Non-Hodgkin Lymphoma is a disease in which malignant (cancer) cells form in the lymph system and it can be indolent or aggressive. Older age, being male, and having a weakened immune system can increase the risk of non-Hodgkin lymphoma. Signs and symptoms of non-Hodgkin lymphoma include swollen lymph nodes, fever, drenching night sweats, weight loss, and fatigue. Tests that examine the lymph system and other parts of the body are used to diagnose and stage non-Hodgkin lymphoma. Certain factors affect prognosis (chance of recovery) and treatment options.

Non-Hodgkin lymphoma is a type of cancer that forms in the lymph system. The lymph system is part of the immune system. It helps protect the body from infection and disease.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma

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Non-Hodgkin lymphoma is usually treated with chemotherapy or radiotherapy, although some people may not need treatment straight away.

In some instances, if the initial cancer is very small and can be removed during a biopsy, further treatment may not be necessary.

Watch-and-Wait Approach:

For low-grade (slow developing) non-Hodgkin lymphoma, a “watch and wait” strategy is often advised, especially when the patient is in good health. This approach acknowledges that some individuals take many years to develop troublesome symptoms, and an immediate start to treatment is often deemed unnecessary. Under the watch-and-wait plan, regular reviews are conducted, and patients are encouraged to return if their symptoms worsen.

Chemotherapy:

Chemotherapy, a widely employed non-Hodgkin lymphoma treatment, employs medicines to eliminate cancer cells. It can be administered independently, in combination with biological therapy, or alongside radiotherapy. The method of administration varies based on the cancer stage, typically delivered intravenously through a drip, orally as tablets, or a combination of both. In cases where there is a risk of cancer spreading to the brain, chemotherapy injections into the cerebrospinal fluid around the spine may be employed.

While usually an outpatient treatment over several months, more extended hospital stays may be required during challenging periods of symptoms or treatment side effects. Notably, chemotherapy can affect bone marrow, potentially leading to fatigue, breathlessness, increased susceptibility to infection, and easy bleeding or bruising. Growth factor medicines may be used to stimulate blood cell production. Other side effects include nausea, vomiting, diarrhea, loss of appetite, mouth ulcers, tiredness, skin rashes, hair loss, and potential infertility.

High-Dose Chemotherapy:

If initial treatment fails (refractory lymphoma), high-dose chemotherapy may be considered, necessitating a stem cell or bone marrow transplant to replace damaged bone marrow.

Radiotherapy:

Radiotherapy is commonly used for early-stage non-Hodgkin lymphoma, administered over short daily sessions for up to three weeks. While generally painless, it can lead to temporary side effects, including sore throat, hair loss, skin reactions, tiredness, nausea, vomiting, dry mouth, and loss of appetite. Long-term risks may include infertility and permanently darkened skin in the treatment area.

Monoclonal Antibody Therapy:

Certain non-Hodgkin lymphomas may be treated with monoclonal antibodies, which target both healthy and cancerous cells, signaling the immune system to attack and eliminate them. Side effects, such as tiredness, nausea, night sweats, rash, and abdominal pain, can be managed, and these treatments may extend for up to two years after initial therapy.

Steroid Medicine:

Steroid medicine is commonly combined with chemotherapy to enhance effectiveness. Administered as tablets or injections concurrently with chemotherapy cycles, short-term side effects may include increased appetite, indigestion, sleeping problems, and agitation. Long-term use could lead to high blood pressure, weight gain, and swelling, but these side effects typically improve post-treatment.

Follow-Up:

Upon completion of treatment, a repeat scan may assess treatment efficacy, followed by regular follow-up appointments to monitor recovery and detect potential cancer relapse. The frequency of appointments diminishes over time.

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