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This information is about a chemotherapy| treatment for non-Hodgkin lymphoma (a type of cancer of the lymphatic system) called CHOP. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer information nurse specialists|.
CHOP is named after the initials of the chemotherapy drugs used in the treatment. It involves the drugs cyclophosphamide|, doxorubicin| (chemical name hydoxydaunorubicin), vincristine| (used to be called Oncovin®) and prednisolone, which is a steroid|.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
CHOP can usually be given to you as a day patient. Before you start treatment you will need to have a blood test, either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse of pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy. All of this may take a couple of hours.
The nurse will then put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this a little painful or uncomfortable but it should not take long. Some people have their chemotherapy given through a thin plastic tube, which is inserted under the skin into a vein near the collarbone (a central line|) or passed through a vein in their arm (a PICC line|). Your doctor or nurse will explain more about this to you.
Once your chemotherapy is ready you will be given anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula or your line, but they can also be given as tablets.
CHOP is given by a combination of injections into the tubing of a drip (infusion) and by drips. The prednisolone is taken as tablets.
The drugs to be given into the vein are usually given in the following order:
When all the drugs have been given the cannula will be removed or your line will be capped. You will be given a supply of anti-sickness tablets to take home with you. You should take these regularly (as directed) even if you are not feeling sick. Some medicines are more effective at preventing sickness than stopping it once it has started. You will also be given a course of prednisolone tablets. It's important to take all the tablets as prescribed by your doctor.
Your doctor may use the word regimen (eg the CHOP regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment that you are receiving.
On the first day of your treatment you will be given doxorubicin, vincristine and cyclophosphamide. On the same day you will begin a five day course of prednisolone tablets. When you have finished the tablets you will have a rest period with no treatment for the next 16 days. This completes what is called a cycle of your treatment. Each cycle takes 21 days – three weeks.
After the rest period the same treatment will be repeated again, which begins the next cycle of your chemotherapy. Usually 6–8 cycles are given over a period of 3–4 months. This makes up a course of treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is having this treatment.
We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drugs, but which are not listed here, please let your nurse or doctor know.
Lowered resistance to infection The chemotherapy drugs can reduce the production of white blood cells by the bone marrow, making you more prone to infection|. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally, it may be necessary to delay your treatment if the number of blood cells (blood count) is still low.
Bruising or bleeding Chemotherapy can reduce the production of platelets (which help the blood to clot). Let you doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.
Anaemia (low number of red blood cells) While having the treatment you may become anaemic. This can make you feel tired| and breathless|. Let your nurse or doctor know if these effects are a problem.
Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting|. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem for you.
Constipation Vincristine (and some anti-sickness drugs) may cause constipation|. Let your doctor or nurse know if this is a problem.
Tiredness Many people feel extremely tired (fatigued)| during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.
Hair loss This usually starts 3–4 weeks after the first course of treatment. Usually all your hair will fall out. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss| is temporary and your hair will start to grow again when the treatment is over.
Sore mouth and ulcers Your mouth may become sore| or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your doctor if you have any of these problems, as they can prescribe special mouthwashes and medicine to prevent or clear any mouth infection.
Taste changes You may notice that your food tastes different. Your sense of taste will usually return to normal after the treatment finishes.
Irritation of the stomach lining Prednisolone can reduce the stomach's protective layer, making it more prone to irritation by stomach acid. Tell your doctor if you have indigestion or any other stomach problems. They can prescribe medicine to relieve these symptoms.
Increased appetite You may notice that you feel hungrier than usual while taking prednisolone. This will stop when you are no longer taking the drug.
Irritation of the bladder Cyclophosphamide may irritate your bladder. It is useful to drink plenty of fluid (up to about two litres) on the day following chemotherapy to help prevent this. If you notice any blood in your urine tell your doctor. Doxorubicin is red and due to this your urine may become a pink/red colour. This may last up to 24 hours after your treatment and is quite normal.
Numbness or tingling in hands or feet This is due to the effect of vincristine on nerves and is known as peripheral neuropathy|. Tell your doctor if you notice these symptoms. The dose of vincristine may need to be reduced. This problem usually improves slowly a few months after treatment is over.
Changes in the level of sugar in your blood Occasionally prednisolone may cause your blood-sugar level to rise. During treatment you may have regular blood or urine tests to check this. Tell your doctor if you get very thirsty or if you are passing more urine than usual.
Fluid retention Prednisolone may affect the salt and water balance in your body. You may notice that your ankles and/or your fingers swell. Let your doctor know if this happens. This is usually only a problem with long-term treatment.
Skin changes Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished. During treatment and for several months afterwards you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection-factor suncream and cover up with clothes.
Sometimes areas of skin which have been treated with radiotherapy may become red and sore. Let your doctor know if this happens.
Changes in nails Your nails may become darker and white lines may appear on them. These changes usually grow out over a few months once the treatment has finished.
Changes in behaviour You may experience mood swings, difficulty sleeping and perhaps anxiety or irritability because of your steroids. Let your doctor know if there are any changes in your behaviour which are worrying you.
Changes in the way your heart works This is rare with usual doses of doxorubicin but may occasionally happen when high doses are used. You may have tests to see how well your heart is working before you start treatment.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Leakage into the tissue around the vein If this happens while doxorubicin or vincristine are being given, the tissue in that area can be damaged. If you notice any stinging or burning around the vein while the drug is being given tell your doctor or nurse immediately.
Fertility Your ability to become pregnant or father a child is likely to be affected by this treatment. It is important to discuss fertility| with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor or nurse.
Loss of periods in women Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular and may eventually stop. In younger women this may be temporary but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
This section is based upon our CHOP chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography|.
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