If you have a type of non-Hodgkin's lymphoma (NHL) that grows slowly, don't be surprised if your doctor suggests you hold off treatment. It's an approach called "watch and wait," and it might be a choice for you if you don't have any pain or other symptoms.
Your doctor will keep a close eye on your disease, and they won't start treatment unless they see signs that your lymphoma is getting active.
It's natural to wonder if it's safe to have cancer but not take action. But experts say it often makes sense.
"With non-Hodgkin's lymphoma, some types may not affect a patient's life for years. If it's slow-growing by nature, you can wait," says Henry Tsai, MD, a hematologist and oncologist at Eisenhower Desert Cancer Care in Rancho Mirage, CA.
If you say "yes" to watch and wait, it's possible you'll need treatment down the road, but some folks never need to get it.
Who It's For
"The watch and wait approach is the standard of care for people whose disease is not widespread and who have no symptoms," says Beatrice Abetti, director of the Leukemia & Lymphoma Society's Information Resource Center.
Research suggests that under the right conditions, it works. Over time, lots of folks do just as well as if they had treatment right away.
Your doctor may suggest watch and wait if you have these types of non-Hodgkin's lymphoma:
- Follicular lymphoma
- Marginal zone lymphoma
- Lymphoplasmacytic lymphoma
You may also consider delaying treatment if:
- You have no symptoms.
- Your lymph nodes are small and don't grow fast or cause problems
- You get OK results from blood tests, such as those that count your blood cells
- Your NHL doesn't affect your heart, lungs, kidneys, or other key organs
"Watch and wait can also be the best approach for some patients diagnosed with widespread NHL that treatment won't likely cure," Abetti says. Even if it's widespread, it may remain stable for years.
How It Works
"Watch and wait doesn't mean being passive," Tsai says. If you choose to delay treatment, your doctor will keep a close eye on you and look for changes. You'll have checkups every 3-6 months, or even more often.
During appointments, your doctor may:
- Talk to you about how you're feeling
- Do an exam
- Take blood tests or scans
They'll check for signs that you may need to start treatment, such as:
- Your lymph nodes get bigger or your NHL affects new ones
- Problems with your bones or other organs
- Your blood cell count goes down
- Your lymphocyte (type of white blood cell) count goes up
- Your spleen gets bigger
- You have anemia that gets worse
Pros
The major benefit of watch and wait is that you don't have to deal with treatment side effects, Tsai says. When you skip chemotherapy, you won't get symptoms like sickness, infection, and hair loss.
Another benefit is your lymphoma cells won't get resistant to medicine, which is a problem for some people. When that happens, treatment may not work as well anymore.
You'll also avoid hospital stays and continue to enjoy the activities that you like.
Cons
There's a risk that your cancer may change to a fast-growing type.
It may also be hard to accept that you're not actively treating your cancer. Tsai says many of his patients struggle with this, but they feel better when they learn that watch and wait is an accepted strategy. It's part of the national guidelines for treating some types of NHL.
How Long You Can Expect to Watch and Wait
"About half of all patients can put off treatment for at least 3 years," Abetti says. "Some patients can be in watch-and-wait mode for 10 years or more." It's possible you'll never need treatment.
There's no way to know for sure if you'll eventually need treatment. You may need it if your:
- Symptoms start up and cause problems
- Lymph nodes swell and change
- Organs or bone marrow isn't working well
How to Decide if It's Right for You to Delay Treatment
If your NHL is slow-growing and you feel good, you can wait, Tsai says. But if you have symptoms -- like pain, fever, weight loss, or appetite loss -- it's better to act than delay.
Also, if you aren't very good about visiting your doctor, watch and wait may not be a good choice. If you wait too long to set up an appointment, your lymphoma may get worse.