Chemotherapy

What is chemotherapy?

• Chemotherapy is the use of drugs to destroy cancer cells, particularly those that have spread to areas other than the area of the primary breast cancer.
• If given after surgery to kill any remaining cancer cells in the body, it is called adjuvant chemotherapy.
• If given before surgery to shrink the tumor before removal, it is called neoadjuvant chemotherapy.
• For the tumors that have spread and cannot be removed by surgery, chemotherapy may be the main type of treatment.
• The drugs used in chemotherapy are called cytotoxic drugs because they kill cells. Most work by interfering with the growth and division of cancer cells. Several different types of cytotoxic agents are used to treat breast cancer. The best results are usually obtained when several drugs are used together, which is known as combination chemotherapy.
• Chemotherapy drugs affect both healthy and cancer cells. When healthy cells are affected, you may experience side effects. Learn about these side effects and how to manage them.

How is chemotherapy given?

• Chemotherapy is given in cycles, with breaks between cycles to help reduce side effects. The rests also allow the cells in normal tissues, and the patient, to recover. The number of cycles depends on the type of cancer you have and how well it is responding to the drugs.
• Chemotherapy regimens for breast cancer usually consist of four to eight cycles, with each cycle ranging in length from 14 to 28 days. You may not receive chemotherapy on every day of a cycle and you may not always receive the same drug or drugs on treatment days. Your doctor will determine what drug or combination of drugs is the most appropriate for you by considering your type and stage of breast cancer, previous treatments, other illnesses, and the possible side effects of the therapy.
• Sometimes chemotherapy is given at a clinic or hospital over a period of several hours, so you will need to make arrangements to get to your scheduled appointments. Depending on the type of chemotherapy that you receive, you may be given "premedications" (medications given before the chemotherapy) in order to prevent certain side effects. You may also have to receive intravenous fluids before or after the chemotherapy.
• The drugs used for chemotherapy come in different forms and may be given directly into a vein (intravenous) or a muscle (intramuscular) or taken by mouth. Some of the drugs must be given in the doctor's office or clinic while others can be taken at home. Some chemotherapy needs to be given in the hospital to allow for special monitoring of both the treatment and side effects.

What to expect with chemotherapy

Chemotherapy drugs circulate throughout the whole body and affect both healthy and cancer cells. When healthy cells are affected, you may experience side effects. The specific side effects depend upon which drugs and regimens are used.

Common side effects may include hair loss, nausea, vomiting, diarrhea, a tingling or numbing sensation of the hands and feet, temporary or permanent loss of menstruation, blisters or sores in the mouth and throat, and a feeling of tiredness.

More serious side effects include lowered blood counts, reduced ability of the blood to clot, an increased risk of infection, and heart or lung disorders. You may need to receive other medications to treat or prevent these serious side effects.

Some side effects occur temporarily or are more noticeable at the start of treatment. Many of the side effects disappear when the drugs are stopped.

Learn more about these side effects of chemotherapy and how to manage them:

• Nausea and vomiting
• Hair loss
• Fatigue
• Dry skin and weak nails
• Possible reduction in fertility

Nausea and vomiting

Nausea and vomiting are sometimes experienced during the course of chemotherapy. Very mild nausea may just be a nuisance to you. More bothersome, treatment-related nausea and vomiting can often be controlled or minimized with specific medications, including anti-nausea medications and anti-acid medications to help with heartburn. Tell your doctor if you experience nausea or vomiting at any time during your treatment.

Some tips for managing nausea and vomiting:

• Choose bland foods, like toast, clear broth, or yogurt.
• Avoid greasy foods and foods with strong tastes or smells.
• Eat small meals frequently during the day rather than three large meals.
• Rest after meals to help digestion.
• Refrain from eating one or two hours before treatment if you find that it makes you nauseous.
• After vomiting, try drinking small amounts of water or clear broth. If those stay down, try other liquids or soft foods.

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Hair loss

Ask your doctor or nurse if your particular chemotherapy will likely make your hair fall out. If your chemotherapy is likely to cause hair loss, there are things you can do to prepare yourself ahead of time:

• Cut your hair short before you start treatment. Short hair is easier to style and can help you adjust to losing your hair.
• Use mild shampoos and soft hairbrushes to protect your hair as it starts to thin. If you plan to wear a wig and want it to match your natural hair color, shop for it before your hair falls out.
• Invest in comfortable cotton or terry cloth turbans, scarves, or caps.
• Consider wearing makeup and earrings to draw attention to your face.

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Fatigue

Chemotherapy-related fatigue can be physically, emotionally, and mentally draining and have a major impact on many areas of your daily routine as well as your relationships and general sense of well-being. You may experience fatigue in the following ways:

• Feeling "wiped out," even after getting plenty of rest
• Having a hard time concentrating or thinking clearly

Treatment-related fatigue may be related to anemia, a manageable condition that occurs when your red blood cell count is low. The key to managing fatigue is to be aware of your energy levels and to pace yourself accordingly.

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Dry skin and weak nails

Chemotherapy reduces the amount of oil your glands secrete and can affect your skin's natural moisture. Using moisturizer more frequently, or using a heavier-weight moisturizer, can help. During the day, use a product with sunscreen to protect your skin from the sun. Using a moisturizing soap may also be helpful.

With some types of chemotherapy, your nails may change their color or shape and become more brittle. The area around the nail bed may become dry, and your cuticles may fray. It's important to keep the area around the nails clean to avoid infection. Do not manually remove loose cuticles. Cut them carefully with clean nail scissors.

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Possible reduction in fertility

If you wish to become pregnant in the future, and your doctor believes chemotherapy may put you into early menopause, you may be able to preserve your fertility by having some eggs removed prior to treatment. Your eggs can be frozen or fertilized in a laboratory and then frozen in the embryonic stage for later use. If you would like to have a baby in the future, make sure everyone on your medical team is aware of your plans.

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