• Chemotherapy for Breast Cancer

    Chemotherapy is a form of therapy that employs drugs to kill cancer cells. The drugs enter the bloodstream and travel through the body in order to kill cancer cells. The side effects from the chemotherapy come from the fact that it destroys normal cells as well as the cancer cells.
    The type of chemotherapy you receive will depend on the type and stage of your cancer. New combinations of chemotherapy are constantly being designed as new information is discovered. The most common chemotherapeutic drug combinations are:
    • Cyclophosphamide (Cytoxan), methotrexate (Amethopterin, Mexate, Folex), and 5-fluorouracil (l, 5-FU, Adrucil)—abbreviated CMF
    • Cyclophosphamide, doxorubicin (Adriamycin), and fluorouracil—abbreviated CAF
    • Doxorubicin (Adriamycin) and cyclophosphamide—abbreviated AC
    • Doxorubicin (Adriamycin) and cyclophosphamide followed by paclitaxel (Taxol), docetaxel concurrent with AC, or docetaxel (Taxotere)—abbreviated TAC
    • Doxorubicin (Adriamycin), followed by CMF
    • Docetaxel (Taxotere) and cyclophosphamide—abbreviated TC
    • Cyclophosphamide, epirubicin (Ellence), and fluorouracil with or without docetaxel
    Chemotherapy is usually given by vein, but some forms can be given by mouth as well. Your oncologist will tell you how many cycles or courses of chemotherapy are best for you. Usually there are between 4-8 cycles when the chemotherapy is delivered on its own.
    The side effects and amount of time required in the doctor’s office depend on the type of chemotherapy you receive, as well as how many cycles you receive and how often. The most common chemotherapy-associated side effects are:
    • Nausea and vomiting
    • Fatigue or tiredness sometimes as a result of suppression by the chemotherapeutic drugs of the blood forming cells in the bone marrow
    • Hair loss
    • “Fogginess” or “chemo brain,” usually mild and inconvenient, but usually not serious or permanent
    • Low blood cell counts (red cells, white cells, or platelets) that can lead to infection or bleeding
    As a result of chemotherapy , you may experience premature menopause , with all the symptoms and effects (including loss of fertility) of “regular” menopause. Some chemotherapeutic drugs also may cause serious side effects later on, including damage to the heart muscle (adriamycin), and very rarely, the development of leukemia much later on.
    In addition to drugs that kill cancer cells (cytotoxic therapy), you may be given estrogen-blocking drugs, such as tamoxifen or the newer class of drugs called aromatase inhibitors (AIs). These drugs will produce symptoms of menopause (eg, hot flashes, night sweats) in many women. They may also produce a condition called “tumor flare” in patients with advanced cancer metastatic to bone, resulting in increased blood calcium. This may be a serious health threat that requires hospitalization.
    Some patients also report such side effects as:
    • Voice change (which may be important to singers, actors, and others who use their voice in employment)
    • Depression
    • Headache
    • Allergic reactions
    Occasionally, deep venous thrombosis (clotting of the veins in the leg) can occur and can be life-threatening. There is also a reported increase in the risk of endometrial cancer in patients who take tamoxifen.

    References

    American Lung Association website. Available at: http://www.lungusa.org . Accessed January 27, 2006.

    Breast cancer. National Cancer Institute website. Available at: http://www.cancer.gov . Accessed January 27, 2006.

    Detailed guide: breast cancer. American Cancer Society website. Available at: http://www.cancer.org . Accessed January 27, 2006.

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