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Lymphoma (cont.)

What Is the Treatment for Lymphoma?

General health-care providers rarely undertake the sole care of a cancer patient. The vast majority of cancer patients receive ongoing care from oncologists but may in fact be referred to more than one oncologist should there be any question about the disease. Patients are always encouraged to gain second opinions if the situation so warrants this approach.

  • One may choose to speak with more than one oncologist to find the one with whom he or she feels most comfortable.
  • In addition to one's primary-care physician, family members or friends may offer information. Also, many communities, medical societies, and cancer centers offer telephone or Internet referral services.

Once one settles in with an oncologist, there is ample time to ask questions and discuss treatment regimens.

  • The doctor will present each type of treatment, discuss the pros and cons, and make recommendations based on published treatment guidelines and his or her own experience.
  • Treatment for lymphoma depends on the type and stage. Factors such as age, overall health, and whether one has already been treated for lymphoma before are included in the treatment decision-making process.
  • The decision of which treatment to pursue is made with the doctor (with input from other members of the care team) and family members, but the decision is ultimately the patient's.
  • Be certain to understand exactly what will be done and why and what can be expected from these choices.

As in many cancers, lymphoma is most likely to be cured if it is diagnosed early and treated promptly.

  • The most widely used therapies are combinations of chemotherapy and radiation therapy.
  • Biological therapy, which targets key features of the lymphoma cells, is used in many cases nowadays.

The goal of medical therapy in lymphoma is complete remission. This means that all signs of the disease have disappeared after treatment. Remission is not the same as cure. In remission, one may still have lymphoma cells in the body, but they are undetectable and cause no symptoms.

  • When in remission, the lymphoma may come back. This is called recurrence.
  • The duration of remission depends on the type, stage, and grade of the lymphoma. A remission may last a few months, a few years, or may continue throughout one's life.
  • Remission that lasts a long time is called durable remission, and this is the goal of therapy.
  • The duration of remission is a good indicator of the aggressiveness of the lymphoma and of the prognosis. A longer remission generally indicates a better prognosis.

Remission can also be partial. This means that the tumor shrinks after treatment to less than half its size before treatment.

The following terms are used to describe the lymphoma's response to treatment:

  • Improvement: The lymphoma shrinks but is still greater than half its original size.
  • Stable disease: The lymphoma stays the same.
  • Progression: The lymphoma worsens during treatment.
  • Refractory disease: The lymphoma is resistant to treatment.

The following terms to refer to therapy:

  • Induction therapy is designed to induce a remission.
  • If this treatment does not induce a complete remission, new or different therapy will be initiated. This is usually referred to as salvage therapy.
  • Once in remission, one may be given yet another treatment to prevent recurrence. This is called maintenance therapy.

Medical Treatment: Radiation and Chemotherapy

Standard first-line therapy (primary therapy) for lymphoma includes radiation therapy for most early-stage lymphomas, or a combination of chemotherapy and radiation. For later-stage lymphomas, chemotherapy is primarily used, with radiation therapy added for control of bulky disease. Biological therapy, or immunotherapy, is routinely used alongside chemotherapy.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It is considered a local therapy, meaning that it should be used to target areas of the body involved by tumor masses. A radiation oncologist will plan and supervise therapy.

  • The radiation is targeted at the affected lymph node region or organ. Occasionally, nearby areas are also irradiated to kill any cells that might have spread there undetected.
  • Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue, loss of appetite, nausea, diarrhea, and skin problems. Radiation of lymph node areas may result in suppression of the immune system to varying degrees. Irradiation of the underlying bone and the marrow within the bone may result in suppression of the blood counts.
  • The radiation is usually administered in short bursts on five days a week over the course of several weeks. This keeps the dose of each treatment low and helps prevent or lessen side effects.

Chemotherapy

Chemotherapy is the use of powerful drugs to kill cancer cells. Chemotherapy is a systemic therapy, meaning that it circulates through the bloodstream and affects all parts of the body.

Unfortunately, chemotherapy also affects healthy cells; this accounts for its well-known side effects.

  • The side effects of chemotherapy depend partly on the drugs used and the doses.
  • Some people, because of variability in metabolism of chemotherapy drugs, tolerate chemotherapy better than other people.
  • The most common side effects of chemotherapy include suppression of blood counts, which could result in increased susceptibility to infection (low white blood cell count), anemia (low red blood cell count that may require a blood transfusion), or blood-clotting problems (low platelet count). Other side effects may include nausea and vomiting, loss of appetite, hair loss, sores in the mouth and digestive tract, fatigue, muscle aches, and changes in fingernails and toenails.
  • Medications and other treatments are available to help people tolerate these side effects, which can be severe.
  • It is very important to discuss and review the potential side effects of each chemotherapy drug in the treatment with the oncologist, pharmacist, or oncology nurse. Medications to lessen the side effects should also be reviewed.

Chemotherapy may be given in pill form, but it is typically a liquid infused directly into the bloodstream through a vein (intravenous).

  • Most people who receive intravenous chemotherapy will have a semi-permanent device placed in a large vein, usually in the chest or arm.
  • This device allows the medical team quick and easy access to the blood vessels, both for administering medications and for collecting blood samples.
  • These devices come in several types, usually referred to as a "catheter," "port," or "central line."

Experience has shown that combinations of drugs are more efficient than monotherapy (use of a single medication).

  • Combinations of different drugs both increase the chance that the drugs will work and lower the dose of each individual drug, reducing the chance of intolerable side effects.
  • Several different standard combinations are used in lymphoma. Which combination one receives depends on the type of lymphoma and the experiences of the oncologist and the medical center where a person is receiving treatment.
  • The combinations of drugs are usually given according to a set schedule that must be followed very strictly.
  • In some situations, chemotherapy can be given in the oncologist's office. In other situations, one must stay in the hospital.

Chemotherapy is given in cycles.

  • One cycle includes the period of actual treatment, usually several days, followed by a period of rest for several weeks to allow recovery from side effects caused by the chemotherapy, particularly anemia and low white blood cells.
  • Standard treatment typically includes a set number of cycles, such as four or six.
  • Spreading the chemotherapy out this way allows a higher cumulative dose to be given, while improving the person's ability to tolerate the side effects.
Medically Reviewed by a Doctor on 9/11/2017

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The eMedicineHealth doctors ask about Lymphoma:

Lymphoma - Experience

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Lymphoma - Symptoms

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Lymphoma - Effective Treatment

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Read What Your Physician is Reading on Medscape

Lymphoma, B-Cell »

Non-Hodgkin lymphoma (NHL) is a heterogenous group of lymphoproliferative malignancies with differing patterns of behavior and responses to treatment (Armitage, 1993).

Read More on Medscape Reference »


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