The several dozen subtypes of lymphoma all call for different treatment options, but speaking in general terms we can itemize the options available to most patients.
Chemotherapy—receiving chemically-based drugs—is one of the most common lymphoma treatment options. Typically patients receive combination chemotherapy—between two and six or more different drugs at a time—to treat their cancer. These combination regimens are known by their acronyms, such as R-CHOP, DA-EPOCH, CVP and ICE.
Radiotherapy—or involved field radiation (IFR)—is another fairly common lymphoma treatment. Radiation is not as common in lymphoma as it is in solid-tumor cancers, because radiation is more effective against solid tumors. When a person with lymphoma has so-called "bulky disease", meaning they have a large tumor possibly in the chest or neck, then IFR will likely be a treatment option, since radiologists can focus the radiation on the tumor and try not to damage any of the surrounding healthy tissue. IFR commonly is given after a patient receives chemotherapy.
Immunotherapy—also known as biological therapy—is a growing treatment field in all cancers, and especially in lymphomas. Notably, the immunotherapeutic drug Rituxan has significantly improved the lives of many lymphoma patients, and is given as a single agent (for example, many patients with follicular lymphoma receive Rituxan on a maintenance basis) and as a part of a larger combination chemotherapy regimen (for instance, Rituxan is the R in the R-CHOP regimen).
Also called watchful waiting, 'watch and wait' refers to an option for some of the more indolent or slow-growing lymphomas in which the patient receives no direct treatment at all. Rather, the patient and his or her doctor simply keep a close eye on the patient's health and well-being, aware that they have cancer but also aware that it is causing no problems and that treatment can wait until a time when the disease worsens or becomes noticeable.
Clinical trials, palliative care and hospice care
Although many subtypes of lymphoma are highly treatable, other forms are not. Some forms are very quick to become resistant to chemotherapy, and recur soon after treatment finishes. These are very aggressive cancers and tend not to respond to treatment. In these cases, it's not uncommon for patients to exhaust first and second line treatments, then be put into a clinical trial. At this stage, doctors generally do not know how to treat the cancer effectively.
Clinical trials are not always the preferred direction. Patients may not be interested in receiving yet another drug or medication, even though they would likely receive the best treatment in such a trial. In these cases, the patient should be made aware of the ability of palliation and hospice care to make their time remaining as comfortable as possible. Unknown to many is the reality that terminal patients tend to live longer and have a higher quality of life when on hospice care then when being given a new drug or another round of chemotherapy. Ultimately the decision must be made by the patient and with the help or his or her loved ones.