Chemotherapy can sometimes be performed before your surgery (neoadjuvant) or afterward (adjuvant), depending on your type of cancer. It’s usually performed according to a regimen.
Chemotherapy drugs are a specific class of medications called cytotoxic agents. They’re designed to kill cancer cells.
Cancer cells grow faster than regular cells. These drugs have the
Some chemotherapy (“chemo”) drugs damage the genetic material of the cells. Others interfere with the way the cells divide. However, 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 people who receive a diagnosis of breast cancer will need chemotherapy. Cancer can often be effectively treated with local therapies like surgery and radiation, without systemic treatment.
Sometimes, chemo can be given upfront before breast surgery (neoadjuvant), and other times after surgery (adjuvant).
Some
- if you have stage 1, 2, or 3 breast cancer
- if the tumor is larger than 0.5 centimeters across
- the status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 biomarkers
If you’ve received a diagnosis of larger tumors where the cells have spread to nearby lymph nodes, you may need a few rounds of chemo. Chemo, in these cases, is used as a therapy before surgery.
If a remaining tumor exists or, depending on the tumor’s biology, after surgery chemo may also be given.
You may go straight to systemic treatment before getting surgery if you’ve received a diagnosis of:
- stage 2 to stage 3 cancer
- triple-negative HER2+ breast cancers
- locally or advanced breast cancer regardless of hormone receptor for HER2 status
While the idea of chemotherapy may be intimidating, significant improvements have been made in managing side effects, making chemotherapy much more tolerable 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. Before deciding on a
- the status of your ER, PR, and HER2 biomarkers
- your age
- your stage of the cancer
- any other health problems
These drugs are usually injected into a vein, either at your doctor’s office or at a hospital. Locations that provide chemotherapy injections are often called infusion centers.
If you have weak veins or are being given a certain type of drug, you may need a port implanted. A port is a device surgically placed in your chest to allow for easy needle access. The port can be removed when therapy is finished.
Typically, a person 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.
Some common drugs and chemotherapy regimens used for breast cancer today are:
| Regimen name (drug initials) | List of drugs in treatment |
| CAF (or FAC) | cyclophosphamide (Cytoxan), 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) |
| AC | doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan) |
| FEC | 5-FU, epirubicin (Ellence), and cyclophosphamide (Cytoxan) |
| TC | docetaxel (Taxotere) and cyclophosphamide (Cytoxan) |
| CMF | cyclophosphamide (Cytoxan), methotrexate, and 5-FU |
| EC | epirubicin (Ellence) and cyclophosphamide (Cytoxan) |
Immunotherapy, such as pembrolizumab (Keytruda), is being combined with chemotherapy before surgery for people with triple-negative breast cancer (ER, PR, and HER2 receptor status are all negative).
While chemotherapy treatments have greatly improved over time, there are often still
Hair loss
Not all chemo drugs cause hair loss, but most of those mentioned above for early stage cancer will have that side effect.
If you’re self-conscious of your hair loss, try to incorporate wigs, hats, and scarves into your wardrobe. This side effect is generally temporary, however. Your hair will likely begin to grow back once you stop chemo treatment.
Nausea
Some may be concerned about nausea as a chemo side effect. But this is becoming less common as treatment methods progress.
You’ll be given steroids and powerful anti-nausea medications along with your infusion. You’ll also be given some medication to take at home. Many people find that they don’t have any nausea at all and can even gain weight on chemo.
Constipation
Constipation can be a side effect of chemo drugs.
Be sure to incorporate fiber into your diet, and take stool softeners if you need to.
Mouth sores
Mouth sores are an occasional side effect. If they appear, you can ask your oncologist for a prescription for “magic mouthwash,” which has a numbing agent.
Also, it’s possible that some chemo drugs will change your sense of taste. The changes should go away after you complete your chemo, but
Fatigue
The most common and persistent side effect of chemo is tiredness.
Chemotherapy affects your blood and bone marrow. Often a person undergoing chemo will become anemic, which causes fatigue.
The effect on the blood also makes you potentially susceptible to infection, so it’s important to rest as much as possible.
Menstrual and fertility changes
If you have a menstrual cycle, you may find that it changes under chemotherapy. Some people start menopause after completing chemotherapy. This becomes more common the closer you are to menopause, which typically starts around the age of 51 in the United States, but can vary based on:
- family history
- genetic factors
- environmental factors
Periods can return after treatment is completed, but this often depends on your age and what kind of chemotherapy drugs were used. Typically, the younger you are, the greater the chance is that your period will return and you’ll produce fertile eggs.
Talk with your doctor if you hope to get pregnant after chemotherapy. They can help design a treatment plan that least affects your fertility.
Neuropathy
While most of these side effects disappear when you complete your chemo regimen, a few may remain. One of these is neuropathy. It occurs when the nerves of the hands and feet are damaged. People with this side effect feel tingling, stabbing sensations, and numbness in these areas.
Osteoporosis
Osteoporosis is another potential lasting side effect. People who’ve undergone chemo should have regular bone density checks.
Increased risk for leukemia
Although rare, receiving certain types of chemotherapy can put you at a higher risk of developing leukemia down the line. If this is the case, it usually appears within 10 years of receiving chemotherapy. But not all chemo raises this risk.
For most people, the benefits of receiving chemotherapy to help treat breast cancer outweigh the
Cognitive difficulties
Cognitive difficulties that occur with treatment can cause short-term memory loss and problems concentrating. This is known as “chemo brain.”
Usually, this symptom improves shortly after therapy concludes. However, sometimes it can persist for years.
Heart weakening
In some cases, chemo can leave you with a weaker heart.
Rarely, an allergic reaction to chemotherapy drugs can happen as well. Your medical team will monitor you closely for any signs that this may occur.
The prospect of undergoing chemotherapy can be scary, but most people are surprised to find that it can be manageable. Many can even keep up with their careers and other regular activities at a reduced level.
It’s important to eat a nutritious diet, stay hydrated, rest as much as possible, and take care of your mental health while undergoing chemotherapy.
Finding out that you must undergo chemo can be difficult, but remember that it won’t last forever.
It may help to talk with others who have gone through the same thing. Explore support groups online, and check out our list of best breast cancer blogs.