Follicular (Low Grade) Lymphoma - Is No Treatment An Option?
Updated June 25, 2014.
Some people with low grade non-hodgkin lymphomas (NHL) are offered an option for no initial treatment. This leaves some wondering - how can no treatment an option for a disease like cancer?
It's the way low grade lymphomas behave:
Unlike the common picture of a fast growing cancer that we have in our minds, low grade NHLs are extremely lazy. They grow slowly, sometimes remain stable over years, and rarely even regress on their own.
This is called 'waxing and waning'. Regardless of treatment, people live for long. Treatment reduces the disease for some time but is often unable to cure it completely. Therefore, for some individuals, immediate aggressive treatment offers no real benefit.
Avoiding unnecessary toxicity of chemotherapy:
If chemotherapy does not greatly affect the outcome of disease in some people, why go through its toxicity? Most chemotherapy drugs and combination treatments have significant side-effects. Doctors feel that these can be avoided initially in some patients by withholding chemotherapy till it is really required.
Who is offered 'No initial treatment'?:
'No immediate treatment' is a valid option to consider for those individuals who
About 40% of the people with disseminated low grade lymphomas can be potentially offered a 'wait and watch' approach.
Close observation is essential:
All patients who choose to not undergo any treatment initially, must be in touch with their doctor regularly. They will be scheduled for regular check-ups, and periodic scans in some cases. This will help the doctor keep track of how the disease is behaving. If the disease shows signs of increasing or spreading, treatment can be started.
'No initial treatment' is not 'No treatment ever required':
Most people who are kept on observation alone will require treatment in the future. It's just that immediate treatment or delayed treatment does not differ much in the outcomes - how long an individual survives. It has been seen that on an average, treatment may be deferred by 1 - 2 years by the wait and watch approach, without compromising on the ultimate outcome of disease.
Some people with low grade non-hodgkin lymphomas (NHL) are offered an option for no initial treatment. This leaves some wondering - how can no treatment an option for a disease like cancer?
It's the way low grade lymphomas behave:
Unlike the common picture of a fast growing cancer that we have in our minds, low grade NHLs are extremely lazy. They grow slowly, sometimes remain stable over years, and rarely even regress on their own.
This is called 'waxing and waning'. Regardless of treatment, people live for long. Treatment reduces the disease for some time but is often unable to cure it completely. Therefore, for some individuals, immediate aggressive treatment offers no real benefit.
Avoiding unnecessary toxicity of chemotherapy:
If chemotherapy does not greatly affect the outcome of disease in some people, why go through its toxicity? Most chemotherapy drugs and combination treatments have significant side-effects. Doctors feel that these can be avoided initially in some patients by withholding chemotherapy till it is really required.
Who is offered 'No initial treatment'?:
'No immediate treatment' is a valid option to consider for those individuals who
- are otherwise well
- don't have B-symptoms (fever, weight loss or night sweats)
- have relatively small lymph nodes that are not fast increasing in size
- have disease that is unlikely to affect the function of vital organs in the body.
About 40% of the people with disseminated low grade lymphomas can be potentially offered a 'wait and watch' approach.
Close observation is essential:
All patients who choose to not undergo any treatment initially, must be in touch with their doctor regularly. They will be scheduled for regular check-ups, and periodic scans in some cases. This will help the doctor keep track of how the disease is behaving. If the disease shows signs of increasing or spreading, treatment can be started.
'No initial treatment' is not 'No treatment ever required':
Most people who are kept on observation alone will require treatment in the future. It's just that immediate treatment or delayed treatment does not differ much in the outcomes - how long an individual survives. It has been seen that on an average, treatment may be deferred by 1 - 2 years by the wait and watch approach, without compromising on the ultimate outcome of disease.
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