Chemotherapy is the use of drugs to kill cancer cells. The drugs can be taken as pills or injected into a vein under the skin. Chemotherapy is systemic therapy, which means the drugs enter the bloodstream and circulate throughout the body to reach and destroy cancer cells wherever they may be.
Doctors give chemotherapy in cycles, in which a period of treatment is followed by a rest period to give the body time to recover. Each chemotherapy cycle generally lasts for several weeks. Most chemotherapy treatments are given on an outpatient basis (in the doctor's office or clinic or hospital outpatient department) but some may require a hospital stay.
Several drugs are combined in the chemotherapy regimens for Hodgkin disease because different drugs kill cancer cells in different ways. The combinations of drugs used to treat Hodgkin disease are often referred to by abbreviations that are easier to remember than the drugs' full names. Although other combinations may be used, the most common regimen in the United States is a 4-drug combination called ABVD, which consists of:
- Adriamycin® (doxorubicin)
- Bleomycin
- Vinblastine
- Dacarbazine (DTIC)
Other commonly used regimens include:
Stanford V
- Doxorubicin (Adriamycin)
- Mechlorethamine (nitrogen mustard)
- Vincristine
- Vinblastine
- Bleomycin
- Etoposide
- Prednisone
BEACOPP
- Bleomycin
- Etoposide (VP-16)
- Adriamycin (doxorubicin)
- Cyclophosphamide (Cytoxan®)
- Oncovin® (vincristine)
- Procarbazine
- Prednisone
Radiation is used along with chemotherapy in the Stanford V regimen, and might be used along with the ABVD regimen as well.
Other chemotherapy combinations may also be used for Hodgkin disease. Most use the same drugs as listed above, but they may include different combinations and be given on different schedules. No matter which regimen is used, it is important that your doctor is familiar with using the regimen and understands its side effects.
Possible side effects
Chemotherapy drugs attack cells that are dividing quickly, which is why they work against most types of lymphoma cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.
The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Diarrhea
- Increased chance of infections (due to low white blood cell counts)
- Easy bruising or bleeding (due to low blood platelet counts)
- Fatigue (due to low red blood cell counts)
These side effects are usually short-term and go away after treatment is finished. If serious side effects occur, the chemotherapy may have to be reduced or delayed.
There are often ways to lessen these side effects. For example, drugs are usually given to help prevent or reduce nausea and vomiting.
Drugs known as growth factors (G-CSF or GM-CSF, for example) are sometimes given to help the white blood cells recover from the effects of chemotherapy and thus reduce the chance of infection. Antibiotics may also be given at the earliest sign of an infection, such as a fever.
If your white blood cell counts are very low during treatment, you can help reduce the risk of infection by carefully limiting your exposure to germs. During this time, your doctor may advise you to:
- Wash your hands often.
- Avoid fresh, uncooked fruits and vegetables and other foods that might carry germs.
- Avoid fresh flowers and plants because they may carry mold.
- Make sure other people wash their hands before they come in contact with you.
- Avoid large crowds and people who are sick (wearing a surgical mask offers some protection in these situations).
If your platelet counts are very low, you may be given drugs or platelet transfusions to help protect against bleeding. Fatigue caused by anemia (very low red blood cell counts) can be treated with drugs or with red blood cell transfusions.
Long-term side effects: Some chemotherapy drugs can have long-term side effects that occur years after therapy has ended. These can affect a patient's heart, lungs, growth, and ability to have children.
Because doxorubicin can cause heart damage, your doctor may order a test to check your heart function before starting you on this drug.
Since bleomycin can cause lung damage, some doctors order tests of lung function (called pulmonary function tests) before starting patients on this drug.
Some chemotherapy drugs can increase the risk of developing a second type of cancer later in life (such as leukemia), especially in patients who have also received radiation therapy.
The severity of long-term side effects can vary, depending on the patient's age at the time of treatment and other factors. Long-term effects are discussed in more detail in the section, "What happens after treatment for Hodgkin disease?"
Before starting chemotherapy, ask your doctor to explain the possible side effects and your chances of having them.
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