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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 (cytotoxic) drugs to destroy the lymphoma cells. The drugs travel round in the blood and reach lymphoma cells wherever they are in the body.
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 three to four 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| done 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 an outpatient, but sometimes it may mean an overnight stay in hospital.
Some people having chemotherapy may find it easier to have a central line|. A central line is a long tube made from silicone rubber that is inserted into a main vein in the chest. 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. Once your treatment is finished, the line is taken out. Usually this is easily done, using local anaesthetic if needed.
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.
Some tubes end in small 'ports' that lie just under the skin of the chest: these are known as implantable ports| (see diagram below). 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. 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.
Platelets are a type of blood cell which help the blood to clot. If the number of platelets in your blood is low you will bruise easily and may bleed heavily from even minor cuts or grazes. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums. We have a section on platelet transfusions|.
Some of the drugs used to treat NHL can make you feel or be sick (nausea and vomiting|), but there are very effective anti-sickness drugs (anti-emetics) to prevent this. If the sickness is not controlled or continues, even with anti-sickness treatment, let your doctor know. They can prescribe other anti-sickness drugs which may be more effective.
Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many find they have to take things much more slowly. Tiredness| can build up over a course of treatment, and if you have 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 is important to have regular mouthwashes to keep your mouth clean and the nurse will 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 chemotherapy drugs will make your hair fall out|. People who lose their hair often wear wigs, hats or scarves. If you are being treated as an inpatient, or you are on income support, you can get a free wig from the NHS. If not, you can still get a subsidised wig from the hospital. Ask your doctor or the nurse about seeing a wig specialist. If your hair falls out it is important to protect your scalp from the sun. If you lose your hair, it will start to grow back within three to six months of finishing your treatment.
Although they may be hard to bear at the time, these side effects will gradually disappear once your treatment is over.
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.
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.
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