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Understanding the Side Effects of Treatment for Hodgkin and Non-Hodgkin Lymphomas


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The goal of treatment for Hodgkin lymphoma is to cure the patient. Chemotherapy or a combination of chemotherapy and radiation can result in cures. Over 75 percent of all people diagnosed with Hodgkin lymphoma can be cured by current treatment approaches. The goal of treatment for non-Hodgkin lymphoma is to destroy as many malignant cells as possible and to induce a complete remission, that is, to eliminate all evidence of disease. In some cases in which this goal is accomplished, a cure may be achieved.

People undergoing treatment for lymphoma may experience some possible side effects. When side effects do occur, most are short-lived and disappear when therapy is completed. In recent years, new drugs have increased physicians? ability to control certain side effects, such as nausea and vomiting, which used to be very troubling for many people. The benefit of treatment, with its goal of remission and, in some cases, cure, outweighs the risks, discomfort, and unpleasantness in most cases.

Early Effects of Treatment
The side effects of treatment for lymphoma depend on the intensity and type of treatment, such as the location of the radiation therapy, the age of the person, and coexisting medical conditions (for example, diabetes mellitus, chronic renal disease, and others). In addition, certain drugs have a specific tendency to affect certain tissues. Two examples are the tendencies for vincristine to affect nervous tissue and bleomycin to affect the lungs.

Suppressed Blood Cell Formation
Decreases in blood cell counts may occur in people treated with chemotherapy. Blood transfusions may be necessary for some people with low blood cell counts. If decreases in white cell counts are severe and continue for extended periods, infection may develop and require antibiotic treatment. Sometimes, doses of chemotherapy or the time between chemotherapy cycles must be altered to allow the person's blood counts to recover from the effects of treatment.

When side effects do occur, most are short-lived and disappear when therapy is completed.

Oral and Gastrointestinal Effects
Treatment for the lymphomas may cause mouth sores, nausea, vomiting, diarrhea, constipation, bladder irritation, and blood in the urine.

Other Effects
Therapy can induce extreme fatigue, fever, cough, lung function impairment, and cardiac function impairment. People undergoing treatment for lymphoma also may experience rashes; hair loss; weakness; nerve function impairment ranging from tingling sensations to, infrequently, more serious impairment of function; and other effects. These diverse effects depend on the drugs and dosages used and the individual's susceptibility.

Effects on Fertility
Some people may have a decrease in fertility after treatment. The risk of infertility varies according to the nature of the treatment, depending on the type and amount of chemotherapy, the location of radiation therapy, and the person's age. Men who are at risk of infertility can consider sperm banking. Women who have ovarian failure after treatment will have premature menopause and require hormone replacement therapy. When childbearing is possible, whether the male or the female partner has received treatment, the incidence of fetal loss and the health of the newborn are very similar to those of healthy couples.

Late Effects of Treatment
There is an increased risk of secondary cancers in people treated for Hodgkin lymphoma and non-Hodgkin lymphomas. Radiation therapy has been associated with cancers of the breast, lung, stomach, bone, and soft tissues. Often, they occur many years after treatment. Radiation therapy to the chest has been associated with various types of heart disease, including inflammation of the surrounding sac (pericardium) or myocardial infarction (classic heart attack). Injury to the thyroid gland may cause decreased thyroid gland function (hypothyroidism), and injury to the lung may follow radiation therapy. Advances in radiotherapy have decreased the frequency of side effects, but these may still occur in people who have been treated in past decades. Exposure to chemotherapy has been associated with an increased incidence of myelogenous leukemia.

The process of making choices about chemotherapy and other treatment options can cause a great deal of anxiety. Often, if people with blood cancers talk to their healthcare providers about the medical questions they have, including how to deal with side effects, they feel some sense of relief in making treatment choices. In addition, your physicians, nurses, social workers, and other health professionals understand the complexity of emotions and special needs of those undergoing treatment. They are available to spend time with you, answer questions, lend emotional support, and provide referrals to other useful resources.

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Excerpted with permission from The Lymphomas: Hodgkin Lymphoma and Non-Hodgkin Lymphomas, copyright by the Leukemia & Lymphoma Society, www.lls.org.

This article was published in Coping® with Cancer magazine, July/August 2008.