Chemotherapy is a treatment using drugs that cure or control cancer. These drugs can be used on their own or with each other. Whether you get chemotherapy or not will depend on the type and stage of the disease, and if you have other symptoms such as fever or night sweats. Chemotherapy can be given before or after radiotherapy.

The drugs used in chemotherapy are carried by the blood stream to almost every part of the body. It is not possible to receive all the treatment required during one visit to hospital and you may have to attend hospital at regular intervals for 3-6 months. There is usually a rest period between each treatment visit to allow your body time to recover from the effects of the drugs. Each visit to hospital where chemotherapy is given is called a cycle. The number of cycles you have will depend on the stage of the cancer and how well it is responding to treatment.

If you have a low-grade lymphoma you may be given chemotherapy in tablet form. This type of treatment can be taken at home. At other times you may be asked to come into hospital for chemotherapy that is given into a vein in your arm.

Chemotherapy for the faster growing lymphomas is given into a vein. It can be given as an injection or by intravenous infusion (drip). A number of drugs may be used with each other. You may have to spend some time in hospital for this treatment –however, most treatments can be given in day-care. Some treatments are given once every three or four weeks for about six months. Other intensive treatments, depending on the type of lymphoma, may be given once weekly for eight to twelve weeks.

If you have lymphoma cells in your spinal fluid or your doctor thinks you may be at high risk you will need extra treatment. You may be given special chemotherapy injections into the spinal fluid. To do this a series of lumbar punctures will be carried out and the chemotherapy given at the same time.

Venous access

If your treatment involves injections or intra-venous infusions it may be helpful to have a central venous line put in. This device can be left in place throughout your treatment. It will make it much easier for you to receive treatment and spare you the discomfort of repeated needle jabs.

A central venous line is a length of narrow flexible plastic tubing (a catheter) that is inserted into a main vein and brought out through the chest or arm. You will be given a local anaesthetic before the line is put in. In most cases, it takes about 10-15 minutes to insert. Removing it is very simple, sometimes needing a small local anaesthetic.

There are other ways to achieve and maintain easy access to veins for blood sampling and treatment. Sometimes the catheter is attached to a port–a small round plastic or metal disc placed under the skin. The port can be used for as long as is needed. Talk to your doctor or nurse. He or she will explain the different options to you.

There are many chemotherapy drugs used to treat lymphoma. The drugs most commonly used include Doxorubicin (Adriamycin), Cyclophosphamide and Vincristine. Other drugs such as Bleomycin and Methotrexate may also be used. All these drugs can be used in combination with each other. Before any chemotherapy is given your doctor will discuss your treatment options with you.

1 - Central venous line is inserted here

2 - The line is channeled under the skin

3 - It comes out here

Chemotherapy for cancer that recurs or has spread

Many people have no further problems after their first treatment for non-Hodgkin’s lymphoma but for some, the cancer does come back or the lymphoma changes from a slow growing lymphoma to a fast growing one. It may also have spread to other parts of the body. There are times when the cancer may have already spread by the time the diagnosis is made.

It is important to know that even if the cancer extends to other parts of the body or recurs it can still be treated. In many cases chemotherapy will cure the disease or at least enable people to live longer with better control of symptoms. Your doctor will consider your general health and where the cancer is located. He or she will also take into account the kind of treatment you have had in the past.

Side effects of treatment

The side effects of chemotherapy vary from one person to another and depend on the drugs used. These unwanted effects happen because while the chemotherapy is working on the cancer cells it can affect normal cells too. In many cases it is possible to have this treatment and have side effects that are well controlled with medication.

Before you start your treatment ask your doctor about any potential side effects. Do tell your doctor about the way you are feeling during your treatment as most side effects can be eased with medication. In most cases the side effects go away when the treatment ends or soon after. Your doctor or nurse can give you something to stop most of them or make them easier to cope with.

Side effects may include:

Infection

Chemotherapy can make you more likely to get infections. This happens because most chemotherapy drugs affect the bone marrow that makes the white blood cells that fight infection. If you do not have enough white cells even minor infections such as a cold or sore throat could make you quite ill. During treatment cycles you will have regular blood tests to make sure that you have enough white blood cells.

Your doctor will ask you to watch out for signs of infection at all times especially if your white cells are low. These signs could include feeling shivery and unwell or running a high temperature of 380c or higher. If this happens tell your doctor straight away. He or she will tell you what to do. Some hospitals prefer you to ring them directly. Check this out with your nurse or doctor before you start treatment. If you have a high temperature or feel unwell you will need a blood test. You may need antibiotics to treat the infection.

While on treatment you will be more at risk of picking up infections. Try to avoid close contact (such as hugging or kissing) with people who have colds or flu and other infections such as chicken pox, shingles or measles. Let your doctor know if you are in contact with these or any other infections. Wash your hands often during the day especially before you eat and after going to the bathroom. Try to avoid crowds. Infection can be a very serious complication of chemotherapy. It needs to be treated as soon as possible. Talk to your doctor or nurse. They will give you more information.

Bruising

Bruising more easily or for no apparent reason is known as purpura. The blood is made up of three different blood cells. Platelets help to make your blood clot to stop the bleeding if you hurt yourself. If there are not enough platelets in your blood (thrombocytopenia), you may bleed or bruise more easily, even from a minor injury.

Let your doctor or nurse know straight away if you are bruising easily or notice tiny red spots under the skin, which can look like a rash (petechiae). He or she will tell you what to do.

Feeling sick (nausea) or getting sick

Not everyone feels sick with chemotherapy, but if you do it can happen before, during or after treatment. It may last for several hours or for a few days after treatment. There are very effective drugs available that prevent or reduce nausea and vomiting.

Ask your doctor to give you medication to stop you feeling sick. Take it as directed by your doctor while you are on treatment.

Sore mouth

Some drugs used to treat lymphoma can cause a sore mouth. They can also cause little ulcers to appear on the tongue, gums and inside the cheeks of your mouth. Try to keep your teeth, gums and mouth very clean, as this will reduce the risk of getting a mouth infection. Clean your teeth after each meal. Use a very soft toothbrush. If you have dentures remove them if your gums are sore. There are special mouthwashes that you can use. Your nurse will show you how to use them properly.

Feeling very tired

You may feel very tired. This tiredness can last for some weeks after treatment has ended. If this happens take things easier. Do less than you would normally do. Rest more if you can. Ask your family or friends to help you at work or at home.

Not wanting to eat

It is best to eat as much you can while on chemotherapy. Eat smaller amounts more often. If you do not feel like eating during treatment, you could try replacing some meals with special food supplements. The dietician will be available to help you.

Diarrhoea

Passing watery bowel motions more than twice a day is known as diarrhoea. You may also have cramping and/or abdominal pain. Tell your doctor, as he or she may be able to give you tablets to prevent this. Drink plenty of clear fluids.

Let your doctor know if the diarrhoea persists for 24 hours.

Constipation

Chemotherapy may slow down the movement of the bowel and your regular bowel habit may change. You may have difficulty passing a bowel motion. This is called constipation.

If this occurs let your doctor or nurse know as soon as possible. You may need to drink more clear fluids and /or take a laxative. In some cases your doctor may have to adjust your treatment.

Hair loss (alopecia)

This is a common effect of some of the drugs used to treat lymphoma. If you do get complete hair loss it will happen quite quickly but try not to worry, as your hair will grow again when treatment stops. Alopecia usually occurs about three weeks into chemotherapy. You may feel upset at the thought of losing your hair. Talk to your nurse about your feelings. He or she will help you find ways of coping with hair loss. You can get a wig when this happens or you may prefer to wear a hat or scarf.

If you would like a wig, organise this before your hair starts to fall out so that you can get a good colour match to your own hair. Your social worker or nurse may be able to arrange for a wig specialist to visit you in hospital. If this is not possible ask if they have the name of a wig fitter you could go to see. Your local hairdresser may be able to help.

In some cases it is possible to get financial assistance with the cost of a wig. Ask your social worker or nurse for more information.

For some patients the amount of hair loss is small. A wig may not be needed.

Infertility

Some of the drugs used to treat Hodgkin's non-Hodgkin’s lymphoma may cause infertility. It may be temporary or permanent.

If you have a different side effect or symptom from those listed that concerns you, tell your doctor or nurse straight away. He or she will tell you what to do.

Chemotherapy is a treatment using drugs to cure or control cancer.

 

The drugs can be given in tablet form, directly into a vein as an injection or through an intravenous infusion (drip).

 

The side effects vary depending on the drugs used. Most side effects are well controlled with medication.