Chemotherapy uses medicine to kill cancer cells. For breast cancer treatment, it has three major purposes:
- To prevent cancer from coming back after surgery and radiation. When chemotherapy is used this way, it’s called adjuvant therapy.
- To shrink a tumor before surgery to make it easier to remove. This is called neo-adjuvant therapy.
- To kill cancer cells that have spread to other parts of the body.
Together, you and your doctor will decide when to start chemotherapy, what drugs to use, and a schedule for taking them. Ask what side effects you can expect from the medication.
Common Chemotherapy Drugs for Breast Cancer
Chemotherapy drugs used to treat early breast cancer include:
- Anthracyclines: This class of drugs includes doxorubicin (Adriamycin) and epirubicin (Ellence).
- Taxanes: This class of drugs includes docetaxel (Taxotere) and paclitaxel (Taxol).
Drugs used to treat advanced breast cancer include:
Choosing a Chemo Combination
Your doctor will probably talk to you about combining different chemo drugs. They may refer to them by abbreviations for their names. Some of the most common include:
- AC: Adriamycin and Cytoxan
- AT: Adriamycin and Taxotere
- CMF: Cytoxan, methotrexate, and fluorouracil
- FAC: Fluorouracil, Adriamycin, and Cytoxan
- CAF: Cytoxan, Adriamycin, and fluorouracil
(FAC and CAF use the same medicines but in different doses and frequencies)
How Do You Get Chemotherapy for Breast Cancer?
You get chemotherapy as a pill or in a vein daily, weekly, or every 2-4 weeks. You may get one drug or a combination of them. Your treatment plan is designed for your particular situation.
If your veins are hard to find, you may get a catheter in a large vein. These devices are inserted by a surgeon or radiologist and have an opening to the skin or a port under the skin, allowing chemotherapy medications to be given. They can also be used to give fluids or take blood samples. Once chemotherapy is finished, your catheter will be removed.
Monitoring Your Treatment
Your doctor will check you regularly to see how your body is handling the chemotherapy. They'll do regular blood tests to count the number of blood cells you have. If you have too few red blood cells, you may get a blood transfusion. If you have too few white blood cells, you could get an injection. If you have too few platelets, which clot blood, you may need a platelet infusion. Your chemotherapy might be postponed until your blood cells or platelets recover.
You may also get imaging scans to see how well the chemotherapy is working.
Short-Term Side Effects of Breast Cancer Chemotherapy
Chemotherapy destroys cancer cells. But it also kills some healthy cells, causing side effects. Medicine can help you feel better. It’s important to tell your doctor if you have any side effects, like:
- Nausea and vomiting
- Loss of appetite
- Mouth soreness
- Hair loss
- Weight gain
- Premature menopause. If you are planning to have children, tell your doctor before starting chemotherapy.
- Lowered resistance to infections
- Increased bleeding. If the platelet count is very low, little red spots may appear on your body. You may bruise or bleed easily.
Long-Term Side Effects of Breast Cancer Chemotherapy
Heart problems, which include:
- Congestive heart failure
- Coronary artery disease
- Arrhythmia, or irregular heartbeat
Lung damage, such as:
- Your lungs don’t work as well.
- The lung lining thickens.
- Your lungs get inflamed.
- You have trouble breathing.
Hormone issues, like:
- Hot flashes
- Lower desire
- Mood shifts
- Bladder control problems
- Fewer or no periods
- Earlier menopause
Bone, joint, and soft tissue damage, which may include:
- Joint pain
Brain and nervous system issues, like:
- Hearing loss
- Damage to brain, spinal cord and peripheral nerves
Thinking problems, which could involve:
- Trouble learning
- Memory problems
- Difficulty paying attention
Oral health issues:
You might have damage to your tooth enamel.
You might not digest food as well.
Chemo can damage bone marrow stem cells, which might lead to cancers like acute leukemia or myelodysplasia.
Working During Chemo Treatment
Most people are able to keep working while being treated with chemo. Ask your doctor to schedule treatments later in the day or right before the weekend, so they don't interfere with a work schedule. You may have to adjust your work hours, especially if you’re having side effects.
How to Recognize a Cancer Emergency
Your doctor and the chemotherapy nurse will let you know what situations would be considered an emergency. But if you have any of the following warning signs, tell your doctor immediately:
- A temperature greater than 100.4 F.
- Any fever and chills. If you can't reach your doctor, go to the emergency room.
- New mouth sores or patches, a swollen tongue, or bleeding gums
- A dry, burning, scratchy, or swollen throat
- A cough that makes mucus
- Needing to pee more, burning when you pee, or blood in your urine
- Heartburn, nausea, vomiting, constipation, or diarrhea that lasts longer than 2 or 3 days
- Blood in your stools