Breast Cancer Treatment: Chemotherapy

Chemotherapy refers to the use of anti-cancer drugs to kill cancer cells. The doctor who determines which drugs and in what dosage is known as a medical oncologist. Chemotherapy can be used for three major purposes:

1. Adjuvant therapy: The goal is to prevent or postpone cancer from coming back after the initial surgery and radiation. Even when the cancer seems to be confined to the breast and lymph glands under the arm, there is a chance that cells may have already spread to other areas that cannot be seen. Chemotherapy is given to try and kill these cells.
2. Neo-adjuvant therapy. Sometimes the cancer in the breast is so big that shrinking it first with chemotherapy may make it easier to do surgery.
3. To treat metastatic disease. If the cancer shows up in parts of the body other than the breast and lymph glands under the arm, it is called metastatic disease. Chemotherapy can be one of the main ways to kill cancer cells that have spread to other parts of the body, and help woman live longer with good quality of life.When to start chemotherapy, what drugs to use, and what side effects to expect varies from woman to woman. Women should discuss this with their doctors.

Common Chemotherapy Drugs

Some of the most common chemotherapy drugs used to treat breast cancer include the following:

• Anthracyclines: This class of drugs includes doxorubicin (Adriamycin), epirubicin (Ellence), and liposomal doxorubicin (Doxil)
• Taxanes: This class of drugs includes docetaxel (Taxotere), paclitaxel (Taxol), and protein-bound paclitaxel (Abraxane)
• Cyclophosphamide (Cytoxan)
• Capecitabine (Xeloda) and 5 fluorouracil (5 FU)
• Vinorelbine (Navelbine)
• Gemcitabine (Gemzar)
• Trastuzumab (Herceptin): This drug is only of use in women whose cancers have the Her2 gene

They are usually given in 2-4 week cycles. In adjuvant and neo-adjuvant settings, they are usually given in combinations of two or more drugs. Single agent (one drug at a time) can be a good choice in treating cancer that has already spread to other areas.

Receiving Chemotherapy

Chemotherapy is given either by mouth or injected into a vein daily, weekly or every 2-4 weeks. Your treatment plan is designed for your particular condition. It may vary greatly from someone else you know who had chemotherapy. For example, while some women stay in the hospital overnight to receive chemotherapy intravenously, others receive chemotherapy for an hour once a day for a week in their doctor's office. Some patients receive chemotherapy in pill form.

Sometimes, if a person's veins are hard to find, it can help to place something called a "port-a-cath" (completely covered with skin and requires no care) or a "Hickman" catheter (hangs outside the chest and must be cleaned and flushed) in a large vein. These devices are inserted by a surgeon or radiologist and have an opening to the skin, allowing chemotherapy medications to be given. They can also be used to administer fluids or take blood samples. The catheters are placed on an outpatient basis using local anesthesia. Once chemotherapy is finished, they can be easily removed.