This is the treatment of cancer with drugs. The aim is to destroy cancer cells while having the least possible effect on normal cells. The drugs are usually given intravenously via a drip and circulate around the body. Chemotherapy is a systemic treatment (treating the whole body) compared with surgery and radiation treatment, which are local treatments to a specific area in the body (for example, breast, chest wall, and axilla).
There are different regimens or combinations of drugs used in breast cancer. Most will contain an anthracycline drug, for example, doxorubicin (Adriamycin). If there is a greater risk of spread and, therefore, greater benefit from chemotherapy, taxanes, for example paclitaxel (Taxol) or docetaxel (Taxotere), may be used.
Treatment is often in cycles at three-weekly intervals, and may last for several months. A medical oncologist will discuss all aspects of the treatment with you.
Chemotherapy is offered to some women with early breast cancer as an additional treatment to surgery, radiation treatment, or both. This is called adjuvant chemotherapy. Adjuvant chemotherapy aims to destroy cancer cells that remain in the body which cannot be detected. In time, these cells will grow to form a recurrence of the breast cancer.
The purpose of adjuvant treatment is to reduce the chance of that happening.
Radiation treatment, if it is necessary, comes after chemotherapy, starting about four weeks after the last cycle of chemotherapy. Hormone therapy, if recommended, may begin either before or after the radiation treatment.
Women who will most likely benefit from chemotherapy are:
women with cancer cells in the lymph glands in their armpit
some women with more aggressive cancers (Grade 3) with no spread of cancer to the lymph nodes
women who are HER2 positive (chemotherapy given with trastuzumab (Herceptin)).
In some cases of larger tumours where women wish to try to avoid mastectomy neo-adjuvant chemotherapy may be used.
Chemotherapy before surgery (neo-adjuvant chemotherapy)
Women with a cancer called inflammatory breast cancer are normally offered chemotherapy before surgery. This is called neo-adjuvant chemotherapy. Neo-adjuvant chemotherapy is also used when women have tumours that are large and have to be reduced in size before successful surgery is possible.
“I was determined I wasn’t going to look sick. I did my hair and wore makeup during treatment. These little things helped me feel better about myself.” Jillian
Side effects of chemotherapy
Chemotherapy side effects vary depending on the particular drugs used. When adjuvant chemotherapy is given to women with breast cancer, side effects may include:
infections–the drugs can lower your ability to fight infections. If you are feverish (your temperature is 38 degrees C or more), or if you feel unwell in any way–don’t wait to see what happens–take action immediately. Contact your cancer doctor or nurse, and follow the advice given.
nausea and vomiting
loss of appetite or taste changes
feeling off-colour and tired
temporary thinning or loss of hair. If you have temporary hair loss you are entitled to a benefit to buy a wig.
weight gain. This is quite common after chemotherapy so trying to keep up regular exercise is important.
difficulty concentrating for some. This is temporary but can take some months after chemotherapy to go away.
loss of libido (interest in sex)
hot flushes, vaginal dryness, mood swings, or other symptoms of menopause.
If you are still having periods, you may find that your periods become irregular or stop while you are having treatment. If you are approaching menopause, your periods may not return once the treatment has stopped.
If you are sexually active, with a male partner, you and your partner should use a reliable contraceptive, such as a diaphragm or condom, during treatment because the drugs can cause birth defects or miscarriage.
Your ability to become pregnant may be affected. Some women may be permanently infertile (unable to become pregnant). This can be very hard to cope with and it may be helpful to talk with others who have been through this; your doctor or to a counsellor or fertility expert.
Chemotherapy drugs may have particular side effects, and these will be discussed with you. Discuss any side effects with your doctor. Side effects are usually temporary and there are ways of reducing the impact of any unpleasant symptoms.
Phone your local Cancer Society for a copy of the booklet Chemotherapy/Hahau, download the booklet from our website, or phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
Photographer: Louise Goossens.