Understanding Hodgkin Lymphoma: Chemotherapy

Chemotherapy treatment (usually called “chemo”) uses medicines that kill cancer cells, often very quickly. These medicines do this by stopping or slowing how the cancer cell divides and multiplies, or how the cancer cells resist dying.   Chemo affects your whole body because it goes through your bloodstream. The drugs can reach the lymphoma cells in almost all parts of your body.

Chemo usually doesn’t refer to one drug but many, because there are lots of different chemotherapy medicines. Most of the time, a combination of more than one chemotherapy is the best way to treat patients with Hodgkin lymphoma.   

When is chemotherapy used?

Chemotherapy may be given either alone or along with radiation therapy. When given alone, it is given in a higher dose designed to kill off cancer cells.

Chemotherapy is usually given by vein, but some forms can be given by mouth. Your medical oncologist will tell you how many cycles or courses of chemotherapy are best for you.

The number of cycles of chemotherapy needed vary. It is relatively common for chemo treatment to begin a week or two after the biopsy.  Most chemo treatments for Hodgkin lymphoma can be given over about six months, assuming there are no delays administering the treatment. 

What can I expect from chemotherapy?

What to Expect

Chemotherapy not only weakens and destroys cancer cells at the site of the tumor, but throughout the body as well. Unfortunately, this means that chemo can unintentionally harm the development of normal cells like your hair, nails, mouth, and digestive tract.

The side effects chemo causes depend on the type of chemotherapy you receive and how many cycles you receive. The most common side effects of chemo are:

  • Nausea and vomiting
  • Fatigue or tiredness
  • Confusion, forgetfulness (“chemo brain”)
  • Decreased blood counts, sometimes with bruising, bleeding, or infection
  • Sores inside your mouth
  • Numbness in your hands and feet
  • Diarrhea, loose stool
  • Increased urgency to have a bowel movement or urinate

Make sure to tell your doctor if you have these conditions before starting chemo. There may be drugs available that can help with these side effects.

If you experience side effects, call your physician right away. It is better to address side effects right away, and there are numerous drugs available to help manage side effects.

How is chemo given?

Chemotherapies come in different forms and can be given in different ways:

  • Intravenously (IV): As an infusion, the medicine comes through a thin needle (IV) in a vein in your hand or lower arm. An oncology nurse will insert the needle before each infusion and take it out afterwards.
  • Injection: As a single shot into a muscle in your leg, arm, hip, or under the skin in the fatty part of your stomach, leg or arm.
  • By mouth: As a pill or capsule. You may take this yourself at home.
  • Through a port: This is inserted in your chest during a short outpatient surgery. It is about the size of a quarter and sit right under your skin. A port is a small disc made of plastic or metal. A catheter (soft thin tube) connects the port to a large vein. The chemo medicines are delivered through a thin needle right into the port. You can also get your blood drawn through the port. Once you have finished chemo, the port is removed in a brief outpatient procedure.
  • Through a catheter in your chest or arm. This is a soft thin tube that is inserted into a large vein. This is done in a short outpatient surgery. The other end of the catheter stays outside your body. This is similar to having a port.

If you have a catheter or port, your medical team will tell you signs of infection to look for.

What’s the advantage to a port or catheter?

Port vs. Catheter

Many doctors recommend getting a catheter or port. It makes chemotherapy easier and more comfortable each time, as you don’t have to be restuck each time, like with an IV or injection.

How often will I have to have chemo?

Your oncologist will set your course of treatment (regimen). Every chemo regimen is made up of cycles. This means a period of treatment followed by a period of recovery. For example, you may get chemo one day and then have two to three weeks of recovery with no treatment. That would be one cycle. In Hodgkin lymphoma, the most common treatment is ABVD (adriamycin, bleomycin, vinblastine and dacarbazine).  This treatment is given every two weeks, or twice a month.  The first tme you receive it it, it is referred to as Cycle 1A, and two weeks after, Cycle 1B.  Then you go onto Cycle 2A, and 2B, and so on.  Each cycle is one month.  Usually, you doctor will repeat your CT and PET scans after 4 cycles.  If the tumors are shrinking, you will typically receive an additional 2 cycles, followed by repeat CT and PET scans. 

You can get chemotherapy in a variety of settings: at a hospital, in a doctor’s office, or in a clinic.. In Hodgkin lymphoma, it is given as an outpatient in a chemotherapy infusion center. If you take chemo in a clinic, hospital or doctor’s office, you usually go home between treatments. In some cases, you may stay in the hospital to be monitored, especially if you develop an infection. This is especially true if your immune system isn’t working as well as it should be. Your doctor will explain where you’ll be getting your treatment.

Is there anything that can make chemotherapy easier to go through?

Passing Time During Chemotherapy

A chemotherapy treatment at a hospital or clinic can take anywhere from one to several hours. Although many chemo treatment areas have televisions and magazines, you may want to bring something to help pass the time. Ideas include:

  • A laptop
  • Knitting, needlepoint or crochet
  • A good book or magazine
  • Crossword or other puzzle book
  • Sketchbook and pencils
  • Cards or board games (if you have someone to play with)
  • MP3 Player or portable CD player to listen to music
  • Paper and pens to keep a journal or write letters

Is there anything I should be thinking about before I start chemotherapy?

Planning Ahead for Chemotherapy

Chemotherapy treatment can drain most of your energy. This is a major process your body is going through. There are some things you should take care of before you start chemo:

  • Get your teeth cleaned and get a dental check-up. Chemo weakens your immune system, so you may be more vulnerable to infections caused by bacteria that are dislodged during teeth cleaning.
  • Get any heart tests (like an EKG) that your doctor recommends.
  • If you’re a woman, get a Pap smear, if you’re overdue. Chemo can alter the results of your Pap smear, so get one beforehand.
  • Find someone to help around the house. Chemo can cause tiredness (fatigue). Line up someone to help with your daily chores: cleaning, grocery shopping, carpooling, and cooking to name a few. Don’t be too proud or stoic to ask for help. Friends and family members will be happy to do something that helps you during this treatment phase. Ask yourself: wouldn’t you be willing to do it for someone else?
  • Be sure to have a back-up plan so if you get sick at home, or in the middle of the night. Although it is rare, if you develop fever or signs of infection, you may need to go to the hospital at inconvenient times. Identify family or friends who are able and willing to help you, and drive you to the hospital. 
  • Join a support group if that sounds helpful.
  • Find out ahead of time what you should and shouldn’t eat or drink on treatment days.
  • Tell your doctor all the vitamins, supplements, over-the-counter and prescription medicines you take.
  • Talk to your doctor about hair loss. Most chemo medicines cause some amount of hair loss. If you plan on wearing a wig, you might want to go ahead and get it so you can match it to your hair color and style.

Return to treatment options. 

Return to "Hodgkin Lymphoma: An Introduction."