Chemotherapy for lymphoma

Ways to have chemotherapy

Chemotherapy is the use of drugs to kill cancer cells or slow their growth. It can be used in various ways depending on the grade and type of lymphoma.

Chemotherapy can be given on its own or in combination with other drug therapies, such as steroids, targeted therapy and immunotherapy, or with radiation therapy.

Intravenous (IV) chemotherapy

Chemotherapy drugs are usually given as a liquid through a drip inserted into a vein (intravenous infusion). The drugs may be injected through a cannula, which is a small plastic tube inserted in a vein, or through a type of central venous access device (CVAD, see below).

The type of device used will depend on how often you need chemotherapy, how long it will take to give each dose, and the length of time you will be having chemotherapy.

Central venous access device

This is a thin plastic tube that stays in the vein throughout the course of treatment.

Common types include:

• PICC (peripherally inserted central catheter) – a thin tube that is inserted into the upper arm
• port-a-cath (port) – a small device that is surgically inserted under the skin of the chest or arm to give access to the veins
• central line (central venous catheter or CVC) – a thin tube with several openings that is inserted into a vein in the neck or chest.

Oral chemotherapy

Some chemotherapy drugs for lymphoma are given as tablets that you swallow.

Having chemotherapy

You will usually have a combination of chemotherapy drugs given over 4–6 months. For Hodgkin lymphoma, the treatment is sometimes completed in 8 weeks.

The drug combination and treatment schedule will depend on the type of lymphoma. Usually, chemotherapy is given over a few days, followed by a rest period of a few weeks. This is called a cycle. The rest period lets your blood counts return to normal.

Throughout your treatment, you will be closely monitored by your doctor, and you will have tests to see how well the chemotherapy drugs are working.

As chemotherapy can reduce the number of blood cells in your body, you will have regular blood tests to check your blood count, as well as your liver and kidney function. You may also be given injections of a drug known as granulocyte-colony stimulating factor (G-CSF). This helps increase your white blood cell count and reduce your risk of infection.

Even if tests show the cancer is in remission after 2 or 3 cycles, chemotherapy may still be repeated several times to help reduce the chance of the lymphoma coming back.

Common side effects of chemotherapy

The side effects of chemotherapy vary depending on the drugs given. Everyone reacts to chemotherapy differently. You may have other side effects not mentioned here. For more information, call Cancer Connect on 13 11 20.

Fatigue

Severe tiredness and lack of energy (fatigue) may make you feel drowsy, exhausted or confused. These symptoms can last for several weeks or months after chemotherapy. Check with your doctor whether your fatigue is related to a low red blood cell count (anaemia). Anaemia may be treated with blood transfusions. If you are up to it, keeping active and exercising can help you feel less fatigued.

Increased risk of infections

Chemotherapy reduces your white blood cell level (neutropenia), making it harder for your body to fight infections. Learn ways to reduce your risk of infection.

Constipation

Some chemotherapy drugs and anti-nausea medicines can cause constipation. Ways to prevent constipation include drinking 6–8 glasses of water a day, eating a high-fibre diet and getting daily exercise.Your treatment team may also suggest or prescribe a suitable laxative or stool softener.

Nerve effects

Some chemotherapy drugs can cause nerve damage (peripheral neuropathy). Symptoms can include tingling, pain or loss of feeling in your fingers and/ or toes, and muscle weakness in your legs. These side effects usually disappear after treatment ends, though they can last a long time or even be permanent.

Bleeding or bruising

A drop in the number of platelets in your blood (thrombocytopenia) can cause heavy bleeding from small cuts or make you bruise easily. You may be given a platelet transfusion to increase your platelet count.

Hair loss

You may lose some hair from your head, eyebrows and eyelashes. Your hair will grow back after treatment. You can wear a scarf, a hat or a wig. You may be able to borrow a wig from a wig library. If you have private health insurance, your fund may cover part of the cost of a wig.

Mouth sores

Chemotherapy can damage the cells in the mouth, causing mouth sores. These usually get better after treatment ends. Keeping your mouth clean will help prevent infections. Use a soft toothbrush after each meal to keep your mouth clean. If using a mouthwash, pick alcohol-free products.

Nausea and vomiting

You will usually be given anti-nausea medicines before having chemotherapy to stop you feeling sick or vomiting. These usually work very well. If you still feel sick or keep vomiting after using the prescribed medicine, let your nurse or doctor know so that another medicine can be tried.

Taking care with infections

If your white blood cell levels drop during treatment, you are more likely to catch colds or more serious infections that need treatment in hospital.

Ways to reduce your risk

To prevent the spread of infection:

• check with your doctor about having vaccines for the flu and COVID-19
• ask people close to you to consider having the flu and COVID-19 vaccines
• ask family and friends with a cold, COVID-19, flu or other contagious infection (e.g. cold sores, measles, chickenpox) to wait until they are well before visiting
• as far as practical, avoid close contact with the people you live with if they are unwell
• try to avoid very crowded places, such as shopping centres or public transport in peak hour
• wash your hands with soap and water before preparing food, eating, and after using the toilet
• prepare and store food properly to avoid foodborne illnesses and food poisoning
• eat freshly cooked foods and avoid raw foods (fish, seafood, meat and eggs) and soft cheeses
• wash fruits and vegetables well before eating.

When to seek medical help

Contact your doctor or go to the nearest hospital emergency department immediately if you experience one or more of the following symptoms:

• a temperature of 38°C or higher
• chills or shivering
• sweating, especially at night
• a burning or stinging feeling when urinating (peeing)
• a severe cough or sore throat
• shortness of breath
• vomiting that lasts more than a few hours
• severe belly pain, constipation or diarrhoea
• unusual bleeding, such as blood in your urine (pee) or black bowel movements (poo) or nosebleeds
• ongoing faintness or dizziness, and rapid heartbeat
• any tenderness, redness or swelling around the site of your intravenous chemotherapy device
• any sudden decline in your health.