First Decisions

The first decision of the treatment phase involves whether to begin treatment immediately, or whether to delay treatment and engage in what is called “watchful waiting.” This decision rests on the type of cells identified during the initial lymph node biopsy, whether they are classified as indolent or aggressive, the stage of the tumor at the time of diagnosis, and whether or not the individual is experiencing symptoms from the lymphoma. In certain specific cases, depending on the information ascertained during the diagnostic and staging phase, the provider may suggest that the patient can delay treatment. Characteristics that may lead to watchful waiting include:

  • A cell type that is deemed “indolent,” meaning very slow growing and not particularly invasive
  • Identification of only a small amount of tumor present (called low tumor burden)
  • Absence of symptoms from the lymphoma

In a watchful waiting phase, the physician will follow the individual very closely, by performing physical examinations, blood tests, and specific imaging studies at regular intervals. Some people in this situation may avoid treatment for years, without their disease



progressing. Treatment is usually initiated If the cancer becomes more active, if it progress and begins to cause symptoms, if overall tumor burden increases, or if the cell type transforms into a more aggressive type.

On the other hand if, at the time of diagnosis, a person is already experiencing significant symptoms, the lymphoma cell type is deemed aggressive, or the malignant cells have already spread out of its original location into other tissues or regions of the body, then treatment may be immediately undertaken, with no period of delay. Treatment for NHL is chosen based on the characteristics of the malignant cells, how widespread the disease is, and the types of symptoms present. Other than watchful waiting, the general categories of treatment include:

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