Chemotherapy for breast cancer
Chemotherapy uses drugs to kill cancer cells or slow their growth. It is called systemic treatment because the drugs circulate throughout the bloodstream.
Learn more about:
- When is chemotherapy used?
- Having chemotherapy
- Side effects of chemotherapy
- Video: What is chemotherapy?
When is chemotherapy used?
When chemotherapy is used before surgery to shrink or control the cancer it’s called neoadjuvant chemotherapy. When used after surgery to reduce the risk of the cancer returning it’s called adjuvant chemotherapy.
Chemotherapy is often used for breast cancers that aren’t sensitive to hormone therapy, are HER2+ or triple negative, or for inflammatory breast cancers. It is sometimes used for hormone sensitive breast cancers.
Different types of chemotherapy drugs are used to treat early and locally advanced breast cancer. The choice of drugs will depend on the type of cancer, how far it has spread and what other treatments you are having. Usually you will have a combination. Common drugs include doxorubicin, cyclophosphamide, fluorouracil, docetaxel, epirubicin and paclitaxel. Your treatment team may also refer to the drugs by their brand names, or letters like AC or FEC. Your medical oncologist will talk to you about the most suitable types of chemotherapy drugs, as well as their risks and side effects.
Chemotherapy is given through a vein (intravenously). You will usually be treated as an outpatient, but occasionally you may have to stay in hospital overnight.
Most people will have chemotherapy for 3–6 months. Drugs are usually given once every three weeks, although some are given on a faster schedule (e.g. once every two weeks or once a week).
Chemotherapy damages cells as they divide. This makes the drugs effective against cancer cells, which divide rapidly. However, some normal cells – such as hair follicles, blood cells and cells inside the mouth or bowel – also divide rapidly. Side effects happen when chemotherapy damages these normal cells. Unlike cancer cells, normal cells can recover, so most side effects are temporary.
You may feel sick or have vomiting for a few hours after each treatment. It’s common to feel sick a few days after a first treatment. Not everyone feels sick and you’ll be given medicine to help prevent it.
You may have loose, watery stools and feel like you urgently need to go to the toilet. Talk to your treatment team if you feel unwell. You may be given medicine to manage diarrhoea.
You may lose the hair on your head, your eyebrows, eyelashes, underarm hair, pubic hair and facial hair.
Hair loss often begins 2–3 weeks after starting treatment. It starts gradually, and becomes more rapid over the next few weeks. Some treatment centres provide cold caps, which may prevent total head hair loss, but this depends on the drugs used. Cold caps may cause discomfort during chemotherapy, so speak to your treatment team for advice. Generally, hair starts to grow back after your treatment ends.
If you think you might like to try wearing a wig, see more on wigs. The Look Good Feel Better program can help you to manage the appearance-related effects of cancer treatment and boost self-esteem. This may include sessions on make-up, skin care and hair styling. Call 1800 650 960 or visit lgfb.org.au.
For more on this, see Hair loss and cancer.
This is also called oedema. Some medicines used alongside chemotherapy drugs can cause the body to hold on to excess fluid (also called fluid retention). This can affect the arm and the trunk, but it is usually temporary and goes away when treatment ends.
Changes to fertility
Your periods may become irregular or stop during chemotherapy. This may be temporary with periods returning to normal after treatment. Sometimes periods may stop permanently, causing infertility. Chemotherapy can lower the number of sperm produced, which can cause temporary or permanent infertility. If you may want to have children in the future, talk to your cancer specialists about your options and ask for a referral to a fertility specialist before your treatment starts.
For more on this, see Fertility and cancer.
Other side effects
Tiredness, mouth ulcers and constipation are all common side effects. Chemotherapy can also lower your immune system, increasing the risk of infection. You might notice changes in thinking and memory (cancer-related cognitive impairment or “chemo brain”) or tingling in your hands or feet (peripheral neuropathy). Anti-nausea or anti-allergy medicines given with chemotherapy can disturb sleep for a few nights. Talk to your treatment team about how to manage any of these side effects.
Although the risk is small, sometimes chemotherapy can damage the heart muscle, which can affect how blood is pumped around the body (cardiomyopathy). Your heart health will be assessed before, during, and after treatment. Rarely, chemotherapy can cause a type of blood cancer.
For more on this, see Chemotherapy.
Video: What is chemotherapy?
If you have cancer, chemotherapy may play a big role in your treatment plan. Learn more in this short video.
Podcast: Coping with a Cancer Diagnosis
A/Prof Elisabeth Elder, Specialist Breast Surgeon, Westmead Breast Cancer Institute and The University of Sydney, NSW; Collette Butler, Clinical Nurse Consultant and McGrath Breast Care Nurse, Cancer Support Centre, Launceston, TAS; Tania Cercone, Consumer; Kate Cox, 13 11 20 Consultant, Cancer Council SA; Dr Marcus Dreosti, Radiation Oncologist and Medical Director, GenesisCare, SA; Dr Susan Fraser, Breast Physician, Cairns Hospital and Marlin Coast Surgery Cairns, QLD; Dr Hilda High, Genetic Oncologist, Sydney Cancer Genetics, NSW; Prof David W Kissane AC, Chair of Palliative Medicine Research, The University of Notre Dame Australia, and St Vincent’s Hospital Sydney, NSW; Prof Sherene Loi, Medical Oncologist, Peter MacCallum Cancer Centre, VIC; Dr W Kevin Patterson, Medical Oncologist, Adelaide Oncology and Haematology, SA; Angela Thomas, Consumer; Iwa Yeung, Physiotherapist, Princess Alexandra Hospital, QLD.
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