Treatment options
Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.
Treatment for lymphoma depends on:
- the stage of the disease
- the location of the cancer
- the severity of symptoms
- your general health and wishes.
Treatment may involve the following.
Surgery
Surgery is rarely used to treat lymphoma. However, it may be used for lymphomas that have started in organs such as the spleen, thyroid or stomach and have not spread from these organs. It can also be used to treat skin lymphomas, if there is only a small number of skin lesions that can be removed completely.
Chemotherapy
Together with radiotherapy, chemotherapy is 1 of the main treatments for lymphoma. The 2 treatments are often used together.
One potential side effect of chemotherapy that is more likely with lymphoma (and leukaemia) than with other types of cancer is tumour lysis syndrome. This occurs when the large number of lymphoma cells in the body break open after they are killed by the chemotherapy medications, releasing their contents into the bloodstream. This can overwhelm the kidneys, leading to a number of serious problems. Extra fluids and certain medicines may be given to avoid this syndrome.
Radiotherapy
Together with chemotherapy, radiotherapy is 1 of the main treatments for lymphoma. The 2 treatments are often used together. However, doctors try to avoid or limit the use of radiotherapy in children with lymphoma because of potential long-term side effects.
Radiotherapy for Hodgkin lymphoma usually targets only the lymph nodes that originally contained the lymphoma and nearby areas that the lymphoma has spread to. This reduces the area of the body that is exposed to radiation.
Radiotherapy can also be used to relieve symptoms caused by lymphoma that has spread to other organs.
For skin lymphomas that are not very thick, the skin may be treated with ultraviolet (UV) light to kill the cancer cells. This may be combined with a medicine (psoralen), taken as a pill, that increases the cell-killing effect of the UV light.
Targeted therapy
Targeted therapy [link] refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells. These types of medicines affect the way that cancer cells grow, divide, repair themselves or interact with other cells.
Brentuximab vedotin, rituximab, obinutuzumab, ofatumumab, ibritumomab tiuxetan and alemtuzumab are types of monoclonal antibody medicines that can be used to treat lymphoma. They attach to proteins that are found on the surface of some types of lymphoma cells. Brentuximab vedotin is attached to a molecule of a chemotherapy medicine, which enters the lymphoma cells and kills them. Ibritumomab tiuxetan has a radioactive molecule attached to it, which acts on the lymphoma cell to kill it.
Several other targeted medicines have been developed to treat skin lymphomas.
Immunotherapy
Immunotherapy involves treatment with medicines that boost the ability of the immune system to attack cancer cells. Interferon may be used as immunotherapy to treat some types of lymphoma, although it can have serious side effects.
Immunomodulating agents, including thalidomide and lenalidomide, may be used to treat some types of lymphoma, usually after other treatments have been tried. They affect the immune system, but their exact mechanism of action is not known.
Topical medicines
Medicines applied directly to the skin (topical medicines) can be used to treat early-stage skin lymphomas. These include topical corticosteroids, chemotherapy medicines, retinoids and immunotherapy medicines.
Stem cell transplant
Chemotherapy may be given in high doses to treat lymphoma, followed by a stem cell transplant to restore the bone marrow that has been destroyed by the chemotherapy treatment. The transplanted cells may come from a donor or from the patient’s own body. They may be taken from the blood, the bone marrow or the umbilical cord blood.
A stem cell transplant from another person (a donor) is only possible if that person has a tissue type that closely matches that of the person with lymphoma. The best donor is often a close relative. Stem cell transplants from the patient’s own body are more common in treating lymphoma. The cells are removed from the blood or bone marrow in the weeks before chemotherapy treatment and are then returned to the patient’s bloodstream.
Follow-up
After treatment for lymphoma, you will need regular follow-up examinations and tests to look for return of the cancer or side effects from treatment. Because there are many different types of lymphoma, which have different treatments and outlooks, the follow-up care that you need will depend on the type of lymphoma.
Some people may require ongoing chemotherapy or radiotherapy to keep the lymphoma under control.
Advanced disease
If treatment is unsuccessful, palliative treatment to control the symptoms of the disease may be the best option. This might include radiotherapy and chemotherapy to shrink tumours or slow their growth, and medicines to relieve pain and nausea.
Recurrent cancer
Lymphoma may recur (come back) after treatment. Secondary cancer is when the cancer spreads to another part of the body.
Treatment for recurrent or secondary lymphoma depends on where the lymphoma comes back, the initial treatment that was used, the length of time since the initial treatment and your general health. It may involve chemotherapy, radiotherapy, targeted therapy or a stem cell transplant.
- American Cancer Society. Hodgkin disease http://www.cancer.org/cancer/hodgkindisease/index.
- National Cancer Institute (2014). Adult Hodgkin lymphoma treatment (PDQ®) http://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq, patient version.
- American Cancer Society. Non-Hodgkin lymphoma http://www.cancer.org/cancer/non-hodgkinlymphoma/index.
- American Cancer Society. Lymphoma of the skin http://www.cancer.org/cancer/lymphomaoftheskin/index.
- American Cancer Society. Non-Hodgkin lymphoma in children http://www.cancer.org/cancer/non-hodgkinlymphomainchildren/index .
- National Cancer Institute (2014). Adult non-Hodgkin lymphoma treatment (PDQ®) http://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq, patient version.
- National Cancer Institute (2014). Adult Hodgkin lymphoma treatment (PDQ®) http://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq, patient version.