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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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Chemotherapy| is the use of anti-cancer drugs to destroy the lymphoma cells. There are different groups of anti-cancer drugs used to treat lymphoma.
The main group that many people think of as 'chemotherapy’ is cytoxic chemotherapy. Cytotoxic means toxic to cells. Cytotoxic drugs are carried in the blood where they can reach cancer cells anywhere in the body.
Our section on chemotherapy| has more details of individual chemotherapy| drugs, combination chemotherapy| drugs and side effects.
Low-grade lymphomas are often treated with chemotherapy tablets that can be taken at home, so you can carry on with your normal activities. At other times, the drugs are given by an injection into a vein in the arm (intravenously). Many chemotherapy treatments can be given to you as an outpatient, although sometimes you may need a short stay in hospital.
The most common types of chemotherapy given for low-grade lymphomas are tablets called chlorambucil|, or a drug called fludarabine|. Fludarabine can be given as tablets or as a liquid into the vein.
A combination of chemotherapy drugs called CVP| is also used. CVP includes the chemotherapy drugs:
A monoclonal antibody| called rituximab| is often given alongside CVP.
Chemotherapy for high-grade lymphomas is given into a vein (intravenously). Usually, a combination of several drugs is given over a few days and this is followed by a gap of a few weeks. This allows your body to recover from any side effects before the next treatment. Your treatment will probably last for several months and during this time you will have regular check-ups. Sometimes the chemotherapy is given once a week over a shorter time span, perhaps 3-4 months.
The most commonly used chemotherapy for high-grade lymphomas is a combination of four drugs called CHOP|. CHOP is a combination of the chemotherapy drugs:
A monoclonal antibody| called rituximab| is usually given alongside CHOP.
Some people with particular types of lymphoma have a lumbar puncture| at the start of chemotherapy. This is to check if there are lymphoma cells in the spinal fluid. If lymphoma cells are found, you will be advised to have chemotherapy directly into the spinal fluid on several occasions until the lymphoma cells are gone. Even if no lymphoma cells are found, your doctors may decide to give several doses of a chemotherapy drug directly into the spinal fluid to prevent lymphoma cells from growing there. Giving treatment in this way is known as intrathecal chemotherapy. Intrathecal treatment may be given as a day case, but sometimes it may mean an overnight stay in hospital.
Some people having chemotherapy may find it easier to have a central line|. This is a long tube made from silicone rubber that is inserted into a main vein in the upper chest or neck. They are also called tunnelled central venous catheters and can be put in under local or general anaesthetic.
Chemotherapy and other drugs can be given through the line and blood samples can be drawn out with a syringe. The central line stays in throughout your treatment. The nurses will show you how to look after your line. Once your treatment is finished, the line is taken out. A local anaesthetic may be used if needed.
Position of a central line
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 the chest. You can have a PICC line put in as an outpatient, using local anaesthetic. Your PICC line can stay in throughout your treatment and can be used to give drugs or take blood. Once you have finished your treatment, the PICC line is easily removed.
The PICC line is threaded through the vein until the end is near to your heart
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. Once your treatment is finished, the port is removed. Usually, this is easily done, using a local anaesthetic if necessary.
Chemotherapy can cause unpleasant side effects, but these can often be well controlled with medicines. Not all drugs cause the same side effects and some people may have very few side effects. Your doctor will tell you about any problems that your treatment may cause.
While the drugs are acting on the lymphoma cells in your body, they also temporarily reduce the number of normal white cells in your blood; a low white blood cell count is called neutropenia. 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 (growth factors|) may also be given to stimulate the production of white blood cells by the bone marrow.
Contact your doctor or the hospital straight away if:
You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally your treatment may have to be delayed if your blood count is still low.
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 the blood to clot. If the number of platelets in your blood is low you may develop blood spots or rashes on the skin (petichiae), bruise easily, have nosebleeds or bleed more heavily from minor cuts and grazes.
If you develop any of these symptoms contact your doctor or the hospital immediately. Some people may need a platelet transfusion|.
Some of the drugs used to treat NHL 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.
Chemotherapy affects people in different ways. Tiredness| can build up over a course of treatment, and if you’ve had a lot of chemotherapy, it can last for several months or more after your treatment has finished. Try to cut down on any unnecessary activities and ask your friends or family to help with jobs such as shopping and housework. Gentle exercise can sometimes help with the symptoms of fatigue.
Some chemotherapy drugs can make your mouth sore| and cause small mouth ulcers. It’s important to have regular mouthwashes to keep your mouth clean. Your nurse can show you how to use these properly. Using a soft toothbrush can be helpful.
If you don’t feel like eating during your treatment, you could try replacing some meals with nutritious drinks or a soft diet. You may find our section on eating problems| helpful.
Unfortunately, some of the drugs used to treat NHL can make your hair fall out|. Ask your doctor if the drugs you are taking are likely to cause hair loss. People who lose their hair often cover this up by wearing wigs, hats or scarves.
Hospital inpatients 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.
You may find our section on coping with hair loss| helpful.
Although they may be hard to bear at the time, these side effects will gradually disappear once your treatment is over.
It's important to remember that chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but may find that they become tired and have to take things slowly. Just do as much as you can and try not to overdo it.
It’s not advisable to become pregnant or father a child while having any of the chemotherapy drugs used to treat NHL, as there is a possibility that the chemotherapy drugs may harm the developing baby. It’s 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.
Chemotherapy can have long-term (permanent) side effects. Again, these will vary depending on the drugs you are treated with.
The most common permanent side effect is infertility| (although not all chemotherapy drugs affect your fertility). Men may stop producing sperm, although they will continue to orgasm and ejaculate normally. Sperm banking| can often be carried out before treatment.
Most women find that their periods stop or become irregular during treatment. They may go back to normal after treatment, but the closer you are to the age of your natural menopause, the more likely it is that chemotherapy will stop your periods permanently. If this happens, you can be given hormone replacement therapy. This will not give you back your fertility, but it helps with menopausal symptoms such as hot flushes, dry skin, vaginal dryness and a drop in sexual desire. There is more information in our section on fertility after treatment for NHL|.
Some chemotherapy drugs may slightly affect the way that your heart works. With some drugs there is a small risk that they may cause another cancer many years later. This risk of long-term side effects has to be balanced against the benefit of the chemotherapy in curing or controlling the lymphoma. If you are worried about the risk of long-term side effects it is helpful to discuss this with your doctor or specialist nurse.
Children with NHL nearly always have high-grade tumours and the main form of treatment is with intensive chemotherapy. Radiotherapy may sometimes be needed as well.
During the initial intensive period of a child’s chemotherapy, they will probably not be able to go to school. Many children worry quite a lot about missing school and getting behind with their work. It’s important to reassure them that they will be able to catch up. Your doctor and the social worker at the hospital can help you to arrange a home tutor for your child during this time.
It may help to talk to your child’s head teacher, to see if the school can arrange to send work home for your child. There is also a teacher attached to the hospital ward who will help with your child’s education if they have to be in hospital for extended periods. The teacher will also keep in touch with your child’s school.
Our children’s storybook, Peppermint ward|, covers many of the issues children face when having chemotherapy.
We have information more information in our section on children’s cancers,| which tells you more about NHL in children| and its treatment.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.