Late and Long-term Side Effects of Hodgkin Lymphoma Treatment
Each type of treatment for Hodgkin lymphoma has side effects that could last for months or longer, or that might not show up until long after treatment has ended. Some side effects, like loss of fertility (ability to have children), could be permanent.
Because so many people are now living for a long time after their treatment, watching for these late and long-lasting side effects is very important. Be sure to discuss what these possible effects might be with your medical team so you know what to watch for and report to the doctor.
One uncommon but very serious side effect of Hodgkin lymphoma treatment is developing a second type of cancer later on. People who have had Hodgkin lymphoma have a higher risk for several types of cancer. See Second Cancers After Hodgkin Lymphoma.
A possible long-term effect of chemotherapy and radiation therapy, especially in younger patients, is reduced or lost fertility. For example, some chemo drugs can affect a male’s ability to make sperm, which might be temporary or permanent. If the patient is old enough and is going to get chemo drugs that can affect fertility, sperm banking should be considered before chemo is started.
Likewise, women may stop having menstrual periods with chemotherapy. This may or may not return to normal. Radiation to the lower abdomen can cause infertility unless the ovaries are surgically moved outside the radiation field beforehand. Moving the ovaries does not affect cure rates because Hodgkin lymphoma almost never spreads to the ovaries.
For unknown reasons, the immune systems of Hodgkin lymphoma patients often do not work normally. Treatments such as chemotherapy, radiation therapy, or removal of the spleen (splenectomy) can add to this problem. Splenectomy was once commonly done but is now rare for people with Hodgkin lymphoma. Patients who have their spleen removed should get vaccinated against certain bacteria.
All people who have had Hodgkin lymphoma should keep up with their flu shots. Keeping up with vaccinations and careful, prompt treatment of infections are very important.
Radiation therapy to the chest or neck to treat Hodgkin lymphoma might affect the thyroid gland, causing it to make less thyroid hormone. People with this condition, known as hypothyroidism, may need to take thyroid medicine daily. People who got radiation to the neck or upper chest should have their thyroid function checked with blood tests at least yearly.
Heart disease and strokes
People who have had radiation to the chest have a higher risk of heart disease and heart attacks. This has become less of a problem with more modern radiation techniques, but it’s important to do what you can to help lower your risk, such as not smoking, staying at a healthy weight, being active, and eating a healthy diet. Some chemo drugs such as doxorubicin (Adriamycin) can also cause heart damage. Your doctor might want to check your heart function for several years after your treatment.
Radiation to the neck increases the chance of stroke because it can damage the blood vessels in the neck that supply the brain. Smoking and high blood pressure also increase the risk of stroke. Once again, it’s important to avoid smoking. It’s also important to have regular check-ups with your doctor and to get treated if you have high blood pressure.
The chemo drug bleomycin can damage the lungs, as can radiation therapy to the chest. This can lead to problems such as shortness of breath, which might not show up until years after treatment. Smoking can also seriously damage the lungs, so it’s important that people who have had these treatments do not smoke.
Special concerns in childhood Hodgkin lymphoma survivors
Just as the treatment of childhood Hodgkin lymphoma requires a very specialized approach, so does follow-up and monitoring for late effects of treatment. Careful follow-up after treatment is very important. The earlier problems are found, the more likely it is they can be treated effectively.
Along with physical side effects (including those listed above), survivors of childhood lymphoma may have emotional or psychological issues. They also may have some problems with normal functioning and school work. These can often be addressed with support and encouragement. Doctors and other members of the health care team can also often recommend special support programs and services to help children after treatment.
To help increase awareness of late effects and improve follow-up care for childhood cancer survivors throughout their lives, the Children’s Oncology Group (COG) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines can help you know what to watch for, what types of health screening should be done, and how late effects may be treated.
It’s very important to discuss possible long-term complications with your child’s health care team, and to make sure there is a plan in place to watch for these problems and treat them, if needed. To learn more, ask your child’s doctors about the COG survivor guidelines. You can also download them for free on the COG website: www.survivorshipguidelines.org. The guidelines are written for health care professionals. Patient versions of some of the guidelines are available (as Health Links) on the site as well, but we urge you to discuss them with a doctor.
For more about some of the possible long-term effects of treatment, see Children Diagnosed With Cancer: Late Effects of Cancer Treatment.
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Children’s Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers. 2014. Accessed at www.survivorshipguidelines.org on April 20, 2016.
Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
National Cancer Institute. Physician Data Query (PDQ). Childhood Hodgkin Lymphoma Treatment. 2016. Accessed at www.cancer.gov/types/lymphoma/hp/child-hodgkin-treatment-pdq on April 20, 2016.
Younes A, Carbone A, Johnson P, Dabaja B, Ansell S, Kuruvilla J. Chapter 102: Hodgkin’s lymphoma. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
Last Medical Review: February 10, 2017 Last Revised: March 30, 2017