Side effects of chemotherapy

Many different drugs are used to treat non-Hodgkin lymphoma (NHL). You might have a combination of drugs or a single drug. Your nurse or doctor will give you written information about the drugs you are having.

All chemotherapy drugs have side effects. But the drugs affect people in different ways. Some people have very few side effects. Your doctor or nurse can't tell how you will react until you have had a particular drug. The side effects you get depend on:

  • which drugs you have
  • how much of each drug you have
  • your own individual reaction to the treatment

Most of the side effects are temporary. They gradually go away when the treatment is finished. There are lots of ways your doctor and nurse can help you manage any side effects you do have. A few side effects are possibly long term. 

Common side effects

Some side effects are common to many chemotherapy drugs.

Chemotherapy drugs often stop the bone marrow from making enough blood cells.

Feeling or being sick can be severe. It can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You may need to try different anti sickness medicines to find one that works.

Contact your doctor or nurse straight away if you’ve been sick more than once in a day.

Tips

  • Avoid eating or preparing food when you feel sick.
  • Avoid fried foods, fatty foods or foods with a strong smell.
  • Drink plenty of liquid to stop you from getting dehydrated.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Fizzy drinks help some people when they are feeling sick.

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

Your mouth might become sore a few days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.        

Your nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.

Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.

Tips

  • Clean your mouth and teeth gently, use a soft bristled toothbrush.
  • Avoid mouthwashes that contain alcohol.
  • Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
  • Moisten meals with gravies and sauces to make swallowing easier.
  • Eating fresh or tinned pineapple can keep your mouth fresh and moist.
  • Avoid acidic fruits such as oranges, grapefruit or lemons.

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.

Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.

Tips

  • Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
  • You could choose a wig for a whole new look.
  • Think about having your hair cut short before your treatment starts.
  • Some people shave their hair off completely so they don't have to cope with their hair falling out.
  • Wear a hairnet at night so you won't wake up with hair all over your pillow.

You are likely to feel very tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy.

After a while you may need to sleep for some time during the day. Rest when you need to.

Tiredness gets better once you finish treatment but it can carry on for some months or years.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Not all of these side effects happen with every drug. You can ask your doctor or nurse which side effects are most common with the chemotherapy drugs you have. You can also find out what the possible side effects of each drug are in our chemotherapy drugs section for non-Hodgkin lymphoma.

Possible long term side effects

Chemotherapy can sometimes cause permanent side effects. 

Your doctors try to choose drugs that cause as few permanent effects as possible. But they will balance this with the importance of successfully treating your non-Hodgkin lymphoma. The possible long term side effects of NHL chemotherapy treatment include infertility, second cancers and heart disease

Infertility

Unfortunately some chemotherapy drugs doctors use to treat non-Hodgkin lymphoma can stop you being able to get pregnant or father a child afterwards. This is called infertility. It is difficult for doctors to say for sure whether this will happen to you. It depends on:

  • the chemotherapy drugs you are having
  • the total dose of the drugs
  • your age if you are a woman

Sometimes men and teenage boys can store sperm before they start their chemotherapy. This is called sperm banking.

For women, chemotherapy can cause an early menopause. Doctors can treat this with hormone replacement therapy. You might also be able to have embryos or eggs frozen so that you can try to have a baby in the future.

Second cancers

There is a chance that your treatment can increase the risk of getting another type of cancer in the future. This is because both chemotherapy drugs and radiotherapy work by damaging cells. They kill the lymphoma cells, but they can damage healthy cells too.

Doctors don't know whether this increased risk of cancer in the future is only because of treatment. People who get lymphoma have a slightly increased risk of getting another cancer anyway.

The lymphoma is an immediate risk to your health. So your doctors have to balance the risks and benefits of your treatment. The main concern is your current lymphoma.

Your doctors ask you to go back to the hospital for check ups for many years. They will check your health and watch out for any signs of a second cancer. Along with clinical trials, this long term follow up helps to find the safest treatments for you and for people with non-Hodgkin lymphoma in the future.

Heart disease

Some drugs for lymphoma can cause heart problems. This is also true of radiotherapy to the heart area. You might have a slightly increased risk of getting heart problems in the future.

Your doctors try their best to treat your lymphoma while keeping down the long term risks as much as they can.

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to:

  • improve treatment
  • make existing treatments better
  • develop new treatments
For support and information, you can call the Cancer Research UK information nurses. They can give advice about who can help you and what kind of support is available. Freephone: 0808 800 4040 - Monday to Friday, 9am to 5pm.
Last reviewed: 
23 Dec 2020
Next review due: 
23 Dec 2023
  • Electronic medicines compendium (Accessed December 2020) 

  • Long-term ovarian function in women treated with CHOP or CHOP plus etoposide for aggressive lymphoma

    J Meissner and others (2015) 

    Annals of oncology, Vol 26, No 8, pages 1771-1776

  • Therapeutic radiation for lymphoma and risk of second primary malignant mesothelioma

    E Chang and others (2017) 

    Cancer causes and control Volume 28, Issue 9, pp 971–979

  • Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk

    F Van Nimwegen and others (2015)

    JAMA internal medicine Vol 175, No 6, pages 1007-17

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