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Chemotherapy for Breast Cancer

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Women suffering from breast cancer are advised chemotherapy as a part of their treatment regime. This brings up many questions related to chemotherapy and its possible side effects in the minds of the cancer patients. In this article, we shall discuss some frequently asked queries regarding chemotherapy.

What is Chemotherapy?

Chemotherapy is a therapy that is given to destroy cancer cells. The drugs used are called as cytotoxic or anti-cancer drugs. This treatment is systemic, that means, the entire body is exposed to drugs.

In case of breast cancer, there are many chemotherapy drugs that can be used to treat the patient. Each drug can be used in combination with other drugs and can be given by different methods.

How is Chemotherapy Drug Administered in case of Breast Cancer?

Chemotherapy drugs can be administered in different ways. The most widely used methods in case of breast cancer include:

  • Intravenously
  • Orally

Intravenous Chemotherapy

In case of intravenous chemotherapy the drugs can be given as injections or drips. The most common way is through a cannula in the arm.

At times, one may be given the drugs through a central line put in the vein in the chest under local or general anesthesia. It is also called as skin-tunnelled catheter, and stays in place for months. Gradually, tissue grows around the ‘cuff’ of the catheter, that helps keep it in place. Once the treatment is finished, the catheter will be removed, again under a local anesthetic.

Sometimes it is placed in the bend of the arm, called as a PICC line. The peripherally inserted central catheter (PICC) is also fitted under local anesthetic and covered with a dressing. It is kept in place till the therapy is over. Thus, one will be taught about caring and changing the dressing at home.

Some are given chemotherapy drugs through an implantable port called the portcath. It is a thin, soft tube made of plastic. It is fitted with a rubber disc at the end. This tube is then inserted into the vein, just above the heart. This procedure is carried out in the operating theatre under the guidance of a surgeon. A special needle is used to insert the drugs into the portcath. This is because; the portcath is hidden under the chest, and not visible like the central line or PICC.

Oral Chemotherapy

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As indicated by the name, these chemotherapy drugs are to be taken as tablets or capsules by mouth. This type of therapy is usually given as a part of home treatment. It is very important that one understands the instructions regarding their intake from the nurse. Read the instructions carefully printed on the medication box. If you have any doubts clear them before taking the drug. Nausea or vomiting experienced after taking the drugs should be brought to the immediate notice of the doctor.

When Is Chemotherapy Advised for Breast Cancer?

Chemotherapy may be advised under several situations. It can be recommended in the following cases:

Neoadjuvant chemotherapy

It is given before a surgery to help shrink large cancers, so that they can easily be removed.

Adjuvant Chemotherapy

This type of chemotherapy is advised to remove any traces of cancer cells left behind after a surgery. This helps in reducing the risk of relapse after mastectomy. Some undetected cancer cells that may break away and spread through the bloodstream can be targeted using adjuvant chemotherapy. This will help in killing these cancer cells and prevent cancer from appearing elsewhere in the body.

Palliative Chemotherapy

This type of therapy is used to control cancer that has spread to the lymph nodes and other organs. This chemotherapy cannot cure cancer, but controls the further spreading of the cancer.

Chemotherapy Drugs for Primary and Secondary Breast Cancer

Some of the drugs used in the treatment of early and locally advanced cancer of the breast include:

  • Cyclophosphamide (C)
  • Docetaxel (T)
  • Doxorubicin (A)
  • Epirubicin (E)
  • 5-Fluorouracil (5FU or F)
  • Methotrexate (M)
  • Paclitaxel (T)

A times chemotherapy drugs can be given in combination to treat cancer. Some of the combinations of the chemotherapy drugs are mentioned below:

  • AC
  • TAC
  • TC
  • CMF
  • TCH
  • ACTH

Some of the drugs used for metastatic breast cancer, that is, cancer that has spread to other organs include:

  • Capecitabine
  • Carboplatin
  • Cisplatin
  • Cyclophosphamide (C)
  • Docetaxel (T)
  • Doxorubicin (A)
  • Epirubicin (E)
  • Eribulin mesylate
  • 5-Fluorouracil (5FU or F)
  • Gemcitabine
  • Ixabepilone
  • Liposomal doxorubicin
  • Methotrexate (M)
  • Paclitaxel (T)
  • Paclitaxel, albumin bound
  • Vinorelbine

What are the Side Effects Related to Chemotherapy?

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Chemotherapy comes with a set of side effects. However, these side effects can be controlled with the help of other drugs. Some of the side effects include:

  • Hair loss
  • Ulcers in mouth
  • Loss of appetite/ increase in appetite
  • Nausea
  • Vomiting
  • Low RBC count
  • Increase in infections due to low WBC count
  • Easy bruising
  • Bleeding
  • Fatigue
  • Premature menopause or change in menstrual cycle
  • Numbness, pain, burning or tingling sensation in the extremities
  • Sensitivity to cold and heat
  • Damage to heart
  • Irritation of palms and soles (Hand-foot syndrome)
  • Increased risk of developing leukemia
  • Infertility

The severity and duration of side effects depend individual to individual. Some women experience the worst of the symptoms, some suffer from very few of these side effects.

How does one Asses if the Chemotherapy is Working?

After completion of chemotherapy, the doctor will schedule follow-up. These follow-ups will include many tests and procedures to check if the patient is cancer-free. These include:

  • Physical examination
  • Checking for any signs or symptoms of cancer
  • Mammogram
  • Bone density testing
  • Tumor marker tests
  • Liver function test

Can One Think About Pregnancy During Chemotherapy?

Women who are menstruating can get pregnant when on chemotherapy. However, the drugs will be given only between 3rd and 9th month. This is because during the first trimester the fetus grows quickly and can be affected by the chemotherapy drugs.

Chemotherapy is safe only during the second and third trimester. Thus, make sure you tell your doctor you are pregnant, before you begin with the therapy. Also, one can plan a pregnancy after about 2 years of chemotherapy. This is because in some cases, one needs to proceed with caution before they get pregnant. In all cases, make sure you speak to the doctor, before taking any step further.

Can One Use Oral Contraceptives during Chemotherapy?

Oral contraceptives are okay to use in some women. However, oral contraceptives should be avoided when on chemotherapy. One can use a condom or diaphragm as a contraceptive method. Speak to your cancer specialist regarding oral contraceptives, before popping one.

Chemotherapy for breast cancer helps in killing all cancer cells and removing any traces of  cancer from the body. However, there are many side effects related to chemotherapy, like infertility and premature menopause. Thus, make sure you speak to your doctor regarding all aspects of chemotherapy, before you start this treatment regime.

Written by: Saptakee sengupta
Date last updated: February 02, 2015