Your Cancer Type Matters
- Your doctor needs to know what type of non-Hodgkin lymphoma you have, to select the right treatment
- Indolent lymphomas are slow-growing and may not need treatment right away
- Genetic changes in your cancer can affect which type of chemotherapy you need
One way doctors divide up these cancers is based on how fast they’re likely to grow and spread. “The two main classifications I think of in terms of non-Hodgkin lymphoma are lymphomas that are more indolent and those that are more aggressive, because those are treated very differently,” Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Institute, tells SurvivorNet.
Read MoreB-Cell or T-Cell?
Another way to classify non-Hodgkin lymphoma is based on the type of cell it affects. All of these cancers involve lymphocytes — white blood cells that help your immune system fight off germs and get rid of abnormal cells. Lymphocytes come in two types: B-cells and T-cell. If you have non-Hodgkin lymphoma, there’s a good chance you have the B-cell variety because of how common it is.From there, non-Hodgkin lymphomas are broken down into even more categories. Some affect larger numbers of people than others. “Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma, and that is an aggressive subtype,” according to Dr. Crombie.
Which Treatment Will Work Best Against Your Cancer?
Once the work of determining your type of cancer is finished, your doctor can focus on the next important step — how to treat you. If you have an indolent cancer and you don’t have any bothersome symptoms, you may not need treatment right away, Dr. Crombie says.
If your cancer is more aggressive, whether it’s T-cell or B-cell, you can expect to get chemotherapy. Chemo may be part of a cocktail of drugs that are given in combination. These drugs work synergistically, going after your cancer in different ways to treat it more effectively.
Sometimes radiation therapy is used together with chemotherapy. Radiation uses high-energy x-rays to eliminate cancer cells. The radiation typically given for non-Hodgkin lymphoma is delivered from a machine outside the body, which is called external beam radiation.
One more thing your doctor will want to investigate is your cancer’s genetic makeup. Using a sample of your cancer cells taken during a biopsy, your doctor will test for genetic mutations and other abnormalities.
In some people with non-Hodgkin lymphoma, genes have swapped places, which doctors refer to as translocations. C-MYC, BCL2, or BCL6 are three common translocations. Having one of them could affect how your cancer spreads, and how well you might do in the future. Translocations can also change the course of your treatment.
“If patients have those translocations, sometimes we give a slightly different version of chemotherapy,” Dr. Crombie tells SurvivorNet.
Dealing With Treatment Side Effects
Most people handle R-CHOP, the standard chemotherapy cocktail that’s given for diffuse large B-cell lymphoma (the most common subtype of non-Hodgkin lymphoma), pretty well, but everyone is different. A few side effects, like fatigue, nausea, and low blood cell counts, tend to pop up more often with these drugs. There are also a few rare but serious side effects, including bladder damage, heart damage, and nerve damage.
Your doctor will do everything possible to keep you comfortable and ease your side effects while you’re being treated, but you need to be open about how you’re feeling. Doctors can often treat side effects or make adjustments to the chemotherapy drug doses as needed.
“We tell patients to make sure they let us know if they’re having any of those symptoms,” Dr. Crombie says. A fever is especially important to note, because it could be a sign that you have an infection, which needs to be treated right away.
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