Hong Kong Cancer Fund

In recent years a lot of progress has been made with the treatment for non-Hodgkin's lymphomas and an increasing number of people can now be cured, even when the disease has spread from the original site.

The low-grade lymphomas grow very slowly and sometimes do not need treatment for a long time, if at all, and regular check-ups are all that is needed. When they do require treatment it is most often with mild chemotherapy - tablets which can be taken at home.

The high-grade lymphomas are faster growing and need treatment with intensive chemotherapy.

Children with non-Hodgkin's lymphomas nearly always have high-grade tumours and the main form of treatment is with intensive chemotherapy. Radiotherapy is not usually part of the treatment programme, but may be necessary in some circumstances.

Your doctor will plan your treatment by taking into consideration a number of factors, including:

	your age
	general health
	the type of lymphoma
	whether it has spread to other parts of the body

Radiotherapy

Radiotherapy treats cancer by using high energy rays which destroy the cancer cells while doing as little harm as possible to normal cells

Radiotherapy is a local treatment and may be used when the lymphoma cells are contained in one or two areas of lymph nodes in the same part of the body.

Chemotherapy

	Chemotherapy is the use of special anti-cancer (cytotoxic) drugs to destroy the lymphoma cells
	They work by stopping the cells from dividing
	As the drugs circulate in the bloodstream they can reach the lymphoma cells all over the body
	With the slow-growing type of lymphoma the drugs can sometimes be given in tablet form and can therefore be taken at home, enabling you to carry on with your normal activities
	At other times, the drugs are given by an injection into a vein (intravenously), usually in the arm, and this may mean a short stay in hospital

Chemotherapy for the more rapid-growing lymphomas is given intravenously.

Side effects

Radiotherapy and chemotherapy affects people in different ways. Some find they are able to lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it

The common side effects may include:

	nausea
	vomiting
	tiredness
	hair loss

Radiotherapy and Chemotherapy are covered in more detail in Understanding Cancer Series. Please download the file.

Bone Marrow Transplant

	Bone marrow transplants are used only in a minority of people with non-Hodgkin's lymphomas. A transplant will normally only be considered if your cancer has already responded well to treatment and you are in remission, but your doctors feel that there is a high chance that the illness may come back
	Bone marrow transplantation is a way of allowing very high doses of chemotherapy and/or radiotherapy to be given, to improve the chances of completely curing the disease
	These high doses will destroy your bone marrow - the substance in the inner part of your bones that manufactures the blood - you need a transplant to make yourself a 'new' blood system after the high dose treatment
	A brother's or sister's bone marrow or, more often, your own bone marrow, can be used as the transplant.

Peripheral Blood Stem Cell Transplants

	Increasingly, many hospitals are moving away from using bone marrow for the transplant and are using cells that can be collected from the blood
	The advantages are that you do not have an anaesthetic for the cells to be collected and, most important of all, the blood recovers much more quickly
	If this is thought to be appropriate for you, you will be asked to have chemotherapy followed by injections of a growth factor - a special protein which makes bone marrow cells multiply and spill over into the blood.

Steroid Therapy

Steroids are drugs that are often given with chemotherapy for lymphomas. They also help you feel better quickly

Side effects

	An increased appetite
	Feeling more energetic and difficulty in getting to sleep
	Puffiness of the eyelids, hands, fingers and feet
	Raised blood pressure
	Slightly greater risk of getting infections
	An increased level of sugar in the blood

It is important to remember that all these side effects are temporary and will gradually disappear as the steroid dose is reduced.

Because of your lowered resistance to infection, it is probably best to avoid people who have a cold or flu while you are taking steroids

You should always carry a card with you stating that you are taking steroids.