Learning the diagnosis and treatment plan for lymphoma

Learning the diagnosis of lymphoma often happens in stages. Some people may be told that their doctors suspect lymphoma before tests are done, others may wonder if they have lymphoma after looking up their symptoms or test results in books or on the internet. Some learn that their symptoms could be caused by one of several serious illnesses, before finding out that the actual cause is cancer. Once told they have Hodgkin or non-Hodgkin lymphoma further tests are often needed to determine which type they have and what stage and grade it is. This determines the treatment and prognosis. A few people we spoke to were started on treatment for one kind of lymphoma but changed to other treatment after more detailed tests or a second opinion showed they had a different type.

Her diagnosis ‘dripped out’ in conversations with professionals on a series of occasions.

Age at interview 35

Gender Female

Age at diagnosis 31

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Looked up her blood test results on the internet and found she was seriously ill. Her doctors…

Age at interview 47

Gender Female

Age at diagnosis 47

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A few people were told their diagnosis over the phone but most learned it face-face from a doctor. Body language or other non-verbal cues often come before the breaking of bad news. Some people said it was helpful to have a close family member with them when they were told the diagnosis because they were too shocked to take in everything that was said. However, being told to bring someone with you could provide an unwelcome clue as to what was going to happen.

Remembers how the behaviour of staff towards him changed during an ultrasound scan and after an…

Age at interview 24

Gender Male

Age at diagnosis 16

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Being asked to bring someone with her to the hospital made her realise that something must be…

Age at interview 40

Gender Female

Age at diagnosis 34

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Felt so shocked and numb that she couldn’t take in everything the doctor was saying about the…

Age at interview 44

Gender Female

Age at diagnosis 36

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Many doctors delivered the diagnosis in a sensitive and reassuring manner. However, some were described as having been blunt, vague, or not giving sufficient information. A woman was asked by her consultant to guess what might be wrong with her and she suggested cancer as the worst possible scenario, never thinking that it would be. Some people we talked to were impressed with the amount of time their consultants gave them, but one woman said that her consultant cut the consultation short while she still had a list of questions. Parents sometimes protected young people from the full truth of their diagnosis, but this protection was not always welcome.

The consultant told her she had mantle cell lymphoma, which has a poor prognosis, but he hoped…

Age at interview 52

Gender Female

Age at diagnosis 45

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Was never told how potentially serious her illness was and the word ‘cancer’ was never mentioned…

Age at interview 41

Gender Female

Age at diagnosis 11

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Few people had heard of lymphoma before their illness and, while some were told it was a type of cancer, others did not remember being told this. Some felt they had to ask what it was and whether it was cancer. Others only realised it was cancer when chemotherapy was mentioned or they got written information. Perhaps, because of this common misunderstanding, the specialist sometimes reinforced the message that lymphoma was a serious condition.

Originally suspected of having pancreatic cancer, she was relieved when told she actually had…

Age at interview 54

Gender Female

Age at diagnosis 54

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When told she might have Hodgkin lymphoma and need chemotherapy she laughed in disbelief – the…

Age at interview 33

Gender Female

Age at diagnosis 20

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Sometimes a doctor would give the diagnosis who didn’t know much about lymphoma, and then people had to wait to see a specialist to find out more. People were commonly shocked and surprised by the diagnosis, particularly if they didn’t feel ill or if they had known people who had died from cancer. Initially people often feared they would die but were encouraged by being told that lymphoma was a ‘good’ cancer to have because it was manageable, and they tried to adopt a positive attitude. One felt she had to help the doctors by keeping herself as well and as positive as possible during treatment. Another said she was determined not to die for the sake of her family.

When told her diagnosis she felt ‘trapped behind a brick wall’ unable to find a way through and…

Age at interview 48

Gender Female

Age at diagnosis 43

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When a doctor told him he had non-Hodgkin lymphoma he at first thought he would die but after a…

Age at interview 43

Gender Male

Age at diagnosis 38

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Some people felt angry about the diagnosis and wondered, ‘Why me?’, but others thought, ‘Why not me? It happens.’ One woman said she had always expected to get cancer because her father had died of it, although there is no evidence of a genetic cause in most cases of lymphoma and it does not run in families. A woman who was keen on sports said she would rather have cancer than be paralysed from the neck down. A woman who’d already had breast cancer was shocked to have cancer again, but felt that she had been proven right because she had believed there was something seriously wrong while she felt the professionals had not taken her seriously.

Sometimes diagnosis took a long time because the symptoms didn’t immediately indicate lymphoma. Tests were sometimes made for other conditions, or symptoms were masked by other health problems. In these cases people were often relieved to finally have a diagnosis and to know what would happen next. A woman who had been expecting a diagnosis with a far worse prognosis said that she jumped for joy when she heard that it was non-Hodgkin lymphoma. Others felt angry about delays in the diagnosis because they felt their symptoms had not been properly investigated. A woman who developed a neck lump in early pregnancy presented it to her GP straight away but was told that it was probably connected to her pregnancy and nothing to worry about. Several professionals repeated this mistaken reassurance throughout her pregnancy. A woman who became worried about her lump that a GP had dismissed previously, chose to go back to a different GP so as not to be discourteous and challenge his professional opinion.

Felt frustrated at having spent such a long time trying to find out what was wrong with him but…

Age at interview 55

Gender Male

Age at diagnosis 52

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Experienced a lot of weight loss, which his doctors put down to his emphysema, and lots of blood…

Age at interview 64

Gender Male

Age at diagnosis 62

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Was annoyed when he discovered that a locum GP he had seen first had falsely reassured him that…

Age at interview 37

Gender Male

Age at diagnosis 36

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When lymphoma comes back

In a minority of people with Hodgkin and high-grade non-Hodgkin lymphoma (NHL) their disease relapses after treatment; this is most likely to happen within the...