- When chemotherapy is given
- Combination chemotherapy
- How chemotherapy is given
- Side effects
- Early menopause
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The aim of chemotherapy is to do the maximum damage to cancer cells while causing the minimum damage to healthy tissue.
When chemotherapy is given
Chemotherapy is often given after surgery to reduce the risk of breast cancer coming back. This is called adjuvant treatment. Your cancer specialist will explain what the benefits are and what side effects you’re likely to get.
Adjuvant chemotherapy is usually given after surgery when the cancer is:
- has spread to the lymph nodes
- triple negative
- HER2 positive (chemotherapy is often given with Herceptin).
Chemotherapy can also be given to shrink a large cancer before surgery (neo-adjuvant treatment). If it shrinks the cancer successfully, only part of the breast may be removed, avoiding the need for a mastectomy.
Cancer research trials are looking at improving the effectiveness of chemotherapy and how side effects can be reduced. You may be asked to take part in a research trial comparing different types of chemotherapy.
There are many different chemotherapy drugs used to treat breast cancer, and they’re often used in combinations (chemotherapy regimen). Some commonly used combinations are listed below, although other combinations may also be used:
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- FEC – 5FU, - epirubicin and cyclophosphamide
- AC – doxorubicin (Adriamycin®) and cyclophosphamide
- CMF – cyclophosphamide, methotrexate and 5FU
- E-CMF – epirubicin and CMF
- FEC-T – FEC followed by docetaxel (Taxotere®)
Adjuvant chemotherapy usually includes a type of drug called an anthracycline drug, such as epirubicin or doxorubicin. If there’s a higher risk of the cancer coming back, the drug Taxotere is also usually included. Your oncologist may offer you a choice of chemotherapy treatments, as different combinations have different side effects.
How chemotherapy is given
Chemotherapy drugs are given into a vein (intravenously) as injections or drips (infusions) or as tablets to take at home. You’ll usually have your treatment in the chemotherapy day unit.
Intravenous chemotherapy is often given through a small tube (cannula) in your arm. Occasionally, it’s given through a soft plastic tube called a central or PICC line. A central line is put into a vein in your chest under a general or local anaesthetic. If a tube is put into a vein in the bend of your arm, it’s known as a PICC line. Chemotherapy can also be given into an implantable port (portacath), which is a thin, soft plastic tube with a rubber disc (port) at the end. The tube is inserted into a vein until its tip sits just above your heart and the port lies under the skin on your upper chest.
Chemotherapy into the vein is given as a session of treatment, usually over a few hours. This is followed by a rest period of a few weeks, which allows your body to recover from any side effects of treatment.
Chemotherapy is given as a series of treatments called cycles. You may have drugs weekly or every three weeks and the complete treatment may take several months. Your doctor or nurse will explain how many cycles of treatment are planned for you and how you’ll be given your chemotherapy.
Chemotherapy drugs can cause unpleasant side effects, but these can usually be well controlled with medicines. The side effects you experience will depend on the drugs you are given, but they may include:
- increased risk of infection
- bruising and bleeding
- feeling sick (nausea)
- hair loss
- poor appetite
- taste changes
- sore mouth
- numbness or tingling in hands or feet
- allergic reaction
- risk of blood clots
Everyone is different and will react to chemotherapy treatment in a different way. Some people may have very few side effects while others will have a lot. Almost all side effects are only short-term and will gradually disappear once the treatment has stopped.
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You'll find more detailed information on chemotherapy side effects here. We also have information to help you manage the side effects here and of cancer treatment in our 'Living with and after cancer' section. here
It’s not advisable to become pregnant while having chemotherapy, as the drugs may harm an unborn baby. It’s important to use effective contraception during your treatment.
You’re usually advised to use condoms if you have sex within the first 48 hours after chemotherapy. Although it’s not proven, it may be possible that a small amount of the drug could pass into vaginal fluid, which could harm your partner.
Younger women may find that chemotherapy brings on an early menopause, which can be difficult to deal with. We have more information in our section on breast cancer and menopausal symptoms
If chemotherapy is likely to make you infertile and you want to have children, it’s important to discuss this with your doctor before treatment begins. You can read more in our section about infertility.