Should I Delay Treatment for B-Cell Lymphoma?

Some types of B-cell lymphoma grow slowly and don't cause symptoms or problems for many years. You and your doctor might decide that you don't need to be treated right away. Instead, you'll choose an approach called "watch and wait" or "watchful waiting."

You might also hear your doctor call this active surveillance. It means that your medical team will monitor your cancer with regular checkups and tests. But you won't get treatment unless your cancer starts to grow or you get symptoms.

Watch and wait has pros and cons. You'll want to weigh the risks and benefits before you decide.

Who Can do Watchful Waiting?

Watch and wait might be an option if you have one of these slow-growing types of B-cell lymphoma:

  • Chronic lymphocytic leukemia (CLL)/small lymphocytic leukemia (SLL)
  • Follicular lymphoma
  • Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)
  • Marginal zone lymphoma

Watch and wait can be an option for early-stage cancers, but it may be possible to delay treatment even if you get a lymphoma diagnosis at a late stage.

Your doctor might suggest you delay treatment if you:

  • Are otherwise healthy
  • Have no bothersome B-cell lymphoma symptoms
  • Have small lymph nodes
  • Don't have lymphoma in any of your major organs (heart, lungs, kidneys, etc.)
  • Are over age 70

 

What Happens During Watchful Waiting?

You'll have checkups every 3 to 6 months with the medical team that treats your cancer. During these visits, your doctor will:

  • Ask if you've had any symptoms
  • Examine you for enlarged lymph nodes
  • Do blood tests to check that your bone marrow, liver, and other organs are working well
  • Possibly do imaging tests such as a CT or PET scan

 

Pros

If you decide to do watchful waiting you can avoid -- or at least delay -- the side effects of treatment. Chemotherapy, for instance, can cause temporary hair loss, nausea, and mouth sores. Radiation may bring on fatigue and skin blisters.

Another advantage of watch and wait has to do with something called treatment resistance. Sometimes lymphoma cells no longer respond to the chemotherapy drugs or other therapy. When you watch and wait, your cancer cells can't become resistant.

You may wonder about the impact on your long-term health if you delay treatment. But studies show that for people with slow-growing types of B-cell lymphoma, there is no difference in the way the disease develops between immediate treatment and watchful waiting. As long as you get regular checkups, waiting can work just as well getting treated.

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Cons

Watchful waiting can cause some people a lot of anxiety. With many other cancers, you need to get treated right away to have the best odds of surviving. It can be hard to live with the knowledge that you have cancer, but you're not doing everything possible to treat it.

Delaying treatment can also bring a lot of uncertainty. Every doctor visit can trigger the fear that your cancer has spread. If you need more sense of control over your future, watch and wait might not be the best option for you.

Even though research shows that watchful waiting can be just as helpful as active treatment for some people, there's always a slight risk that a delay could allow your cancer to grow and affect your odds of surviving.

When to Start Treatment

The "watch" part of watch and wait means that you'll see your doctor every few months for exams. You should also keep an eye out for symptoms at home, and report them to your doctor right away.

Your doctor will probably suggest that you start treatment if:

  • You have fever, night sweats, and weight loss for no reason
  • Your lymph nodes have grown
  • You have cancer in new lymph nodes
  • Tests show that the lymphoma has spread to your organs or bones
  • Your blood cell count has dropped

 

Should You Do Watch and Wait?

Most people with B-cell lymphoma will eventually need to be treated. If you have a slow-growing lymphoma that isn't causing symptoms, watchful waiting might be the right choice for you. Discuss the benefits and risks of all your treatment options with your doctor before making your decision.

Even if your doctor recommends that you wait, make sure that you're totally comfortable holding off on treatment. If you feel nervous or anxious, this might not be the right approach for you.

WebMD Medical Reference Reviewed by Louise Chang, MD on June 09, 2018

Sources

SOURCES:

American Cancer Society: "Chemotherapy for Non-Hodgkin Lymphoma," "Radiation Therapy for Non-Hodgkin Lymphoma."

Blood Journal: "Is watch and wait still acceptable for patients with low-grade follicular lymphoma?"

Lymphoma Action: "Active monitoring ('watch and wait')."

Lymphoma Canada: "Watch and Wait."

Lymphoma Nation: "About Watchful Waiting."

Leukemia & Lymphoma Society: "Watch and Wait."

Memorial Sloan Kettering Cancer Center: "Ready to Fight, but My Doctor Says to Wait: Watchful Waiting after a Lymphoma Diagnosis."

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