Late effects of lymphoma treatment

Late effects are health problems that develop months or years after treatment. Not everyone gets late effects. Whether or not you develop them depends on many factors. Before you start treatment, your medical team should talk to you about any that might affect you.

On this page

Will I get late effects?

What is the difference between late effects and ongoing side effects?

How can I reduce my risk of late effects?

Heart (cardiovascular) problems

Other (second) cancers

Lung problems

Thyroid function

Reduced fertility

Less common late effects

Frequently asked questions about lymphoma treatment and late effects

Will I get late effects?

Late effects develop months or years after finishing treatment. Whether or not you get them depends on the type of lymphoma you were diagnosed with, the treatment you’ve had, and other individual factors. 

No one can say for certain if you’ll get late effects. Your medical team should talk to you about your individual risk before you start treatment. They can also tell you about any ways that might help to lower your risk of developing late effects.

Once you finish treatment, you and your GP should be given a treatment summary. This outlines what treatment you had – including any late effects it might cause, and any screening tests you might need to check for them. 

Lymphoma-related risk factors

Risk factors to do with the lymphoma include the:

• type of lymphoma
• treatment you have.

In general, people treated for Hodgkin lymphoma have a slightly higher chance of developing late effects than people treated for non-Hodgkin lymphoma. This could be related to age. 

People who are treated in childhood or early adulthood also have a higher risk of developing late effects. 

Treatment-related risk factors

Your doctor should give you information about the risks based on your treatment plan. Risk factors relating to treatment include the:

• type or types of treatment you had
• how much treatment you had.

Stage 3 or 4 (advanced stage) lymphomas usually need more complex treatment than stage 1 or 2 (early stage) lymphomas. This can increase the risk of late effects.

In general, the treatments used today have a lower risk of causing late effects than those used in the past – you can find out more about this in our frequently asked question section.

It's difficult to work out what symptoms I might have had, even without lymphoma and so much treatment over 25 years. I'm 74 now, and I guess age is playing a part. My haematology team are always very responsive to my concerns.

Nuala, treated for lymphoma

Radiotherapy

Late effects of radiotherapy can happen when the treatment area (radiotherapy field) includes important tissues or organs. 

For example, radiotherapy given to the chest could affect the health and functioning of both the heart and the lungs. Radiotherapy given to the neck could affect the thyroid gland.

Chemotherapy

Late effects of chemotherapy depend on which drug or drugs (regimen) you had, as well as the dose. 

In general, high-dose chemotherapy (including that given before a stem cell transplant) can cause more severe late effects than lower-dose treatment. 

Your doctor should give you information about the drugs used in your treatment, including their late effects. 

Targeted treatments and antibody therapy

As many of these treatments are quite new compared to other treatments, scientists and doctors will get more information about them over time. However, in general, it seems that targeted treatments and antibody therapies cause fewer side and late effects – this is probably because they target and attack lymphoma cells more precisely than other treatment types. They therefore damage fewer healthy cells, which means fewer unwanted (side and late) effects of treatment.

Steroids

Taking steroids at a high dose can increase the risk of developing bone problems as a late effect.

Individual risk factors

Individual risk factors include age, lifestyle and genetics can affect your likelihood of getting late effects. For example, in some cases, having a family history of cancer might put you at a higher risk of developing cancer. Having chemotherapy could further slightly increase this risk.  

Age

In general, the risk of late effects is higher for people who have treatment in childhood or young adulthood. Younger people have more years of their life ahead of them – which gives more time for late effects to develop than in someone who is older. 

Lifestyle

Lifestyle factors can heighten or lower your risk of developing late effects. In general, following a healthy lifestyle can help you to live well with and beyond lymphoma. This includes good diet and nutrition, taking exercise, managing stress and getting enough sleep. It is also recommended to limit alcohol intake and not to smoke. Keeping informed about your health can also help you to know when to ask for help from a doctor.

I follow a healthy lifestyle and take regular exercise, but I do get easily tired. My husband and I look after our two grandchildren 4 to 5 days per week, getting them to school in the mornings, taking them to their after-school activities and so on.

Nuala, treated for lymphoma

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What is the difference between late effects and ongoing side effects?

Late effects are different to longer-lasting side effects of lymphoma treatment:

• Side effects start during or soon after treatment, although they might go on for many months or years afterwards. An example of this is fatigue, a type of extreme tiredness that can be physical, mental and emotional.
• Late effects do not start until months or years after treatment finishes.

However, in some pecases, side effects and late effects can cause the same symptoms – for example, extreme tiredness (cancer-related fatigue) or nerve damage (peripheral neuropathy).

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How can I reduce my risk of late effects?

To help reduce the risk of developing late effects, it can help to know signs and symptoms to look out for so that you can seek medical attention if you notice them. This can give a better chance of doctors being able to help you effectively manage or treat them. 

It is important to take up invitations to screening programmes and attend health appointments. In general, follow a healthy lifestyle and keep informed about your health.

Follow-up, screening and a healthy lifestyle

• Keep up-to-date with any health appointments, including follow-up after lymphoma treatment, sight checks and dental appointments.
• Go to any health screening programme appointments you’re offered – if you have had radiotherapy to the breast area before the age of 36, you are likely to be invited for breast screening appointments (which might be an MRI scan with or without a mammogram) sooner and more frequently than if you had not had lymphoma treatment.
• Check with your medical team about any vaccinations you should or shouldn’t have.
• Follow a healthy lifestyle, which includes eating well, taking exercise, not drinking too much alcohol, getting enough rest, and managing stress.
• Protect your skin from the sun, especially if you have had radiotherapy.

Tell any health professional that you’ve had treatment for lymphoma - show them your Treatment Summary - so they have all the necessary information.

Tracy Howe, Lymphoma nurse specialist

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Heart (cardiovascular) problems

Your medical team can give you information about your risk of developing heart problems based on your treatment, and on any individual risk factors.

Some lymphoma treatments can increase the risk of developing heart problems such as:

• Atherosclerosis – where blood vessels carrying blood away from the heart get clogged-up. This can be serious, particularly if it affects blood flow to vital organs (the brain, heart, lungs, kidney or liver).
• Heart (coronary) disease, including angina (where less blood flows to the heart) and heart attack (sudden blockage of the blood to the heart).
• Heart valve disease, where one or more of your heart valves stops working properly – which affects blood flow around the body.
• Heart rhythm problems (arrhythmia), which is where your heart beats too quickly, too slowly or irregularly. Arrhythmia can lead to a number of health problems. You can find out more on the British Heart Foundation website.

You might have a higher risk of developing heart problems after the following treatments:

• Anthracycline chemotherapy drugs, such as doxorubicin – the risk goes up with higher doses and more courses of treatment. Scientists are studying whether medication can be given to help lower this risk – for example, taking statins (cholesterol-lowering drugs).
• Checkpoint inhibitors – a type of targeted treatment.
• Radiotherapy given to the chest – this increases with higher doses of radiotherapy and in people who are treated when they are under 50 years old.
• Stem cell transplant – there is a slightly higher risk of developing a heart condition within the first 10 years after treatment. You might be given medicines to help with heart health, such as tablets to lower blood pressure and to prevent reduced blood flow (angina).

Individual risk factors that can increase your risk of developing heart problems include:

• being over 65 years old
• being very overweight (obese) or very underweight
• too little exercise, smoking, drinking a lot of alcohol
• high blood pressure
• high cholesterol
• diabetes
• family history of heart disease

General signs of heart problems

Your medical team can tell you about signs of heart problems to look out for. Some of the common ones are:

• shortness of breath, especially after doing physical activity
• feeling uncomfortable to lie flat due to difficulty breathing
• an ongoing cough with white, frothy phlegm
• feeling extremely tired
• swollen ankles.

British Heart Foundation has information about heart health, including a publication about understanding your heart health.

Reducing your risk of developing heart problems

Follow a healthy lifestyle to reduce your risk of developing heart problems. This includes eating a healthy diet, taking regular suitable exercise, limiting your alcohol intake and not smoking.

The British Heart Foundation has more information about heart problems. They also offer advice on keeping your heart healthy.

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Other (second) cancers

Lymphoma treatment can increase your risk of going on to develop another cancer type (known as a second cancer) or a different type of lymphoma. However, most people do not go on to develop a second cancer. Second cancers develop due to previous cancer treatment.

Last autumn, I told my haematology team about changes in my bowel function. They arranged tests and a large growth was found, which looked suspiciously like cancer. I had it removed in December - it turned out it wasn't cancer after all, which was a huge relief.

Nuala, treated for lymphoma

Second cancers are different to secondary cancers (metastasis). With secondary cancers, the original (primary) cancer spreads to another part of the body – an example is breast cancer spreading to the lungs.

You can read more about second cancers in our frequently asked questions section.

There are some general tips to help lower your risk of developing a second cancer:

• Ask your medical team about second cancers for which you might be at a higher risk. Find out from them what signs or symptoms to be aware of, so that you can contact them if you notice any.
• Check with your clinical nurse specialist or your GP about cancer screening programmes – these can help to find cancers early. As someone who has been diagnosed with lymphoma, you might be advised to have some screening checks sooner or more frequently than someone who has not had lymphoma.
• If you have had radiotherapy, check your skin in the treated area for changes. The British Association of Dermatologists has information on how to reduce the risk of a second skin cancer.
• Follow a healthy lifestyle to help reduce your risk of health problems in general, including cancers.

Find out more about reducing your risk of cancer on Cancer Research UK’s website. 

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Lung problems

Some lymphoma treatments can cause scarring of your lungs (pulmonary fibrosis). This includes:

• radiotherapy to the chest
• bleomycin (a chemotherapy drug)
• rituximab (a targeted treatment). 

Lung damage can be seen on X-rays or scans of the lungs. Depending on the treatment you’ve had, you might have scans to check for such damage. More severe damage can cause symptoms such as shortness of breath.

Pulmonary fibrosis can affect the type and amount of physical activity you’re able to do – your medical team can refer you to a respiratory specialist, who can give you advice about exercise that is safe and suitable for you. You are also likely to be advised to have the annual flu and COVID-19 vaccination. 

Reducing your risk of developing lung problems

Ask your medical team what you can do to help lower your risk of developing lung problems. In general, the recommendations are to:

• follow a healthy lifestyle – it’s particularly important not to smoke.
• tell any health professionals who treat you what lymphoma treatment you’ve had – for example, if you have any surgery in the future, tell the anaesthetist beforehand, so that they can take any necessary precautions.
• check with your doctors about any activities you should not do. For example, scuba diving could increase your risk of developing lung problems.
• have any vaccinations as advised by your medical team.

I'm affected by breathlessness. My GP has checked my heart and it is functioning normally. My haematology team has ordered a lung function test. As I have been prone to chest infections, I am going to ask them if I can also have a chest X-ray, in case I have an infection.

Nuala, treated for lymphoma

Hormone problems

Lymphoma treatment can cause changes to hormones that affect metabolism, the body’s response to stress and reproduction. You might therefore be affected by:

• problems with thyroid function
• reduced fertility
• reduced bone health.

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Thyroid function

The thyroid gland makes thyroxine, a hormone that controls how your body uses energy.

Some lymphoma treatments can cause you to develop an underactive thyroid (hypothyroidism) – where your thyroid gland makes less thyroxine than it should. Hypothyroidism can make you feel tired, constipated and more sensitive to the cold than usual. You might also gain weight easily. 

The treatments that could cause hypothyroidism include:

• radiotherapy to the neck or upper chest
• some chemotherapy drugs
• some targeted therapies. 

Your doctor can give you advice about your risk depending on your treatment.

The risk of developing hypothyroidism is at its highest in the first 5 years after lymphoma treatment. It stays higher after this time compared to if you had not ever had treatment.

Hypothyroidism is diagnosed by a blood test and is easily treated with thyroxine tablets. You might be offered regular blood tests to keep check on your thyroid functioning. 

If you think you have symptoms of thyroid problems and you’re no longer having follow-up appointments, speak to your GP about your concerns.

British Thyroid Foundation has more information about hypothyroidism.

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Reduced fertility

Some lymphoma treatments can affect reproductive organs. This can happen with:

• chemotherapy
• radiotherapy given to your tummy area (abdomen)
• radiotherapy given to the area below your belly button (pelvis).

Less is known about the effects of targeted treatments. 

We have separate information about reduced fertility, including fertility preservation options.

Bone health

Lymphoma treatment can make your bones become weak and thin (osteoporosis). This can make them more likely to fracture or break.

Treatments that could affect your bone health in this way include:

• some types of chemotherapy – this could be as a direct effect of the drugs themselves, or by the drugs causing a lowering in the level of sex hormones (oestrogen or testosterone), which can affect bone strength
• radiotherapy, in the area or areas of the body treated with radiation
• steroids taken at a high dose.

In children and young people, lymphoma treatment can also affect bone growth. We have a separate section on our website with more information about lymphoma in children and young people.

To maintain bone health, it’s important not to smoke and to limit alcohol intake to within recommended levels. Eat a healthy diet with plenty of calcium and vitamin D, keep to a healthy weight. Weight-bearing exercises are also important in keeping your bones strong.

Tracy Howe, Lymphoma nurse specialist

The Royal Osteoporosis Society has information about bone health, including recommendations for exercises for bones.

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Less common late effects

There are some other, less common late effects of lymphoma treatment, which we outline below. Talk to your medical team about any risks of which you should be aware.

Eye problems 

Radiotherapy to the eye or eye socket can cause eye problems such as dryness and cataracts (cloudy patches in the lens of your eye that reduce your vision). 

Have regular eye check-ups and tell your optometrist (optician) what lymphoma treatment you have had.

Dental problems 

Radiotherapy to the head and neck increases your risk of tooth decay. Have regular check-ups with your dentist. Follow their advice to keep your mouth, teeth and gums healthy.

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Frequently asked questions about lymphoma treatment and late effects

Below, we answer some frequently asked questions about lymphoma treatment and late effects. Speak to your medical team about advice specific to your situation.

Will I get late effects?

Although it’s not possible to say for certain if, how and when you might get late effects, your medical team can give you information about your risks. They base this on the treatment you’ve had, your age, general health and any other risk factors.

What’s the difference between late effects and ongoing side effects?

Late effects are different to longer-lasting side effects of lymphoma treatment:

• Side effects start during or soon after treatment, although they might go on for many months or years afterwards. An example of this is fatigue, a type of extreme tiredness that can be physical, mental and emotional.
• Late effects do not start until months or years after treatment finishes.

However, in some cases, side effects and late effects can cause the same symptoms – for example, extreme tiredness (cancer-related fatigue) or nerve damage (peripheral neuropathy).

Am I more likely to develop a different type of cancer (second cancer) after lymphoma?

Your medical team should talk to you about any increased risks of getting a second cancer.

In general the risk of a second cancer is higher in people treated for Hodgkin lymphoma than those treated for non-Hodgkin lymphoma. This can be because:

• treatments for some non-Hodgkin lymphomas (such as low-grade non-Hodgkin lymphoma) can be less intensive than those used to treat Hodgkin lymphomas
• people treated for Hodgkin lymphoma are often younger than people treated for non-Hodgkin lymphoma, which gives more time for another cancer to develop. 

The risk of developing cancer goes up more if you have a family history of cancer.

Chemotherapy

Second cancers that develop as a late effect of chemotherapy include lung, bowel, breast and skin cancer, and the blood cancers myelodysplastic syndromes (MDS) and leukaemia. Some people treated for high-grade lymphoma go on to develop a low-grade lymphoma.

Radiotherapy

With radiotherapy, you have an increased risk of developing another (second) cancer in the parts of your body that were within the treatment area (radiotherapy field).

Targeted treatments

As targeted treatments are all still quite new, more time is needed before scientists can be sure of any links to second cancers.

Are late effects less common with treatments used now compared to in the past?

Lymphoma treatments used now generally damage fewer healthy cells in your body, which causes fewer side and late effects. 

• Treatments are now given at a lower intensity than they used to be – scientists and doctors have worked out that these give outcomes that are as good as when they are given at a higher intensity.
• There are newer treatments such as targeted treatments and antibody therapies, which can more precisely target the lymphoma cells.

How can I manage the emotional impact of the possibility of late effects?

Living with and beyond lymphoma can have a significant emotional impact. You might worry about the possibility of late effects of lymphoma treatment, or about your health more generally. 

One way that can help to manage this is to stay informed about your health – find out from your medical team what you can do to help you stay well. This includes knowing about any signs of late effects to look out for and who to contact if you notice any. 

Remember that we are here to support you – you might be interested in our support services, including our Live your Life self-management programme and our health and wellbeing resources.