Chemotherapy drugs are a specific class of medications called cytotoxic agents, designed to kill cancer cells. Cancer cells grow faster than regular cells. These drugs disrupt the growth of fast-growing cells, leaving slower growing cells generally unharmed.
Some chemotherapy or “chemo” drugs damage the genetic material of the cells, while others interfere with the way the cells divide. Unfortunately, some also affect other fast-growing cells in the body, such as hair, blood cells, and cells in the stomach lining and mouth. This accounts for some of the more common side effects.
Not all those diagnosed with breast cancer will need chemotherapy. Cancer can often be effectively treated with local therapies like surgery and radiation, and no systemic treatment is necessary.
Those who are diagnosed with larger tumors, whose cells have spread to nearby lymph nodes, may find themselves facing a few rounds of chemo. In these cases, chemo is used “adjuvantly,” or to prevent cancer from returning after the tumor has been removed.
Women diagnosed with some stage 3 cancers and larger tumors may go straight to systemic treatment before turning to surgery. This is called neoadjuvent treatment. While the idea of chemotherapy may strike terror in your mind, there have been significant improvements in controlling side effects. Going through chemotherapy is much easier than it used to be.
In cases of early-stage cancer, an oncologist can make an informed decision about which drugs are best to use. A patient’s age, the stage of the cancer, and other health problems will all be taken into consideration before deciding on a chemo regimen.
These drugs will be injected into a vein, either at your doctor’s office or at a hospital. Locations that provide chemotherapy injections are often called “infusion centers.”
You may need a port implanted if you have weak veins or are being given a more corrosive drug. A port is a device that is surgically placed in your chest that allows for easy needle access. The port can be removed when therapy is finished.
Typically, a patient is given several drugs, often called a regimen. Regimens are designed to attack the cancer at different stages of growth and in different ways. Your chemo drugs will be given on a regular schedule in doses called “rounds.” According to the American Cancer Society, the most common drugs used for breast cancer today are:
- CAF (or FAC): cyclophosphamide (Cytoxon), doxorubicin (Adriamycin), and 5-FU
- TAC: docetaxel (Taxotere), doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan)
- AC → T: doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan) followed by paclitaxel (Taxol) or docetaxel (Taxotere)
- FEC: → T, 5-FU, epirubicin (Ellance), and cyclophosphamide (Cytoxan) followed by docetaxel (Taxotere) or paclitaxel (Taxol)
- TC: docetaxel (Taxotere) and cyclophosphamide (Cytoxan)
- TCH: docetaxel, (Taxotere) carboplatin, and trastuzumab (Herceptin) for HER2/neu-positive tumors
Many chemotherapy drugs don’t cause hair loss, but most of those mentioned above for early-stage cancer will have that side effect. Hair loss is one of the most visible side effects of cancer treatment. It can also be the most distressing, as it marks you as a cancer patient. Many stores sell wigs and scarves, and some charities will help you afford them if necessary.
Vomiting and nausea is another feared side effect. But in today’s world, this is becoming less common and seen more on TV than in infusion centers. You will be given steroids and powerful anti-nausea meds along with your infusion, and you’ll also be given some medication to take at home. Most women are pleasantly surprised to find that they don’t have any nausea at all, and can even gain weight on chemo.
Unfortunately, constipation can be a real problem, and you must be vigilant about getting enough fiber and taking stool softeners. Mouth sores are a problem for some. If this happens, you can ask your oncologist for a prescription for “Magic Mouthwash,” which has a numbing agent. Taste changes are possible with some chemo drugs.
The most common and persistent side effect is tiredness. Chemotherapy affects your blood and bone marrow, and often a patient will become anemic, which causes fatigue. The effect on the blood also leaves you potentially susceptible to infection. It’s important to rest and only do what is necessary. Rarely, an allergic reaction to chemotherapy drugs can happen, but you will be watched very closely for any signs that this may occur. While most of those side effects go away when you complete your chemo regimen, a few problems may remain. One of these is neuropathy, which occurs when the nerves of the hands and feet are damaged. People with this problem feel tingling, stabbing sensations, and numbness in these areas.
Osteoporosis is another potential lasting side effect, and a patient who has had chemo should have regular bone density checks. “Chemo brain,” cognitive difficulties that occur with treatment, can cause short-term memory loss and problems concentrating. Usually, this symptom improves shortly after therapy concludes. However, sometimes it can persist for years. In some cases, chemo can leave you with a weak heart.
Learning that you have to undergo chemotherapy is naturally frightening. But most women are surprised to find that it’s quite manageable. Many can even keep up with their careers and other regular activities at a reduced level.
While undergoing chemo, it’s important to eat right, get as much rest as possible, and keep your spirits up. Finding out that you must undergo chemo can be difficult, but remember that it will end in a few short months.
If you find yourself depressed or fearful, it may help to talk to others who have gone through the same thing, either through a support group or online.