Treatment Overview

Different types of treatment are used for different types of non-Hodgkin's lymphoma (NHL). Treatment of NHL depends on:

• The stage of the disease.
• The type of lymphoma. The kind of treatment you have will depend on whether you have B-cell or T-cell lymphoma and whether it is fast-growing or slow-growing.
• The size of the tumor, where the lymphoma is located, and what organs are involved.
• Your general health.
• Whether you have had lymphoma in the past (recurrent disease). Although lymphoma that has come back (recurred) may be controlled, it often is not curable.

Initial treatment

Treatment recommendations that may be appropriate when you are first diagnosed with non-Hodgkin's lymphoma include:

• Watchful waiting (surveillance), a period of time after the diagnosis of some types of NHL when you are not receiving treatment but are still being watched closely by your doctor. Watchful waiting gives as good or better results than more aggressive treatment for some types of NHL, such as advanced low-grade indolent lymphoma.
• Radiation therapy, which is often the treatment of choice for early-stage, indolent NHL. Radiation therapy may be used alone or combined with other treatment options for more advanced NHL.
• Chemotherapy, which kills cancer cells or stops them from dividing. The way chemotherapy is given depends on the type and stage of cancer. This may include taking it by mouth or having it injected into a vein or muscle. Or chemotherapy may be placed directly into the spine, an organ, or into the belly.
• Monoclonal antibody therapy. This is a cancer treatment that uses special antibodies that attach to cancer cells and destroy them without harming normal cells. Examples include rituximab (Rituxan) and alemtuzumab (Campath).

If you have recently been diagnosed with non-Hodgkin's lymphoma, you may experience a lot of emotions. Most people experience some denial, anger, and grief. Other people may have fewer emotions. There is no "normal" or "right" way to react to a diagnosis of lymphoma. There are many steps you can take to help with your emotional reactions. You may find that talking with family and friends helps you with your emotions. Some people may find that spending time alone is what they need.

If your reaction is interfering with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who may have had similar feelings can be very helpful.

You may use home treatment to help you manage the side effects that may happen with NHL or its treatment.

Ongoing treatment

Schedule regular follow-up examinations with your doctor after you have been treated for non-Hodgkin's lymphoma. Follow-up care is an important part of the overall treatment plan. During regular follow-up care:

• You will probably be seen about every 3 months for the first year and then less often the next year or two. After that, you will only need a checkup each year if you have had no relapse.
• Changes in health can be discussed with your doctor. To monitor your health, your doctor may obtain lab tests, such as a chemistry screen and CBC, and imaging tests, such as a chest X-ray or CT scan.

Report to your doctor any problems you have, as soon as they appear. If you are having a problem, you may need to make some new appointments.

Treatment if the condition gets worse

You may be offered the following treatment options if your disease progresses:

• Radiation therapy may be used alone or in combination with other treatments if non-Hodgkin's lymphoma (NHL) recurs. Targeted radiation therapy uses monoclonal antibodies to deliver radiation directly to lymphoma cells.
• Chemotherapy often effectively treats recurrent NHL. Sometimes a person may take one type of chemotherapy for several cycles and later be switched to different medicines if the first medicines are no longer working.
• Stem cell transplant is often used to treat recurrent lymphoma. Stem cell transplant may be offered as part of standard treatment or in a clinical trial. Talk with your doctor to see if a clinical trial may be available for your type of recurrent disease.
• Biological therapy may be used to treat recurrent lymphoma.

What to think about

Survival rates have improved as a result of clinical trials. Clinical trials provide evidence about new medicines and treatments that may help people who have non-Hodgkin's lymphoma live longer and have a better quality of life. If you are interested in taking part in a clinical trial, check with your doctor to see if there are any clinical trials available in your area.

Your doctor may use the term "remission" instead of "cure" when talking about the effectiveness of your treatment. Although many people with non-Hodgkin's lymphoma are successfully treated, the term remission is used because cancer can return. It is important to discuss with your doctor the possibility of recurrence.

Even after effective treatment for NHL, you may be at slightly higher risk for other types of cancer, especially melanoma, lung, brain, kidney, and bladder cancers. Be watchful for any symptoms of cancer.

For more information about specific treatments, see the following topics:

• Adult Non-Hodgkin's Lymphoma - Health Professional Information[NCI PDQ]
• Adult Non-Hodgkin's Lymphoma - Patient Information[NCI PDQ]

Non-Hodgkin's lymphoma can also occur in children and adolescents, but it is not very common. When children get NHL, it is not the same kind that is common in adults. Also, treatments for children and adolescents are different from treatments for adults.

For more information about treatments for children and adolescents, see the following topics:

• Childhood Non-Hodgkin's Lymphoma - Health Professional Information[NCI PDQ]
• Childhood Non-Hodgkin's Lymphoma - Patient Information[NCI PDQ]