Waiting for Lymphoma Treatment
- People with slow-growing non-Hodgkin lymphoma may be able to wait to start treatment
- Doctors monitor patients very closely during the waiting period, and start treatment when needed
- Anyone with an aggressive cancer such as diffuse large B-cell lymphoma should not wait to get treated
“Watchful waiting is a wonderful and a terrible thing all at the same time,” Dr. Caitlin Costello, hematologist-oncologist at UC San Diego Health, tells SurvivorNet. “It’s wonderful to not need treatment, but oftentimes terribly agonizing to just feel like you’re sitting there waiting for someone to tell you that you need treatment.”
Read MoreWho Can Afford to Wait?
Watchful waiting may be appropriate for people with indolent cancers such as follicular lymphoma or marginal zone lymphoma, Dr. Costello says. Indolent means the cancer is growing slowly, so it’s not likely to spread while you wait. Another reason to wait is if your cancer isn’t causing you any symptoms. It’s important when considering whether to wait that your lymph nodes aren’t growing quickly, and that none of your major organs — such as your heart or lungs — is being affected by your cancer. Even with a slow growing cancer, your doctor will do a risk-benefit assessment to find out if the advantages of starting treatment outweigh the risk of side effects from that treatment. For some people, the answer is clearly yes, because they would benefit from treatment. “Whereas for other patients, we’d say it’s really not worth it at this point. The risk of the treatment isn’t worth the potential small benefit for you,” Dr. Costello adds.Waiting has a few definite advantages. For one thing, you’ll avoid treatment side effects. Also, your cancer won’t have a chance to become resistant and stop responding to treatment.
What Happens While You Wait
Watchful waiting doesn’t mean that your doctor will do nothing. As the word “watchful” in the phrase implies, your doctor will carefully monitor you on a regular basis, and will start you on treatment as soon as you need it.
You’ll have periodic check-ups to go over your symptoms. During those visits, your doctor will likely do physical exams and give you blood tests. Sometimes you may need imaging scans such as x-rays and computed tomography (CT) to see if your cancer has progressed. In between visits, it’s important to let your doctor know if you have any new symptoms.
Who Shouldn’t Wait?
Anyone with an aggressive form of the disease, such as diffuse large B-cell lymphoma, should never wait, Dr. Costello says. With a cancer that spreads rapidly, waiting could mean taking too big of a risk. Usually, you’ll start right away on treatment, which often involves a combination of chemotherapy and other drugs called R-CHOP.
“When you wait and watch is after the treatment is over,” she tells SurvivorNet. Once you’ve finished your treatment regimen and your doctor confirms with imaging tests that you’ve gone into remission, the waiting will begin. “Over the course of the next five years or so, you’ll be monitored at varying levels of frequency in order to ensure that the lymphoma does not relapse.”
Whether you’ve waited from the start or you’re waiting after a remission, your treatment team will probably suggest that you start treatment if you develop symptoms such as fevers, night sweats, or weight loss. Another reason to go on treatment is if your lymph nodes start to grow or your blood tests indicate that the cancer is in your organs or bone marrow. If you’re in one of these situations, your doctor will go over your treatment options with you.
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