Im on r-chop and since my 2nd treatment my ankles and feet are swollen all the time. Should I be concerned

Swelling During R-CHOP: What You Should Know

I'm glad you're paying attention to changes in your body during treatment. Ankle and foot swelling (called edema) during R-CHOP is something that definitely warrants a conversation with your care team, as it can have several different causes—some related to treatment, some not.

Why Swelling Can Happen During R-CHOP

R-CHOP is a chemotherapy combination that includes rituximab (an immunotherapy), cyclophosphamide, doxorubicin, vincristine, and prednisone. Swelling in the feet and ankles can occur for several reasons during this treatment:

Treatment-related causes:

• Fluid retention from the prednisone (a steroid that's part of R-CHOP)—steroids commonly cause the body to hold onto salt and water
• Lymphatic system effects—since lymphoma affects your lymphatic system, and R-CHOP is treating it, changes in fluid drainage can occur
• Chemotherapy side effects—some components can affect how your body handles fluids
• Vincristine effects—this drug can sometimes cause peripheral neuropathy (nerve issues) that may be associated with swelling

Other possible causes:

• Infection or inflammation
• Heart or kidney function changes
• Blood clots (rare but serious)
• Nutritional changes

What You Should Do Right Now

Contact your oncology team before your next scheduled appointment. According to the NCCN Guidelines for Patients with Marginal Zone Lymphomas, one of the key questions to ask your care team is: "What side effects should I watch for that could be life-threatening? When should I call my care team?"

This is exactly the kind of situation where you should reach out. Your team needs to know:

1. When did the swelling start? (You mentioned after your 2nd treatment)
2. How severe is it? (Can you press your thumb into the skin and see an indent? Can you still fit into your shoes?)
3. Is it in both feet equally or one more than the other?
4. Any other symptoms? (Pain, redness, warmth, shortness of breath, chest pain, weight gain)
5. Any recent changes in diet, activity level, or other medications?

Questions to Ask Your Oncology Team

Based on NCCN Guidelines recommendations for managing side effects during treatment:

1. "Is this swelling related to my R-CHOP treatment, or should we investigate other causes?"
2. "What can I do to help reduce the swelling?" (elevation, compression stockings, salt restriction, etc.)
3. "Are there any warning signs I should watch for that would mean I need emergency care?"
4. "Should I take any medications to help with this, or avoid any?"
5. "Will this swelling go away after treatment ends, or might it be longer-term?"

What You Can Do in the Meantime

While waiting to talk with your team:

• Elevate your feet when sitting or lying down
• Avoid standing for long periods
• Don't add extra salt to your food
• Stay well-hydrated (unless your doctor told you otherwise)
• Wear comfortable shoes
• Note any changes or worsening

When to Seek Immediate Care

Go to the emergency department or call 911 if you experience:

• Sudden severe swelling in one leg
• Warmth, redness, or pain in the calf
• Chest pain or shortness of breath
• Severe weight gain (more than 2-3 pounds in a day)

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.

Your oncology team has your complete medical picture and can determine what's causing this and the best way to manage it. Don't wait—reach out to them today.