Your doctor may advise you to just wait and watch for symptoms. This does not mean that you are denied treatment. You will pass all the necessary range of tests and will most likely be hospitalized for the duration of the diagnosis. It’s just that in the case of non-Hodgkin’s lymphomas in the early stages, it is difficult to determine the type of disease and select appropriate procedures. During the observation phase, you will have to discuss which treatment is best for you.
This type of cancer lends itself well to chemotherapy, radiation therapy and immunotherapy both immediately after diagnosis and after some time. And most patients live as long (and maybe even longer), because it is possible to collect a more accurate history and develop a better treatment strategy.
In this case, you most likely will not have to deal with side effects of treatment, such as hair loss, nausea, concomitant infections.
As long as you regularly visit a doctor and keep him informed of any changes, there should be no additional risk factors.
Who can be advised by “watchful waiting”?
The oncologist will recommend observing the disease if it is in a "sluggish" stage, that is, the symptoms do not worsen, but it does not get any better. To do this, you need to carefully study all the tests, take a biopsy of the affected lymphatic tissue and monitor the behavior of the cancer cells.
For example, a type of non-Hodgkin lymphoma called follicular lymphoma is often recommended to be observed first before proceeding with active treatment.
The same approach is applied to other varieties:
- Marginal area lymphoma,
Lymphoplasmacytic lymphoma (also known as Waldenstrom macroglobulinemia)
Chronic lymphocytic leukemia (CLL), or small lymphocytic lymphoma (MLL).
Hodgkin's nodular lymphoma with a lymphoid prevalence is also indicated to be observed first before starting treatment. However, this is a rather rare disease, only 5% of all patients with Hodgkin’s lymphoma make a similar diagnosis.
Non-Hodgkin's lymphoma: before treatment
Lack of active treatment does not mean refusing to visit a doctor. You have to show yourself to the oncologist every 3 to 6 months and thoroughly tell him about your well-being. First of all, pay attention to the feeling of fatigue (how often it occurs, for what reasons, how long it lasts, etc.).
During each visit, a lymph node biopsy will be taken to monitor tumor growth.
A doctor can also prescribe several types of blood tests and screening tests: computed tomography, MRI or positron emission tomography (PET).
In addition, in later stages of lymphoma, a bone marrow biopsy may be necessary.
All these procedures should confirm that the cancer does not affect the vital organs (lungs, heart, kidneys) and is still localized in the lymph nodes.
Such visits may last longer than during the initial inspection. Your doctor must make sure that the condition does not worsen and everything is under control.
The diagnosis of non-Hodgkin's lymphoma. What to do while waiting?
In between appointments, carefully monitor your well-being. Call your oncologist right away if you:
started to lose your appetite and can’t eat,
lose weight fast, but eat as usual
get tired more than before, and for a long time you can’t restore strength,
periodically feel intense heat, sweat a lot,
you feel itchy in different parts of the body,
observe the proliferation of lymph nodes, which were already slightly swollen.
Some of these symptoms can cause other illnesses, such as infections. An oncologist may advise following them a couple of days to see if they disappear. If they are provoked by non-Hodgkin lymphoma, in any case there will be time for preparation for treatment.
Disease monitoring time should be used to good effect. Firstly, you need to reconsider the diet and, if necessary, lose weight, secondly, completely abandon alcohol and smoking, and thirdly, start regular exercise and strengthen immunity.
It is imperative that the body receives all the nutrients and trace elements in the right amounts. Therefore, refuse casual snacks and junk food, switch to vegetables and fruits, protein foods, and if necessary, take vitamins.
It is important to understand that a diagnosis of Non-Hodgkin's lymphoma is not a sentence. Try to live a normal life, do daily chores and work, do not focus on illnesses. Maintaining the right mental attitude is crucial for fighting cancer. Therefore, seek support from relatives, find support groups on the Internet or through your medical center, and seek experience and advice from people who have already managed to overcome cancer.
Non-Hodgkin's lymphoma: what is it?
Non-Hodgkin's Lymphoma (NHL) is the common name for cancer diseases, which comprise more than 30 varieties, where the cell structure is fundamentally different from the cell structure of Hodgkin lymphoma. With this type of disease, malignant cells form in organs with lymphatic tissue (spleen, thymus, tonsils, etc.) and in the lymph nodes themselves.
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According to statistics, the prognosis of life is such that only 25% of patients are cured of this disease.
But there are several factors that influence the outcome of the disease. These factors are timely access to a medical institution, proper diagnosis, qualified treatment, age and even gender of the patient. So, according to studies, non-Hodgkin's lymphoma, women are sick much less often than men. It is also more common in the elderly and adults than in children. But if the disease is found in children (usually older than 5 years) or adolescents, then the NHL can provoke new diseases in the organ system and often this leads to death.
Reasons for the NHL
In recent years, this type of cancer has a tendency to increase. This disease is especially common in people over 40 years of age and ranks sixth in mortality among malignant diseases. In this situation, naturally, scientists make attempts to study the true cause of the disease. But to date, a reliable reason has not been fully established. Based on observations, studies of patient histories, doctors identified some causes of non-Hodgkin lymphoma.Consider them:
- Heredity. As is often observed in many cancers, if someone in the family has had cancer, then the risk for the next generation is high. This is also the case with non-Hodgkin lymphoma. Accurate laboratory studies to prove this, no. But there are statistical observations confirming this factor.
- Old age and obesity. Often the disease occurs after 60 years. Perhaps this is due to a different etiology, acquired due to the age of the patient.
- Ecology. It is established that in areas where a man-made disaster occurred, people are often exposed to cancer, including lymphomas.
- Viral infections. It has been proven that HIV, Epstein-Barr virus, severe forms of hepatitis can provoke the occurrence of lymphoma, due to the fact that they inhibit human immunity
- Radiation. If the patient has had cancer treated with radiation therapy, the risk of lymphoma increases. This is due to the fact that during radiation therapy, healthy blood cells are deformed. This can trigger the appearance of one of the types of lymphoma.
This list is not final. Scientists are also studying the influence of bad habits, such as smoking, alcohol, certain medications, various types of carcinogens on blood formation in humans.
Signs of illness
The clinical picture with neojkinskogo lymphoma is very bright. First of all, lymphoid tissue suffers. This group of lymphomas manifests itself in three stages:
- Enlarged one or many lymph nodes. P mainly their increase is observed on the neck, armpits, groin. Often by touch they become painful.
- Lymphoma affects the internal organs. This phenomenon is called an extranodal tumor. So, for example, there is a lymphoma of the stomach, central nervous system, conjunctiva, etc. At the same time, nausea, vomiting is observed, vision decreases, headaches intensify. If lymphoma affects the respiratory tract, a chronic cough occurs, accompanied by pain in the sternum.
- A person loses weight dramatically, up to anerexia, the temperature rises to a febrile state.
These symptoms are not reliable and require additional diagnosis.
NHL has 4 degrees of development and 3 types of the course of the disease. The choice and method of treatment and prognosis depend on the degree and type of the disease. Consider them:
- The first stage is the easiest, since the disease does not yet manifest itself. Only a few changes in the blood test are possible. Single enlargements of the lymph nodes are possible.
- The second stage is characterized by primary changes in the internal organs, tumors in the peripheral lymph nodes are possible.
- The third stage shows clear signs of the disease. It spreads to both sides of the diaphragm and abdominal cavity.
- The fourth stage is characterized by damage to the central nervous system, bone marrow, and skeleton. This stage of non-Hodgkin lymphoma is the most difficult for both the patient and specialists in choosing treatment methods.
Non-Hodgkin's lymphoma is divided into three types of course. They are called aggressive, indolent and highly aggressive. It is when the clinical picture is bright, with the simultaneous manifestation of all four, this indicates an aggressive appearance of non-Hodgkin lymphoma. The indolent look is lethargic and does not manifest itself for a long time. But with an aggressive survival prognosis, it is much better than with a sluggish course. It is extremely rare to cure the indolent form of non-Hodgkin lymphoma. A highly aggressive species is characterized by a fast, uncontrolled course of the oncological process.
Non-Hodgkin lymphomas are divided into B-cell and T-cell. Depending on what type of patient is ill, predictions can be made.
- Diffuse - refers to an aggressive look, but the chance of cure is high. It is localized in the inguinal, cervical and axillary zones. This large-cell lymphoma includes lymphoma, anaplastic large-cell ALK-positive, anaplastic large-cell lymphoma, ALK-negative.
- Follicular lymphoma - is an indolent species. If treatment is started adequately and on time, the survival rate is 60-70%.
- Small cell - refers to an indolent species. Treatment often does not lead to a positive result. Due to the slow spread, this disease can live up to 10 years.
- Mantle cell lymphoma - occurs in 6% of patients. It is a complex form.
- Marginal area lymphomas. Malignant cells spread slowly. With adequate therapy, rapid remission can be achieved.
- Mediastinal lymphoma - mainly found in women. It is observed only in 2% of patients. The prognosis for recovery is 50%.
- Lymphoplasmacytic lymphoma characterized by an increase in blood viscosity, because of which there is a rupture of capillaries, the formation of blood clots in the vessels. It occurs only in 1% of patients. The prognosis depends on the speed of the disease. It can reach up to 20 years.
- Hairy Cell Leukemia - often found in the elderly. Progresses slowly. Treatment is not always required.
- Burkitt's Lymphoma - has an aggressive character. More often men under 30 suffer. Intensive chemotherapy is used. But the forecasts are pessimistic, since the life expectancy is only 2-3 years.
- Lymphoma of the central nervous system - affects the central nervous system. The survival forecast is only 30%.
- Lyphocytic plasmacytoma - a malignant tumor is formed from bone marrow cells and lymph nodes.
T-cell lymphomas include:
- Lymphoma or leukemia from progenitor cells - is a rare variety of Hodgkin lymphoma (2%). Leukemia or lymphoma is characterized by the number of blast cells in the bone marrow.
- Peripheral lymphomas - these include cutaneous lymphomas, panniculitis-like, extranodal, angioimmunoblastic and lymphomas with enteropathy.
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The prognosis for life with T-cell lymphoma is poor, since this type of lymphoma is super-aggressive and more often patients are in the terminal stage of the disease.
Non-Hodgkin's lymphoma is an extremely severe type of cancer, therefore, the choice of diagnostic method with the subsequent choice of therapy is up to oncology hematologists. The main stage of diagnosis is a lymph node tissue biopsy and bone marrow puncture. But to clarify the prognosis of life, the state of internal organs, a number of medical procedures, diagnostic methods are also carried out, such as blood tests, x-rays, MRI, ultrasound, lymphoscintigraphy, bone scintigraphy. After a thorough diagnosis and determination of the type and stage of non-Hodgkin's lymphoma, if one is found, the specialists select the type of therapy.
When confirming the diagnosis of NHL, doctors choose a treatment regimen based on what specific form of non-Hodgkin lymphoma the patient suffers from, how widespread the disease is inside the body, at what stage lymphoma is.
The main treatment methods are:
The success of treatment depends on how much the disease has progressed, at what stage it is. If the disease is localized and does not have a tendency to develop, it is possible to achieve the complete destruction of lymphoma, cure, or at least prolong the life of a person. With the widespread spread of malignant tumors, the treatment is rather complicated and is aimed at increasing the life expectancy and improving the quality of life of the patient. With super-aggressive and some indalent types of NHL, when the disease is not amenable to therapy, the patient is not left to their own devices. It provides spiritual, psychological help.
If the prognosis for aggressive NHL is favorable, there is standard therapy according to the ASOR (CHOP) scheme, which involves the administration of drugs: Doxorubicin, Oncovin, Cyclophosphamide, as well as taking Prednisolone. Treatment is carried out in courses.
With partial regression of non-Hodgkin lymphoma, drug therapy is carried out in combination with radiation therapy in the affected areas.
If large tumor sizes are observed after treatment, the so-called large-cell diffuse NHL, then the risk of relapse is high. The dose of drugs is increasing. Specialists call this therapy "despair therapy." Remission can be achieved in 25% of cases. But this achievement is of short duration. Then the patient is prescribed high-dose chemotherapy. This method of treatment is advisable in the first relapse, observed with aggressive lymphoma.
With the indolent type of lymphoma, malignant neoplasms respond poorly to treatment. Doctors use traditional chemotherapy, which gives a short remission. But after some time, relapses often occur.
Surgical intervention is justified if the tumor does not spread and is isolated, which is extremely rare.
Nutrition in the NHL:
- It must be frequent and fractional, not allowing to gain excess weight, adequate in energy consumption to exclude weight accumulation,
- Food should be healthy, containing both proteins, fats, carbohydrates in moderation, and containing vitamins and minerals necessary for recovery,
- The amount of salt should be limited, therefore, it is necessary to limit the use of pickles and smoked meats.
It was previously noted that the prognosis depends on the type of non-Hodgkin lymphoma, its stage. With B-cell lymphoma, the prognosis is more favorable than with T-cell. But medicine does not stand still. As a result of adequate therapy, the patient’s life can be extended by 10 years and this is a good result. It is important to be attentive to your body.
With timely access to medical institutions, detection of the disease and the right choice of treatment, the chances of recovery reach up to 70%.
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There are many good treatments for non-Hodgkin lymphoma, but don't be surprised if your doctor advises you not to treat it now. This is called “watchful waiting,” and sometimes it’s the best way to deal with an illness.
You can also hear your doctor call this option “watch and wait” or “active observation”. This does not mean that you will never receive treatment. Your doctor will closely monitor your cancer and check for signs of worsening. At this point, you two will discuss which treatment is best.
About 30% of people with non-Hodgkin’s lymphoma are vigilantly waiting to find out they have the disease. Most of them do not receive treatment until 1-3 years later. Some people go 20 or more years before they need treatment.
Once you start treatment, cancer usually responds just as well to chemotherapy, radiation, and immunotherapy as if you started when you were first diagnosed. Most people also live as long as if they started treatment right away, and possibly even longer, because by the time you start treatment, the treatment may be better.
With a watchful expectation, you won’t have to deal with the side effects of treatment, such as hair loss, infections, and nausea. And time without treatment means that your cancer cells will not become resistant to drugs or other types of therapy.
As long as you regularly check your doctor and stay informed about any changes in your body, there should be no additional risk.
Who should get watchful waiting?
Your doctor will only recommend a cautious wait if your illness is "lazy," which means that it remains the same and does not worsen. To check if you find yourself in such a situation, he will carefully check your symptoms and examine the cancer cells under a microscope.
A type of non-Hodgkin lymphoma called follicular lymphoma often gets a cautious approach to anticipation. Other types that may allow you to skip treatment at this time:
- Lymphomas of the marginal zone
- Lymphoplasmacytic lymphoma (also known as Waldenstrom macroglobulinemia)
- Chronic lymphocytic leukemia (CLL) / small lymphocytic lymphoma (CLL)
Hodgkin lymphoma with a predominance of nodular lymphocytes (NLPHL) also sometimes gets an alert, but not many people have this type of cancer.
What happens during watchful waiting?
Even if you do not receive treatment, you will often see a doctor, usually every 3–6 months. He will want to know if you have any symptoms, such as a feeling of tiredness. He will also see if there are any changes in your lymph nodes - small organs that filter out harmful substances, including microbes.
Your doctor may also order blood tests and screening tests, such as computed tomography, MRI, or PET. They will help confirm that parts of your body, other than the lymph nodes, such as the heart, lungs, and kidneys, are still healthy.
These doctor visits can be longer than regular appointments to make sure you have time to go through everything.
What should I do during watchful waiting?
Between your doctor’s visits, keep an eye on how you feel. Call your doctor if you notice any of these symptoms:
- Start losing your appetite
- Lose pounds without trying
- Get a fever or sweat
- Feeling more tired than usual
- Feel itchy
- Lymph nodes that are already swollen begin to grow larger
- There are lymph nodes that are not swollen before swelling.
There may be other things besides your cancer, such as an infection that can cause some of these symptoms. Your doctor may advise you to wait a little longer to see if they disappear. If the cause is non-Hodgkin lymphoma, you still have time to prepare for treatment.
You can also use the time during watchful waiting to become as healthy as possible. If you start treatment, you will need all the strength. Make sure you eat well, lose weight, if necessary, quit smoking, exercise regularly and do not drink alcohol if you drink.
You can also find a support group online or through your health center. This way you can get the advice of people who go through the same thing as you.