in only one part of the body. Treatment is normally given daily, Monday to Friday, over the space of two to six weeks. You should not have to stay in hospital between appointments.

The radiographer will need to first carefully plan your treatment. This may involve one or several appointments. The radiographer uses a machine to 'map' out the lymphoma and decide what parts of your body the radiotherapy should be directed at. This may involve making small marks on your skin with a type of marker pen.

Radiotherapy itself is painless, but it has a number of common side effects. These can vary, depending on which part of your body is being treated. For example, if the affected lymph nodes are in your throat, radiotherapy can lead to a sore throat, while treatment to the head can lead to hair loss.

Other common side effects include:

  • tiredness
  • nausea
  • vomiting
  • dry mouth
  • loss of appetite

Monoclonal antibody therapy

Monoclonal antibody therapy can be used to treat some types of non-Hodgkin's lymphoma. Monoclonal antibodies are special medicines designed to recognise specific cancer cells and then destroy them.

The type of monoclonal antibody therapy used to treat non-Hodgkin's lymphoma is a medicine called rituximab. Rituximab attaches itself to the surface of a cancerous cell and stimulates the immune system to attack and kill the cell.

Rituximab can be used to treat low-stage non-Hodgkin's lymphoma, or can be combined with chemotherapy to treat high-stage non-Hodgkin's lymphoma.

Rituximab is administered directly into your vein over the course of a few hours. The usual recommended dose is once a week for four weeks.

It is common to experience flu-like symptoms when you are being treated with rituximab. Possible symptoms include:

  • headache
  • fever and/or chills
  • fatigue
  • muscle pain

You may be given additional medication to prevent or lessen side effects. Side effects should improve over time as your body gets used to rituximab.

Steroids

Steroids are used in combination with chemotherapy to treat some cases of lymphoma. Research has shown that using steroids makes the chemotherapy more effective.

Steroids are given intravenously, usually at the same time as your chemotherapy. A short-term 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
  • an increase in your energy levels
  • problems sleeping

On rare occasions, you may have to take steroids on a long-term basis. Side effects of long-term steroid use include:

  • swelling in your hands, feet and eyelids
  • weight gain
  • indigestion
  • raised blood pressure
  • a slightly higher risk of developing infections

Treatment for low-grade non-Hodgkin's lymphoma

Some people with non-Hodgkin's lyphoma have low-grade lymphomas that grow very slowly. In this case, there is little or no change in the disease for�long periods of time.

If your lymphoma is classified as low-grade, treatment may be postponed,�and you will just have regular check ups to make sure your lymphoma has not spread any further. This is known as active surveillance or watchful waiting.

The first treatment given for low-grade lymphoma is usually chemotherapy, often in combination with a monoclonal antibody. If your lymphoma is in one group of lymph nodes only, you may be given radiotherapy on that area.

After treatment, many people with low-grade lymphoma have no active signs of the disease. This is known as remission. If the lymphoma returns, it can be treated again with chemotherapy, radiotherapy or monoclonal antibodies. Low-grade non-Hodgkin's lymphoma can often be controlled in this way for many years.

Medical Review: May 26, 2010

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