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Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy the lymphoma cells by disrupting their growth. The drugs can reach lymphoma cells anywhere in the body through the bloodstream.
Our section on chemotherapy discusses the treatment and its side effects in more detail. Information about individual chemotherapy drugs, and combination chemotherapies and their particular side effects, is also available.
The drugs may be given as tablets or capsules, or by injection into a vein (intravenously) in your arm. A combination of several drugs is normally given over a few days followed by a gap of a few weeks. This is known as a 'cycle' of treatment. It allows your body and blood cells to recover from any side effects before the next treatment. Your treatment will probably last for several months. During this time you will have regular check-ups.
The treatment is usually given as an outpatient but sometimes it may mean spending a few days in hospital. The combinations of drugs most commonly used for Hodgkin lymphoma include:
Other drugs, or combinations of drugs, may also be used.
Some people having chemotherapy may find it easier to have a central line. A central line is a long, hollow tube made from silicone rubber that is inserted into a main vein in the chest. They are also called skin-tunnelled central venous catheters and can be put in under a local or general anaesthetic.
Chemotherapy and other drugs can be given through the tube and blood samples can be collected. This saves you the pain or discomfort of repeated injections. The central line stays in place throughout your treatment. Once your treatment is finished, the line is taken out. A local anaesthetic maybe used if necessary.
A PICC line (peripherally inserted central catheter) is like a central line, but is put into a vein in the bend of your arm, instead of your chest. You can have a PICC line put in as an outpatient, using local anaesthetic. Your PICC line can also stay in place throughout your treatment and can be used to give drugs or take blood. Once your treatment is finished, the PICC line is easily removed.
Some tubes end in small 'ports' that lie just under the skin of the chest: these are known as implantable ports. The port can be used to give chemotherapy and other drugs, and also to take blood samples. You will be given either a local or a general anaesthetic before the port is inserted.
Chemotherapy can cause unpleasant side effects, but these can often be well controlled with medicines. The main side effects are described here, along with some ways of avoiding or reducing them.
While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal white cells in your blood. When these cells are reduced you are more likely to get an infection and you may tire easily. During chemotherapy your blood will be tested regularly and, if necessary, you may be given antibiotics to treat any infection. Injections of growth factors may also be given to stimulate the production of white blood cells by the bone marrow.
If your temperature goes above 38ºC (100.5ºF), or you suddenly feel unwell even with a normal temperature, contact your doctor at the hospital straight away.
If the level of red blood cells (haemoglobin) in your blood is low you will become very tired and lethargic. You may also become breathless. These are all symptoms of anaemia – a lack of haemoglobin in the blood.
Anaemia can be very successfully treated by blood transfusions. You will feel more energetic and the breathlessness will be eased. A drug called erythropoietin (EPO) may also be used to help your bone marrow produce more red blood cells.
Platelets are a type of blood cell which help to clot the blood. If the number of platelets in your blood is low you may bruise very easily or develop blood spots or rashes on the skin. You may suffer from nosebleeds or bleed more heavily from minor cuts or grazes. If you develop any unexplained bruising or bleeding, contact your doctor or the hospital immediately. We have a section on platelet transfusions.
Some of the drugs used to treat Hodgkin lymphoma may make you feel sick (nauseated) and possibly vomit. There are now very effective anti-sickness drugs (anti-emetics) to prevent or greatly reduce nausea and vomiting. Your doctor will prescribe these for you.
Some chemotherapy drugs can make your mouth sore and cause small ulcers. Regular mouthwashes are important and your nurse will show you how to do these properly. If you don't feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. The dietitian at the hospital can give you advice. You may find our section on eating problems helpful.
Unfortunately, some of the drugs used to treat Hodgkin lymphoma can make your hair fall out. Ask your doctor if the drugs you are taking are likely to cause hair loss or other specific side effects. People who lose their hair often cover this up by wearing wigs, hats, or scarves. Hospital in-patients can get a free wig from the NHS and your doctor or nurse will be able to arrange for a wig specialist to visit you. However, people being treated as outpatients usually have to pay for their wigs.
If your hair falls out due to chemotherapy, it will normally grow back over a period of 3–6 months after the treatment.
Although they may be hard to bear at the time, these side effects will disappear once your treatment is over.
It is important to remember that chemotherapy affects different people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many find that they become very tired and have to take things much more slowly. Just do as much as you can and try not to overdo it.
It is not advisable to become pregnant or father a child while having any of the chemotherapy drugs used to treat Hodgkin lymphoma, as there is a possibility that the chemotherapy drugs may harm the foetus. It is important to use effective contraception during your treatment and for a few months afterwards. You can discuss this with your doctor or specialist nurse.
Condoms should be used during sex within the first 48 hours after chemotherapy in order to protect your partner from any of the drug that may be present in semen or vaginal fluid.
Your doctor will tell you what problems, if any, to expect from your treatment.
Many children worry a lot about missing school and falling behind with their work. It is important to reassure them that they will be able to catch up. Your child's doctor and the social worker at the hospital can help arrange a home tutor for your child during this time.
Most children manage to go to school in between their cycles of chemotherapy. It is important to talk to the teachers about your child's illness and to ask them to let you know when there are any infections, such as chicken-pox or measles, in your child's class. It is also advisable not to let your child get over-tired, so games and PE are probably best avoided during the period of treatment.
Your child may be reluctant to go back to school, as they may feel embarrassed about hair loss. However, it is very helpful for your child to keep in touch with their friends. If this is a problem, discuss it with your doctor and with the schoolteachers.
Our section on children's cancers gives information and suggestions on coping with a child's illness.
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