health info :: hiv treatment :: n.h. lymphoma

Non-Hodgkin’s Lymphoma (NHL)

June 2005 View PDF
Reprinted from National Cancer Institute, www.cancer.gov, US

Methods of treatment

Chemotherapy and radiation therapy are the most common treatments for non-Hodgkin’s lymphoma, although bone marrow transplantation, biological therapies, or surgery are sometimes used.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for non-Hodgkin’s lymphoma usually consists of a combination of several drugs. Patients may receive chemotherapy alone or in combination with radiation therapy.

Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic treatment because the drugs enter the bloodstream and travel throughout the body.

Usually a patient has chemotherapy as an out-patient (at the hospital, at the doctor’s office, or at home). However, depending on which drugs are given and the patient’s general health, a short hospital stay may be needed.

These are some questions patients may want to ask the doctor before starting chemotherapy:

What is the goal of this treatment?
What drugs will I be taking?
Will the drugs cause side effects? What can I do about them?
What side effects should I report to you?
How long will I need to take this treatment?
What can I do to take care of myself during treatment?
How will we know if the drugs are working?

Radiation
Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells. Treatment with radiation may be given alone or with chemotherapy. Radiation therapy is local treatment; it affects cancer cells only in the treated area. Radiation therapy for non-Hodgkin’s lymphoma comes from a machine that aims the high-energy rays at a specific area of the body. There is no radioactivity in the body when the treatment is over.

These are some questions a patient may want to ask the doctor before having radiation therapy:

What is the goal of this treatment?
What are its risks and possible side effects?
What side effects should I report to you?
How will radiation be given?
When will the treatments begin? When will they end?
What can I do to take care of myself during therapy?
How will we know if the radiation therapy is working?
How will treatment affect my normal activities?

Sometimes patients are given chemotherapy and/or radiation therapy to kill undetected cancer cells that may be present in the central nervous system (CNS). In this treatment, called central nervous system prophylaxis, the doctor injects anticancer drugs directly into the cerebrospinal fluid.

Bone marrow
Bone marrow transplantation (BMT) may also be a treatment option, especially for patients whose non-Hodgkin’s lymphoma has recurred (come back). BMT provides the patient with healthy stem cells (very immature cells that produce blood cells) to replace cells damaged or destroyed by treatment with very high doses of chemotherapy and/or radiation therapy. The healthy bone marrow may come from a donor, or it may be marrow that was removed from the patient, treated to destroy cancer cells, stored, and then given back to the person following the high-dose treatment. Until the transplanted bone marrow begins to produce enough white blood cells, patients have to be carefully protected from infection. They usually stay in the hospital for several weeks.

These are some questions patients may want to ask the doctor before having a BMT:

What are the benefits of this treatment?
What are the risks and possible side effects? What can be done about them?
What side effects should I report to you?
How long will I be in the hospital? What care will I need after I leave the hospital?
How will the treatment affect my normal activities?
How will I know if the treatment is working?

Biological
Biological therapy (also called immunotherapy) is a form of treatment that uses the body’s immune system, either directly or indirectly, to fight cancer or to lessen the side effects that can be caused by some cancer treatments. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body’s natural defenses against disease. Biological therapy is sometimes also called biological response modifier therapy.

These are some questions patients may want to ask the doctor before starting biological therapy:

What is the goal of this treatment?
What drugs will I be taking?
Will the treatment cause side effects? If so, what can I do about them?
What side effects should I report to you?
Will I have to be in the hospital to get treatment?
How long will I need to take this treatment?
When will I be able to resume my normal activities?

Surgery
Surgery may be performed to remove a tumor. Tissue around the tumor and nearby lymph nodes may also be removed during the operation.

These are some questions a patient may want to ask the doctor before surgery:

What kind of operation will it be?
How will I feel after the operation?
If I have pain, how will you help?
Will I need more treatment after surgery?
How long will I be in the hospital?
When will I be able to resume my normal activities?

Clinical Trials
Many people with non-Hodgkin’s lymphoma take part in clinical trials (research studies). Doctors conduct clinical trials to learn about the effectiveness and side effects of new treatments. In some trials, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the standard therapy to another group; or they may compare one standard treatment with another. Research like this has led to significant advances in the treatment of cancer. Each achievement brings researchers closer to the eventual control of cancer.

Doctors are studying radiation therapy, new ways of giving chemotherapy, new anticancer drugs and drug combinations, biological therapies, bone marrow transplantation, peripheral blood stem cell transplantation, and new ways of combining various types of treatment. Some studies are designed to find ways to reduce the side effects of treatment and to improve the patient’s quality of life.

People who take part in these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science.

Patients who are interested in taking part in a clinical trial should talk with their doctor. They may also want to read the National Cancer Institute booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know, which describes how studies are carried out and explains their possible benefits and risks. The NCI Web site at www.cancer.gov provides detailed information about ongoing studies for non-Hodgkin’s lymphoma. Another way to learn about clinical trials is through the Cancer Information Service.

Preparing for treatment

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