non-Hodgkin's lymphoma treatment
Many people with non-Hodgkin's lymphoma want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before you visit your doctor.
To help remember what your doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to your doctor – to take part in the discussion, to take notes, or just to listen.
You do not need to ask all your questions at once. You will have other chances to ask your doctor to explain things that are not clear and to ask for more information.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat non-Hodgkin's lymphoma include hematologists, medical oncologists, and radiation oncologists. Your doctor may suggest that you choose an oncologist who specializes in the treatment of lymphoma. Often, such doctors are associated with major academic centers.
Getting a second opinionBefore starting treatment, you might want a second opinion about your diagnosis and your treatment plan.
It is a good idea to get a second opinion about the type of lymphoma that you have. The treatment plan varies by the type of lymphoma. A pathologist at a major referral center can review your biopsy.
You also may want a second opinion about your treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather your medical records and arrange to see another doctor. Most of the time, it is not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To be sure, you should discuss this delay with your doctor. Some people with non-Hodgkin's lymphoma need treatment right away.
There are a number of ways to find a doctor for a second opinion:
Preparing for treatmentThe choice of treatment depends on many factors, including:
You may want to ask the doctor these questions before treatment begins:
Treatment methodsIf you have indolent non-Hodgkin's lymphoma without symptoms, you may not need treatment for the cancer right away. The doctor watches your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.
If you have indolent lymphoma with symptoms, you will probably receive chemotherapy and biological therapy. Radiation therapy may be used for patients with Stage I or Stage II lymphoma.
If you have aggressive lymphoma, the treatment is usually chemotherapy and biological therapy. Radiation therapy also may be used.
If non-Hodgkin's lymphoma comes back after treatment, doctors call this a relapse or recurrence. People whose lymphoma comes back after treatment may receive stem cell transplantation.
Because cancer treatments often harm healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person, and they may change from one treatment session to the next. The younger a person is, the easier it may be to cope with treatment and its side effects.
Before treatment starts, the health care team will explain possible side effects and suggest ways to help you manage them.
At any stage of the disease, you can have treatments to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care.
You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods.
Watchful waitingPeople who choose watchful waiting put off having cancer treatment until they have symptoms. Doctors sometimes suggest watchful waiting for a patient with indolent lymphoma. A person with indolent lymphoma may not have problems that require cancer treatment for a long time. Sometimes the tumor may even shrink for a while without therapy. By putting off treatment, a patient can avoid the side effects of chemotherapy or radiation therapy.
If you and your doctor agree that watchful waiting is a good idea, the doctor will check you regularly (every 3 months). You will receive treatment if symptoms occur or get worse.
Some people do not choose watchful waiting because they don't want to worry about having cancer that is not treated. Those who choose watchful waiting but later become worried should discuss their feelings with the doctor.
You may want to ask the doctor these questions before choosing watchful waiting:
ChemotherapyChemotherapy uses drugs to kill cancer cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach cancer cells in almost all parts of the body.
You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually in an outpatient part of the hospital, at the doctor's office, or at home. Some patients need to stay in the hospital during treatment.
If a patient has lymphoma in the stomach caused by H. pylori infection, the doctor may treat this lymphoma with antibiotics. After the drug cures the infection, the cancer also may go away.
The side effects of chemotherapy depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:
Your doctor can suggest ways to control many of these side effects.
You may want to ask the doctor these questions before starting chemotherapy:
Biological therapyPeople with certain types of non-Hodgkin's lymphoma may have biological therapy. This type of treatment helps the immune system fight cancer.
Monoclonal antibodies are the type of biological therapy used for lymphoma. They are proteins made in the lab that can bind to cancer cells. They help the immune system kill lymphoma cells. Patients receive this treatment through a vein at the doctor's office, clinic, or hospital.
Flu-like symptoms such as fever, chills, headache, weakness, and nausea may occur. Most side effects are easy to treat. Rarely, a patient may have more serious side effects, such as breathing problems, low blood pressure, or severe skin rashes. Your doctor or nurse can tell you about the side effects that you can expect and how to manage them.
You may want to ask the doctor these questions before having biological therapy:
Radiation therapyRadiation therapy (also called radiotherapy) uses high-energy rays to kill non-Hodgkin's lymphoma cells. It can shrink tumors and help control pain.
Two types of radiation therapy are used for people with lymphoma:
You are likely to become very tired during external radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
People who get systemic radiation also may feel very tired. They may be more likely to get infections.
If you have radiation therapy and chemotherapy at the same time, your side effects may be worse. The side effects can be distressing. You can talk with your doctor about ways to relieve them.
You may want to ask the doctor these questions before starting radiation therapy:
Stem cell transplantationA transplant of blood-forming stem cells allows a person to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow. Later, the patient receives healthy blood-forming stem cells through a flexible tube placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.
Stem cell transplants take place in the hospital. The stem cells may come from the patient or from a donor:
Supportive careNon-Hodgkin's lymphoma and its treatment can lead to other health problems. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment.
You may receive antibiotics and other drugs to help protect you from infections. Your health care team may advise you to stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it can be serious, and you will need treatment right away.
Non-Hodgkin's lymphoma and its treatment also can lead to anemia, which may make you feel very tired. Drugs or blood transfusions can help with this problem.
Complementary and alternative medicineSome people with cancer use complementary and alternative medicine (CAM):
However, some types of CAM can create health problems. An alternative medicine may not work as well as standard treatment. Patients with aggressive lymphoma who use alternative medicine instead of standard treatment may reduce the chance to control or cure their disease.
It is important to keep in mind that some complementary medicines may interfere with standard treatment. Combining CAM with standard treatment may even be harmful. Before trying any type of CAM, you should discuss its possible benefits and risks with your doctor.
Some types of CAM are expensive. Health insurance may not cover the cost.
You may want to ask the doctor these questions before you choose CAM:
NutritionIt is important for you to eat well. Eating well means getting enough calories to maintain a good weight and enough protein to keep up your strength. Good nutrition may help people with cancer feel better and have more energy.
But eating well can be hard. You may not feel like eating if you are tired or in pain. Also, the side effects of treatment (such as nausea, vomiting, or mouth sores) can be a problem. Some people find that foods do not taste as good during cancer treatment.
The doctor, dietitian, or other health care provider can suggest ways to maintain a healthy diet.
Follow-up careFollow-up care for non-Hodgkin's lymphoma is important. Your doctor will watch your recovery closely and check for recurrence of the lymphoma. Checkups help make sure that any changes in your health are noted and treated as needed. Checkups may include a physical exam, lab tests, chest X-rays, and other procedures. Between scheduled visits, you should contact the doctor right away if you have any health problems.
Related category• HEALTH AND DISEASE
Source: National Cancer Institute
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