Chemotherapy: What to Expect

https://www.breastcancer.org/treatment/chemotherapy/process

Even after you and your doctor have decided on a chemotherapy regimen, you may still have questions about what to expect and how chemotherapy will affect your daily routine.

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Your doctor and oncology nurse can answer your questions. They will give you a lot of information before your chemotherapy starts and will be there for you as your treatment goes on. If you are receiving chemotherapy as an infusion through a thin needle in your hand or arm, an oncology nurse will be with you during the whole procedure. If the chemotherapy is in pill form, you will take it at home. With either form of chemotherapy, you should contact your doctor or nurse by phone if you’re experiencing severe side effects such as mouth sores, nausea that doesn’t go away after you take the medicine, diarrhea, or fever.

Most cancer doctors’ offices and treatment centers have a doctor or nurse available 24 hours a day to answer questions. Make sure you know how to contact someone outside of regular office hours in case you have questions or concerns.

It’s important to remember that each person responds differently to chemotherapy. There are certain general reactions that most people can expect, but don’t worry if your reactions — physically or emotionally — are different from someone else’s.

In this section, you can read about what to expect if you’re having chemotherapy:

How Chemotherapy Works

https://www.breastcancer.org/treatment/chemotherapy/how_it_works

ChemoMchCk

Chemotherapy medicines prevent cancer cells from growing and spreading by destroying the cells or stopping them from dividing.

Cancer cells tend to grow and divide very quickly with no order or control. Because they’re growing so fast, sometimes cancer cells break away from the original tumor and travel to other places in the body. Chemotherapy weakens and destroys cancer cells at the original tumor site AND throughout the body.

Most normal cells grow and divide in a precise, orderly way. Still, some normal cells do divide quickly, including cells in hair follicles, nails, the mouth, digestive tract, and bone marrow (bone marrow makes blood cells). Chemotherapy also can unintentionally harm these other types of rapidly dividing cells, possibly causing chemotherapy side effects.

Chemotherapy is used to treat:

  • early-stage invasive breast cancer to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back
  • advanced-stage breast cancer to destroy or damage the cancer cells as much as possible

When treating early-stage breast cancer, it’s fairly common for chemotherapy to be given after surgery, as soon as you recover. Doctors call this “adjuvant” chemotherapy because it’s given in addition to surgery, which is considered the primary treatment.

In some cases, chemotherapy is given before surgery to shrink the cancer so that less tissue has to be removed. When chemotherapy is given before surgery, it’s called “neoadjuvant” chemotherapy.

In many cases, chemotherapy medicines are given in combination, which means you get two or three different medicines at the same time. These combinations are known as chemotherapy regimens. In early-stage breast cancer, standard chemotherapy regime…

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Who Gets Chemotherapy?

https://www.breastcancer.org/treatment/chemotherapy/who_gets_it

Chemotherapy is used to treat all stages of breast cancer, including cancer that has come back in the breast area and breast cancer that has spread to other parts of the body (metastatic disease). Chemotherapy treatments are tailored specifically for each person’s unique situation. When deciding on which chemotherapy medicines would be best for you, you and your doctor will take into account the stage and other characteristics of the cancer, such as hormone-receptor status and HER2 status. You’ll also consider your menopausal status and any other treatments you’ve had.

Women who are pregnant can safely have chemotherapy after the first trimester. Visit the Treatment for Breast Cancer During Pregnancy page for more information.

Chemotherapy for early-stage disease

Early-stage breast cancer generally means cancer that is classified as:

  • stage I
  • stages IIA and IIB
  • some stage III

(For more information on the specific characteristics of each cancer stage, visit the Breastcancer.org Stages of Breast Cancer page.)

Chemotherapy is used after surgery to remove the breast cancer to get rid of any cancer cells that may be left behind and to reduce the risk of the cancer coming back. In some cases, chemotherapy may be used before surgery to shrink the tumor so less tissue needs to be removed.

Each person’s treatment plan will be different, but there are some general guidelines about who would benefit from chemotherapy:

  • Chemotherapy is almost always recommended if there is cancer in the lymph nodes, regardless of tumor size or menopausal status.
  • Doctors recommend more aggressive treatments for premenopausal women diagnosed wit…

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Chemotherapy Medicines

https://www.breastcancer.org/treatment/chemotherapy/medicines

Chemotherapy medications for breast cancer include:

Choosing a Chemotherapy Combination

https://www.breastcancer.org/treatment/chemotherapy/your_chemo_combo

It may seem like you’re facing a big alphabet soup of medicine combinations when you and your doctor start to talk about which chemotherapy regimen might be best for you.

There are a number of tried-and-true chemotherapy regimens used to treat breast cancer, including:

  • AC: Adriamycin and Cytoxan
  • AT: Adriamycin and Taxotere
  • CMF: Cytoxan, methotrexate, and fluorouracil
  • FAC: fluorouracil, Adriamycin, and Cytoxan
  • CAF: Cytoxan, Adriamycin, and fluorouracil

    (The FAC and CAF regimens use the same medicines but use different doses and frequencies)

Your doctor also may recommend using only one medicine at a time such as Adriamycin or another anthracycline, or a taxane (Taxotere, Taxol, or Abraxane).

You and your doctor will consider several important factors when deciding on a chemotherapy regimen:

  • The characteristics of the cancer. The cancer’s stage, hormone-receptor status, HER2 status, and lymph node status will influence the chemotherapy regimen your doctor recommends.
  • Your menopausal status and general health. Your doctor will take into account your general health and menopausal status when recommending a chemotherapy regimen. If you have heart problems, high blood pressure, or another condition for which you’re being treated, this will likely affect the chemotherapy medicines that will work best for you. Chemotherapy is effective for people of all ages — your age shouldn’t stop you from being offered chemotherapy.

It’s important to remember that while there are many standard chemotherapy regimens, each person’s treatment plan will be unique because each cancer is unique. Doctors have developed and tested effective treatment plans of different lengths and dosages using different medicines.

Most short-term chemotherapy side effects can be managed with lifestyle changes and medicines that can help redu…

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Talking to Your Doctor About Chemotherapy

https://www.breastcancer.org/treatment/chemotherapy/talk_to_doc

Talking to your doctor about chemotherapy and all the different regimens and medicines might seem overwhelming at first. Ask your doctor for written chemotherapy information that you can take home with you. Doctors often have special kits or booklets with information about chemotherapy and how it’s given.

Don’t be afraid to ask questions. Ask for a phone number so you can call someone if you think of questions after your appointment. A doctor or oncology nurse should be available to answer questions in between appointments. If you have a question, don’t hesitate to call.

To help you figure out the benefits and risks of chemotherapy, you might want to ask your doctor these questions:

  • Why are you recommending chemotherapy?
  • What are the chances that I’ll get more benefits from chemotherapy compared to the treatments I’m already getting?
  • Is chemotherapy likely to make me live longer?
  • Will chemotherapy reduce the risk of the cancer coming back (recurrence)? By how much?

    (To learn more, visit the Understanding the Risk of Recurrence page.)

  • Which chemotherapy medicine or combination of medicines is best for me?
  • What are the pros and cons of the regimen you’re recommending for me?
  • How will we know if the chemotherapy is working?
  • If this chemotherapy regimen doesn’t work, are there others we can try?
  • What are my other treatment options?
  • Are there clinical trials on chemotherapy that you think would be beneficial for me?

While there may not be perfect answers for every question, your doctor should be able to discuss the risks and benefits of a chemotherapy regimen with you and help you make the best decision for you and your unique situation.

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Managing Chemotherapy Side Effects

https://www.breastcancer.org/treatment/chemotherapy/side_effects

Chemotherapy destroys cancer cells because the medicines target rapidly dividing cells. But normal cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair also divide rapidly. So chemotherapy affects them, too.

The healthy cells in your body can repair the damage that chemotherapy causes — your hair will grow back and your energy levels will rise. But cancer cells can’t repair themselves very well.

The side effects you may have from chemotherapy depend on the regimen you’re on, the amount of medicine you’re getting, the length of treatment, and your general health. The side effects you have may be different from someone else who is on the same regimen.

While your body is recovering from chemotherapy, other medicines can help ease many of the side effects you may have. It’s important to tell your doctor and oncology nurse about any side effects you’re having. If medicines aren’t controlling the side effects, your doctor or nurse can help you find something that works.

Most chemotherapy side effects go away shortly after you’ve finished chemotherapy. Still, some side effects may take several months or longer to go away completely. When you and your doctor are deciding on a chemotherapy regimen, weighing the benefits versus the side effects is part of the process. Your doctor can give you an idea of the side effects you’re likely to have.

Learn more about some of the most common chemotherapy side effects by clicking on the links below:

Staying on Track With Chemotherapy

https://www.breastcancer.org/treatment/chemotherapy/staying_on_track

Chemotherapy works best when you get the amount of medicine for the number of cycles recommended by your doctor. It’s best if chemotherapy is given on time, with no major delays.

When treating early-stage breast cancer, chemotherapy usually starts as soon as you’ve recovered from surgery. When treating advanced-stage or metastatic breast cancer, chemotherapy can begin when your doctor recommends it. Chemotherapy usually is given in cycles — a specific period of treatment followed by a period of recovery. The total chemotherapy regimen usually lasts between 3 and 6 months.

Because chemotherapy can last up to 6 months, you might encounter challenges in sticking to your treatment plan:

  • Your treatment schedule may conflict with the demands of your job or family. Getting to the treatment facility also can be a challenge for some people. Both of these situations may make you miss or postpone appointments.
  • Common chemotherapy side effects include nausea, fatigue, and a higher risk of infections. If you’re feeling bad from side effects, you may be tempted to skip appointments or interrupt treatment.
  • If you’re taking any of your chemotherapy medicines as pills or liquid, it can be hard to remember to take the correct amount each day. This is especially true if you’re taking more than one medicine.

Here are some tips to help you stick to your treatment plan:

  • In general, it’s not a good idea to skip chemotherapy for vacations or other personal events. But you can ask the staff members at your treatment center to help you plan your treatment cycles so that any events take place when you’re likely to be feeling good.
  • If you are working, try to schedule your chemotherapy infusion treatments for Thursday or Friday afternoons. That way you’ll have all weekend to rest and manage any side effects you may have.
  • Remember that side effects have nothing to do with how well your treatment is …

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Mastectomy vs. Lumpectomy

https://www.breastcancer.org/treatment/surgery/mast_vs_lump

Under certain circumstances, people with breast cancer have the opportunity to choose between total removal of a breast (mastectomy) and breast-conserving surgery (lumpectomy) followed by radiation.

Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for people with only one site of cancer in the breast and a tumor under 4 centimeters. Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).

Deciding factors

Although most women who have a choice prefer the less invasive lumpectomy, deciding between lumpectomy and mastectomy depends on a how you feel about the following:

  • Do you want to keep your breast? If it’s important to you to keep your breast, you may decide to have lumpectomy with radiation instead of mastectomy.
  • Do you want your breasts to match as much as possible in size? For most women, lumpectomy has a good cosmetic result. In rare cases when a larger area of tissue needs to be removed, lumpectomy can cause the breast to look smaller or distorted. There are types of reconstruction available for both lumpectomy (if there is significant distortion) and mastectomy. If you need to have a large area of tissue removed and two breasts of matching size are very important to you, you and your doctor will need to decide which surgery is best for your situation.
  • How anxious will you be about breast cancer coming back? If removing the entire breast would help you worry less about the possibility of the breast cancer coming back (recurrence), you might consider mastectomy.

There are also other, less personal factors that can affect which type of surgery you have:

  • Where you live: Research has shown that women who live in the United States are more likely to have mastect…

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