Ready to Fight, but My Doctor Says to Wait: Watchful Waiting after a Lymphoma Diagnosis

Woman diagnosed with lymphoma

Doctors for Nancy Hughes, pictured here with her son, recommended a watch and wait approach after she was diagnosed with follicular non-Hodgkin’s lymphoma.

When 47-year-old Nancy Hughes was diagnosed with follicular non-Hodgkin’s lymphoma in 2007, she went into fight mode — but her doctor had another idea.

Memorial Sloan Kettering hematologic oncologist John Gerecitano instead recommended the “watch and wait” approach, in which Nancy, from Hampton Bays, New York, would be monitored regularly and put on chemotherapy only if her disease progressed.

This recommendation, especially in lymphoma, doesn't mean we're telling patients there's no treatment for them.
John F. Gerecitano oncologist

“I remember thinking, this is insane. I have cancer, you have to get rid of it,” the mother of two recalls. “And I think that’s everybody’s initial response.”

That’s a response Dr. Gerecitano often finds himself receiving whenever he advocates a watch and wait approach for lymphoma patients. 

“This recommendation, especially in lymphoma, doesn’t mean we’re telling patients there’s no treatment for them,” he says. “We know from the data that harm will not come from waiting.”

Also called active surveillance, watch and wait is a common treatment strategy at MSK and other top cancer institutions for lymphomas that pose no immediate threat to a patient’s health.

“Some lymphomas can be treated like chronic conditions such as diabetes or high blood pressure, where we manage them over time,” says Dr. Gerecitano, who recently led a trial for Venetoclax, a new FDA-approved lymphoma drug.

Even though that’s good news, the plan can still lead to tremendous anxiety. Many patients are skeptical about holding off on active treatment.

“It causes understandable anxiety when you tell patients they have cancer and that they should sit on the sidelines,” he says. “We live in a culture in which cancer is seen as an enemy that has to be actively fought.”

But the surveillance is called “active” for a reason. Usually, patients are first assessed every three to six months. Once doctors understand the disease’s growth pattern, they can sometimes space patients’ visits further apart — but they’re always carefully monitored.

Monitoring Can Safely Last for Years

At MSK, lymphoma experts typically recommend active surveillance for around 30% of lymphoma patients. Others are advised to start immediate treatment with chemotherapy, radiation, or surgery. But the hands-off approach has been proven to work just as well in select patients, and also negates the risk of side effects from treatment, Dr. Gerecitano says.

“These are lymphomas that are unlikely to cause an immediate threat to a patient’s overall health,” he says, adding that some lymphomas often take two to five years to cause problems severe enough to tackle with active treatments.

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Helping Patients Cope with Anxiety

Despite the evidence, convincing some patients that watch and wait is the best approach is still extremely challenging.

While Nancy initially wanted to eliminate the cancer as quickly as possible, she says she “knew during the first meeting” that she could trust Dr. Gerecitano.

Female doctor in lab coat on left speaks with patient wearing blue top.
Lymphoma is a blood cancer that starts in the body’s immune system cells. It is one of the most common forms of cancer in adults. Learn more about treatment options for all types of the disease.
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“I just had the utmost faith in his decision-making,” she recalls.

Dr. Gerecitano also tells patients that prudently waiting to launch active treatments allows for “the accrual of better weapons. Almost every year there are breakthroughs in the treatment of lymphomas.”

To respond to patients’ fears, MSK doctors typically schedule longer office visits so they have time to fully explain their recommendations. “When we sit and tell patients all of the information, most feel comfortable with active monitoring,” he says. “We find that investing this time is worth it if we can spare patients the unnecessary side effects of chemo or prevent them from developing treatment resistance.”

To help patients cope with the potential emotional strain of waiting, MSK also offers patient support groups, an online community, and individual and family counseling.

Dr. Gerecitano recommends that his patients stay physically active, not only to decrease the risk of lymphoma-related blood clots but also to keep their energy levels up. “It’s important to get in the best place mentally and physically during that time,” he says. “This will help them when it is time to fight.”

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Time Heals

Nine years after her diagnosis — with the disease still posing little threat — Nancy has made peace with her treatment plan.

“I think just as with anything else, time makes it better,” she says. “When you go in for your appointments, those can be a little anxiety producing. But as time as progresses it just gets easier to process.”


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Commenting is disabled for this blog post.

I too was diagnosed with nhl 5 years ago by a local hematologist. I went straight to Sloan Kettering immediately after. Dr. Paul Hamlin recommended the "watch and wait" approach. Last year one of the lympnodes on my neck was swollen due to a infection (was not life threatening) my dr recommended a radiation treatment called the "boom boom" treatment. I did not have to do it but I didn't want to walk around with this lump on my neck any longer. I had Two quick very low dose radiation treatments with absolutely zero side effects and the lump was gone within a week and nodes back to normal. I see my Dr every 6 months only need one CAT Scan a year!

This process of the wait and see has worked very well for me. I don't dwell on it at all. I know that it's being looked at carefully and I know if I start to have any symptoms of my disease I will be taken care of immediately by the amazing Dr's and nurses at Sloan. I am in the best hands in the world.

I highly recommend it and obviously Memorial Sloan Kettering care.


Laura Pergola

Dear Laura, thank you so much for sharing your experience. We are happy to know you are doing well and have felt well-cared for by your MSK team!

I was just diagnosed with multiple myeloma. What insurance does memorial Sloan Kettering accept. I would like a second opinion

My husband was diagnosed with Non Hodgkins Lymphoma in Jan 1997. He had half a lung removed and a mild chemo treatment in NJ. Almost 2 years later it came back and we decided to go to MSKCC. After a round chop in 1999 it returned. Dr Zelenetz started him on Rituxan in August thru Sept 2001. He was in remission for 14 years and last June we found out it is active again. Now they are watching and waiting..... We were very anxious when he had the biopsy and Thanx to Dr Zelenetz he has made us realize this is the best "non-treatment" at this time.

Dear Betty, thank you for sharing your husband’s experience. We’re glad to know that he has felt well-cared for by Dr. Zelenetz, and we wish him well as he continues with his care plan.

I have been recently diagnosed with cancer and have spent weeks being tested for the place of origin ,still with no concrete evidence of anything! I have been told it is stage four and still have not had any treatment! I would like to come there for a second opinion,or at least a concrete diagnosis,some empathy and compassion!I am frightened and alone.

Dear Taryn, we are sorry to hear about your cancer diagnosis. If you would like to make an appointment with one of our specialists for a second opinion and a discussion of your treatment options, please call our Physician Referral Service at 800-525-2225. We also offer a number of support resources to help our patients who are living with advanced disease. Thank you for reaching out to us.

Dr. G is a God send. I am blessed he is my Dr.

I agree Mike. Dr G is the best. We are so very fortunate!!

My wife is diagnosed with folliculotropic mycosis fungoides (FMF). We are based out of India.She has two conflicting reports about bone marrow involvement.Our oncologist has started her on Methotrexate .Her PET CT is normal and no lymph node is involved .We are very anxious about the line of treatment because of conflict in reports. Is it possible to take second opinion remotely from MSKCC for international patients ?

Dear Tarun, we are sorry to hear about your wife’s diagnosis. Please contact our International Center to arrange for a review of her medical records by one of our specialists. Our International Center can be reached via email at To learn more about our services for international patients, please visit Thank you for reaching out to us.

I've been treated for marginal b zone splenic NHL since 2002 by Dr.Noy at Sloane. Dr.Noy is a very good doc.

Dear Melinda, we are glad to know that you have felt well-cared for by Dr. Noy. Thank you for kind words!

I have MALT marginal zone. I am on watch and wait with Matthew Matasar, the greatest and most wonderful doctor in the world. I love Dr. Matasar.

Dear Eve, we appreciate your kind comments and are glad to know that you felt well-cared for by Dr. Matasar!

I was diagnosed with MALT Lymphoma, under the care of the wonderful Dr. Paul Hamlin, and just finished radiation therapy at MSKCC! Dr. Shepherd is my awesome radiology oncologist!! I won't know if I'm in remission until the end of October, but I feel I'm getting the best possible care at Sloan!! I feel so lucky to be able to be treated here!! The doctors and nurses are exceptional here!! ❤️

Dear Kim, we are sorry to hear about your diagnosis, but are glad to hear that you have felt well-cared for by your MSK team. Thank you for your kind words!

Had biopsy of my glenoid lesion 11/03/2016 in recovery room my doctor told me i have lymphoma., my world became dark. Had CT scan of abdomen ,pelvis and chest done and no mets seen . whole body bone scan done .no mets seen. my CBC normal result.Until today I'm waiting for my Doctor to call me with official result of my biopsy.No loss weight.

Dear Fatima, we are sorry to hear about your diagnosis. If you would like to make an appointment with one of our specialists to discuss possible treatment options, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

My husband has recently been diagnosed with Waldenstrums disease- so far his only symptom has been increasing IGM 1000-1500 and bone marrow results seem to support the diagnosis. I understand this is an extremely rare type of cancer. Is this something you folks will deal with?

My husband was diagnosed in Sept. with indolent follicular B-cell non-Hodgkins lymphoma. He was staged at Stage 3 and has four of the five FLIPI risk factors. Do those factors change the wisdom of following the watchful waiting his oncologist wants him to follow? It's scary! Right now, he is asymptomatic.

Dear Judith, we’re sorry to hear about your husband’s diagnosis. Unfortunately we are not able to provide medical advice on our blog. If he would like to come to MSK for a consultation with one of our experts, you can call 800-525-2225 or go to for more information on making an appointment. Thank you for your comment, and best wishes to both of you.

How often should you get a PET scan?

In remission 12 years DLBCL. PET shows rt axillary growth (SUV 4.0)/ CT 1.3 cm + left iguana (SUV 3.9). No other common symptoms; many indolent symptoms such as neuropathy hands/feet. Failed axillary needle biopsy. Recent 5x CABG. How demonstrate lymphoma is now indolent not aggressive DLBCL or transformed. Age 82. Refused 2nd laparotomy. Still carried as CR patient. Second opinion?

I wish I had a diagnosis of some kind because I have just been in limbo.
I have basically been begging my doctor for a referral to a Hematologist. For over 4 years I have had stagnant lumps in groin and below chin. Since last year I developed reoccurring lumps in neck, stomach and under right arm; these new ones go up and down but never go away completely. I have severely low iron (99), consistent build up on mucus and itchy skin. I have been told that the lumps on my neck are reactive, except they never go away completely.
I have gotten ultra sounds and several blood test. I have been diagnosed with ulcer colitis and then undiagnosed by another specialist.
Recently, my neck lumps got the biggest they have been (pea size) and I had cold sweats. By the time I went to the doctor they went back down but still able to feel them. I am literally just waiting and do not know what to do or who cares to help me figure out what is going on in my body.
I still have stomach inflammation (severe gastritis) symptoms but from research can be related to lymphoma especially because the Gastroenterology can not make a diagnoses. They are just not making the necessary links and I should not have to be begging for almost 2 years for a biopsy.

Dear Cydine, we’re sorry to hear about what you’re going through. If your doctor is not giving you the help you need we recommend that you seek out a different doctor. If you’re interested in speaking to someone about a consultation at MSK, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.