The Furry Monkey

CHOP

So, you've been told you'll be having the CHOP regimen. Sounds weird! What does it mean? What will it do? How will you know it is working? All sorts of questions, and hopefully, here are some of the answers for you.

Chemotherapy for Non-Hodgkin's Lymphoma usually consists of several drugs given together, called combination chemotherapy. Combinations are used because different drugs damage or kill cancer cells in different ways. This provides a better mechanism for killing more tumour cells because using the drugs together (syngergism) rather than individually, may help them work better. In addition, drugs added together in lower doses, help reduce the likelihood of side effects without reducing the overall amount of effective chemotherapy.

For e.g., the combination CHOP is currently considered standard therapy and uses drugs with smaller amounts of toxicity while sustaining a full capacity to destroy Non-Hodgkin's Lymphoma.

A chemotherapy regimen is a combination of anticancer drugs given at a certain dose in specific sequence according to a strict schedule.

CHOP is an abbreviation for the following drugs.

Cyclophosphamide

Doxorubicin or Hydroxydaunorubicin

Vincristine

Prednisolone

You will see your doctor regularly whilst you have this treatment so that they can monitor the side effects of the chemotherapy. ALWAYS discuss any worries you have with your Doctor. They are there to help you and cam make some of the side effects less traumatic.

Here you will find information about the individual drugs, what they look like, how it is given to you, and possible side effects. Not everyone gets all the side effects, however I seem to have had most of them, and even one which is not a known side effect, but when I had it after each chemo session it was decided by the hospital that it was a related side effect!

CYCLOPHOSPHAMIDE (ENDOXANA) - C

What does it look like?
It is a clear fluid and is dissolved from powder. It is available as pink or white tablets.

How will it be given to me?
It can be given as an injection into the vein (either through a cannular or through a PICC or Hickman Line), or by mouth in tablet form.

What side effects may I get?
Nausea and vomiting - (there are now very effective drugs given to prevent or reduce nausea and vomiting).
Reduction in bone marrow function - which can result in anaemia, risk of bruising or bleeding and infection. Your lowest point is 10-14 days after chemo, this then steadily increases and returns to normal within 21 days. Just in time to be zapped with the next dose of chemo usually.
Loss of appetite - the steroids you are given to take at home after your chemo sessions are designed to increase your appetite. What is taken away with one drug is replaced with another.
Hair Loss - usually starts 3-4 weeks after the first dose of this drug. It may be lost completely or just thin. Be prepared with wigs or hats and scarves if you think this may bother you. It appears to worry other people more than patients as most just stare or keep looking. If you make eye contact, they quickly stop this for a while so I've found! Staring is rude and I don't like it!!!
Irritation of the bladder - it is healthy to drink lots of plain water in your daily diet, continue this!
Fertility - you should have discussed this with your doctor prior to starting the CHOP treatment. There are options available to you.
Contraception - it is not advisable to become pregnant or father a child whilst taking this drug as it may harm the developing foetus.

Less common side effects:
Temporary live function change, which will return to normal once treatment is finished.
Mouth sores and ulcers.
Diarrhoea.
Changes in nails.
Skin changes.
Changes to lung tissue.
Second cancer.
Changes in your heart function.
Some people experience hot flushes, a strange taste in the mouth, dizziness and a feeling of a blocked nose when the drug is given. Mention this to the nurse/doctor and they can adjust the drip to reduce the feelings for you.

DOXORUBICIN HYDROCHLORIDE (ADRIAMYCIN) - H

What does it look like?
This one is fun, it is red! If given through a PICC line it looks like Irn-Bru!

How will it be given to me?
It can be given as an injection into the vein (either through a cannular or through a PICC or Hickman Line), or by mouth in tablet form.

What side effects may I get?
Nausea and vomiting - (there are now very effective drugs given to prevent or reduce nausea and vomiting).
Hair Loss - usually starts 3-4 weeks after the first dose of this drug. It may be lost completely or just thin. Be prepared with wigs or hats and scarves if you think this may bother you. It appears to worry other people more than patients as most just stare or keep looking. If you make eye contact, they quickly stop this for a while so I've found! Staring is rude and I don't like it!!!
Reduction in bone marrow function - which can result in anaemia, risk of bruising or bleeding and infection. Your lowest point is 10-14 days after chemo, this then steadily increases and returns to normal within 21 days. Just in time to be zapped with the next dose of chemo usually.
Mouth sores and ulcers - the hospital can prescribe medicenes to help you care for your mouth, or if you have a nice friendly dentist ask for their advice.
Skin changes - your skin may darken. Also the day after your chemo you may notice redness on your face.
Fertility and contraception - as above.
Sensitivity to the sun - avoid the sun if possibe, or wear a high protection factor suncream.

Less common side effects:
Heart function
Diarrhoea
Skin changes
Changes in nails
Fever and chills
If you notice any stinging or a burning sensation around the vein whilst receiving this drug, let the nurse or doctor know, also if the area around the injection site becomes red or swollen. You may experience hot flushes when this drug is being given.

VINCRISTINE (ONCOVIN) - O

What does it look like?
It is a clear fluid which has been dissolved from powder form.

How will it be given to me?
It can be given as an injection into the vein (either through a cannular or through a PICC or Hickman Line), or by mouth in tablet form.

What side effects may I get?
Abdominal cramps - drink plenty of fluids, eat lots of fibre and if possible take gentle exercise. If you feel you need help with your digestion, speak to your Doctor who can prescribe medicine to help you.
Fertility and contraception - as above.
Numbness or tingling in the hands and feet - this is vincristine affecting your nerve endings. Tell your doctor if you notice these symptoms.
Fertility and contraception - as above.
Less common side effects:
Hair Loss - usually starts 3-4 weeks after the first dose of this drug. It may be lost completely or just thin. Be prepared with wigs or hats and scarves if you think this may bother you. It appears to worry other people more than patients as most just stare or keep looking. If you make eye contact, they quickly stop this for a while so I've found! Staring is rude and I don't like it!!!
Reduction in bone marrow function - which can result in anaemia, risk of bruising or bleeding and infection. Your lowest point is 10-14 days after chemo, this then steadily increases and returns to normal within 21 days. Just in time to be zapped with the next dose of chemo usually.
Changes in Taste - speak to your nurse or doctor for advice.

PREDNISOLONE TABLETS - P

What does it look like?
It is a clear fluid which has been dissolved from powder form.

How will it be given to me?
It can be given as an injection into the vein (either through a cannular or through a PICC or Hickman Line), or by mouth in tablet form.

What side effects may I get?
Stomach lining irritation - more stomach acid is produced by taking steroids and it can also lower the production of protective stomach mucus. Try taking your tablets with milk - I found this helped me for a while. Although at the moment, indigestion is chronic which I've never really experienced in my life before.
Blood sugar level changes - you may be asked to test your urine for sugar. Tell the doctor if you get very thirsty or are passing more urine than normal.
Fluid retention - your fingers and ankles may swell. You may also feel bloated in your stomach.
Increased appetite - see I told you - it makes you feel hungrier.
Increased risk of infection and slow healing of injuries - tell your doctor if you notice signs of infection or if cuts take longer to heal than normal.
Menstrual changes - women may find that their periods stop or become irregular.
Behaviour changes - mood swings, anxiety, sleeplessness, irritability. I always take my steriods with cereals and milk to aid digestion, this doesn't help with my sleeplessness though!
Less common side effects:
Changes to your eyes - may occur with long term use. Also an increased risk of eye infections.
Muscle wasting - may occur with very long term use.
Cushing's Syndrome - may occur with long term use - can cause acne, puffiness in face, marks on the skin and facial hair on women. Discuss with your doctor if you are experiencing any of these symptoms.
Osteoporosis - may occur with very long term use. Calcium can be lost from your bones resulting in pain and increased risk of fractures and breakages, and loss of height.

Whilst you are taking CHOP drugs, or indeed any drugs, please alert your doctor of any side effects or problems you are experiencing, they will be able to help you or at least minimise some of the side effects.

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