Chemotherapy for breast cancer
Chemotherapy uses drugs to kill cancer cells or slow their growth. It may be 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?
Chemotherapy may be used at different times:
- before surgery to shrink or control the cancer (neoadjuvant chemotherapy)
- if the cancer is not sensitive to hormone therapy and/or is HER2 positive
- after surgery to reduce the risk of the cancer returning (adjuvant).
Different types of chemotherapy drugs are used to treat early and locally advanced breast cancer. The choice of drug 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 and paclitaxel. Your health professionals may also refer to the drugs by their brand names. Your medical oncologist will talk to you about the most suitable types of chemotherapy, 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. Usually drugs are 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 lose the hair on your head, and your eyebrows, eye lashes, underarm hair, pubic hair and beards can also be affected. It’s common for hair loss to begin two to three weeks after starting treatment. You’ll probably lose some hair gradually at first, and then more rapidly 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. For information about cold caps, speak to your treatment team.
Generally, hair begins to grow back after treatment ends (Learn about wigs).
The Look Good Feel Better program helps people manage the appearance-related effects of cancer treatment. This may include sessions on make-up, skin care and hair styling to boost self-esteem during treatment. Call 1800 650 960 or visit lgfb.org.au.
For more on this, see Hair loss and cancer.
You may feel sick with or without vomiting for several hours after each treatment. You will be given medicine to prevent nausea.
Some women find that their periods become irregular or stop during chemotherapy. Periods may return to normal after treatment or they may stop permanently (menopause), causing infertility. For men, chemotherapy can lower the number of sperm produced, which can cause temporary or permanent infertility.
If you may want to consider having children in the future, talk to your cancer specialists about the 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
Common side effects include tiredness, mouth ulcers and constipation.
Chemotherapy can also lower your immune system, increasing the risk of infection. Some people experience changes in thinking and memory (cancer-related cognitive impairment or “chemo brain”) or pins and needles (peripheral neuropathy).
Sometimes chemotherapy can damage the heart muscle, which can affect how blood is pumped around the body (cardiomyopathy). Although the risk is small, your heart health will be assessed before starting treatment and continue during treatment. Rarely, chemotherapy can cause a type of blood cancer.
For more on this, see Chemotherapy.
Video: What is chemotherapy?
Prof Bruce Mann, Professor of Surgery, The University of Melbourne, and Director, Breast Tumour Stream, Victorian Comprehensive Cancer Centre, VIC; Dr Marie Burke, Radiation Oncologist, and Medical Director GenesisCare Oncology, QLD; Dr Susan Fraser, Breast Physician, Cairns Hospital and Marlin Coast Surgery Cairns, QLD; Ruth Groom, Consumer; Julie McGirr, 13 11 20 Consultant, Cancer Council Victoria; A/Prof Catriona McNeil, Medical Oncologist, Chris O’Brien Lifehouse, NSW; Dr Roya Merie, Staff Specialist, Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, NSW; Dr Eva Nagy, Oncoplastic Breast Surgeon, Sydney Oncoplastic Surgery, NSW; Gay Refeld, Clinical Nurse Consultant – Breast Care, St John of God Subiaco Hospital, WA; Genny Springham, Consumer.
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