CHEMOTHERAPY FOR BREAST CANCER:

 What is chemotherapy?

Chemotherapy, often called chemo for short, uses medicines to stop or slow the growth of breast cancer cells. Chemotherapy is considered systemic therapy because it travels through the bloodstream and affects the whole body.

Breast cancer cells grow and divide faster than healthy, normal cells. Chemotherapy affects rapidly dividing cells, such as cancer cells, more than it affects healthy cells. Still, chemotherapy medicines are powerful and can damage healthy cells, especially cells that grow and divide quickly.

There are a number of chemotherapy medicines used to treat breast cancer. In many cases, a chemotherapy regimen will use a combination of two or more medicines. Depending on the breast cancer's characteristics, chemotherapy medicines may be combined with other treatments, such as hormonal therapy, radiation therapy, targeted therapy, or immunotherapy.

There are a number of chemotherapy medicines used to treat breast cancer. In many cases, a chemotherapy regimen will use a combination of two or more medicines.

Depending on the breast cancer's characteristics, chemotherapy medicines may be combined with other treatments, such as hormonal therapy, radiation therapy, targeted therapy, or immunotherapy.

Chemotherapy as the primary treatment for advanced breast cancer

If breast cancer has spread to other parts of your body and surgery isn't an option, chemotherapy can be used as the primary treatment. It may be used in combination with targeted therapy.

The main goal of chemotherapy for advanced breast cancer is generally to improve quality and length of life rather than to cure the disease.

How Chemotherapy works:

Chemotherapy medicines stop or slow the growth of breast cancer cells by destroying the cells or stopping them from dividing.

Breast cancer cells usually grow and divide very quickly in an out-of-control fashion with no order. Because the cancer cells grow and divide so quickly, they break away from the original tumor and travel to other places in the body.

Because chemotherapy travels throughout the body in the bloodstream, it works on the cancer cells in the original tumor and throughout the body.

 How long does chemotherapy take for breast cancer?

Typically, you receive chemotherapy in cycles. You may receive chemo every week or every two, three or even four weeks. Cycles are usually two to three treatments long. Each cycle includes a rest period to allow your body to recover. For example, you may have the same treatment every Monday for three weeks. Then you have an extra week to recover before repeating the cycle. Many people have multiple treatment cycles in a row. Treatment may last three to six months.

What happens after chemotherapy for breast cancer?

Immediately after chemotherapy, you may feel sleepy or nauseated. Typically, the side effects of chemotherapy go away after you complete all prescribed cycles.

After all of your cycles of chemotherapy are completed, your healthcare provider may order imaging tests, such as CT scans or MRIs, to show whether the cancer is gone or the tumor has shrunk.

What are the advantages of chemotherapy for breast cancer?

Chemotherapy can effectively shrink cancerous cells before surgery. It can also decrease your risk of breast cancer coming back after surgery.

How you prepare:

Assess the potential benefit of chemotherapy

When deciding whether chemotherapy is right for you, your doctor considers:

Cancer size and grade. Larger cancers and higher grade cancers are more likely to recur and are more likely to benefit from chemotherapy.

Lymph node status. If your breast cancer has spread to your lymph nodes, your doctor may recommend chemotherapy.

Age. Breast cancer that occurs at a younger age may be more aggressive than cancer that develops later in life. So doctors may recommend that younger people with breast cancer undergo chemotherapy.

Previous treatments. If you've had chemotherapy before, your doctor considers this when developing your treatment plan.

Your general health and other medical conditions. Your overall health may affect your ability to tolerate side effects of chemotherapy. Certain health problems, such as heart disease or diabetes, may affect which drugs are selected for your chemotherapy.

Hormone receptor status. If your cancer cells have receptors for the hormones estrogen and progesterone, your doctor may recommend hormone therapy in addition to chemotherapy.

Genetic profile. For certain types of breast cancer such as hormone receptor positive breast cancer, your doctor may have your cancer cells tested to learn more about their genetic makeup.

Gene expression profiling tests, such as Oncotype DX, EndoPredict and MammaPrint, may help predict the risk of recurrence and give your doctor an idea of how your cancer cells might respond to chemotherapy. If it's not clear whether you'd benefit from chemotherapy, these tests can be helpful. But they're not useful for everyone and are only used in certain situations.

Your preferences. Talk with your doctor about your preferences for your care. These can be taken into consideration, especially when multiple options for therapy are available.

What are the side effects of chemotherapy?

Although some people have no side effects at all, most people experience one or more side effects during treatment with chemotherapy. The side effects vary with different types of chemotherapy. Some of the common side effects and their treatment are discussed here.

Tiredness

Tiredness is common during chemotherapy treatment. This can last for a few days after each treatment session (cycle). Sometimes the tiredness lasts for a few weeks

and can still be there when the next treatment cycle is due.

It is important that you rest for a few days after treatment. After this, you should try and get back to some of your normal activities even if you still feel very tired. It has been shown in research trials that regular exercise actually reduces fatigue. Physical activity also has other health benefits, such as minimizing weight gain and preventing cardiovascular problems. Exercise also reduces the chances of breast cancer coming back in the long-term.

Hair loss

Hair loss is a common side effect of chemotherapy. This is a distressing part of treatment for many women. Fortunately, this hair loss is temporary.

The effect of chemotherapy varies with different drugs and from one person to another. Hair loss usually starts within a few weeks of the first dose of chemotherapy. The hair may gradually thin over several weeks or may fall out quite quickly. Hair loss can occur on all parts of the body, not just the head. Hair begins to grow back as soon as the treatment finishes. It grows about one centimetre each month. Sometimes it is a different colour or texture at first.

Losing your hair, even when it is temporary, is upsetting. Chemotherapy and breast care nurses are experienced in helping people through this. They can talk to you about the use of wigs, scarves and hats. Some hospitals have ‘scalp cooling’ equipment. This may reduce the amount of hair loss experienced. Wig libraries are available in some hospitals.

Changes to taste and appetite

Chemotherapy may cause changes in the taste of food, and even alterations to the taste of coffee and water.

Often women describe food as having a ‘metallic taste.’ These changes to taste are called “dysgeusia.” This problem may be difficult to counteract. Changes in taste, combined with nausea or uneasiness in the stomach, may cause cravings for unusual foods, rather like the symptoms of pregnancy. Care must be taken to avoid high calorie snacks as weight gain often occurs during chemotherapy.

It is important to keep your strength up by eating frequent small meals and trying different foods. Talking to a dietician or an experienced chemotherapy or breast nurse can be very helpful.

Skin sensitivity

Chemotherapy may cause changes in the skin, making it more sensitive to the sun. The skin may also darken or become dry and itchy. Always let your doctor know if you develop these problems. It is important to avoid exposure to the midday sun, and to use sunscreen if you are outside. Sorbolene is recommended for the treatment of dry skin.

Take steps to improve your overall health

Make healthy choices before cancer treatment so you'll feel strong as your treatment begins. Continuing healthy choices during treatment may help minimize side effects.

Your doctor may recommend that you:

Get plenty of rest.

Stay active and make the time to exercise.

Eat a balanced diet rich in fruits, vegetables and whole grains.

Minimize stress

Avoid infections, such as the common cold and the flu. Talk with your doctor about recommended vaccinations, including annual flu vaccines. Also engage in behavior to reduce the risk of infection while on active chemotherapy, such as washing hands or using hand sanitizer before eating and using gloves while doing yardwork.

See your dentist for any signs of infection in your teeth or gums.

Undergo blood tests to check your liver and kidney function and tests to check your heart function. If problems show up, your doctor may delay your treatment or select a chemotherapy drug and dosage that is safer for you.