Sometimes, a recommended course of action at the time of diagnosis may be to 'watch and wait'. This is the case in around two-fifths of patients who have an indolent non-Hodgkin's lymphoma. This is, however, very uncommon in the treatment of aggressive non-Hodgkin's lymphoma.
To be suitable for this 'watch and wait' approach, patients must have an advanced-stage lymphoma. In other words, one that is not confined to just one or two groups of lymph nodes. They must also be well in themselves and their lymphoma must not be causing any symptoms itself. As long as they remain well, if their lymph nodes are small and are not getting bigger quickly, and if there is no evidence that the lymphoma is affecting the function of any of their major organs, then a 'watch and wait' approach can be used.
A 'watch and wait' approach is also sometimes used for patients with an indolent lymphoma that has relapsed.
While it might sound risky to adopt this 'watch and wait' approach, studies have shown that, in suitable patients, the outlook in 'watch and wait' patients is no different from that of patients who start active treatment at the time of diagnosis and the 'watch and wait' approach delays the side effects of therapy. It therefore is possible that the doctor recommends not to start treatment until it is needed. Clinical trials, assessing the benefits of immediate treatment compared with the 'watch and wait' approach, are ongoing.
It is important to remember that the 'watch and wait' approach is not the same as a 'do nothing' approach. 'Watch and wait' patients are seen regularly in the outpatients' clinic. The size of their lymph nodes is monitored to make sure that they are not getting bigger, and tests are performed to check that the lymphoma is not affecting any of the major organs or bone marrow.
'Watch and wait' patients must also be aware of the possible symptoms of lymphoma, in particular the three symptoms referred to as 'B symptoms':
If these symptoms appear, it may mean that active treatment must be started.
Most 'watch and wait' patients do go on to need active treatment for their non-Hodgkin's lymphoma, typically about 18 months after the start of the 'watch and wait' approach.