Chemo For Breast Cancer

1 What is a Chemotherapy for Breast Cancer?

In chemotherapy for breast cancer, powerful drugs are used to target and destroy breast cancer cells.

Chemotherapy for breast cancer is frequently used with other treatments, such as surgery, radiation, or hormonal therapy.

Combining chemotherapy for breast cancer with other treatments may increase the chance of a cure or decrease the risk of cancer recurring.

If cancer has recurred or spread, chemotherapy for breast cancer may control cancer in order to prolong your life. Or it can help ease the symptoms that cancer is causing.

However, chemotherapy for breast cancer also carries a number of risk of side effects, some temporary and mild, others more serious and permanent.

You doctor can help you decide whether chemotherapy for breast cancer is the best choice for you.

2 Reasons for Procedure

A patient will need to undergo a chemotherapy for breast cancer for the following reasons:

  • Chemotherapy after surgery for early breast cancer: After surgical removal of a tumor from a breast, your doctor may suggest chemotherapy to destroy any hidden cancer cells and also to reduce your risk of the cancer returning. This is known as adjuvant chemotherapy.Your doctor may recommend adjuvant chemotherapy if your risk of cancer recurring or spreading to other parts of your body (metastasizing) is high, even if there is no evidence of cancer after the surgery. You may be at a higher risk of metastasis if cancer cells are found in lymph nodes near the breast with the tumor.It is very important to discuss with your doctor about how much does the chemotherapy decrease the chances of cancer recurring, and whether this decrease in risk is worth the side effects of the chemotherapy that might be effective in your case.
  • Chemotherapy before surgery for early breast cancer: Some women with breast cancer receive chemotherapy prior to the surgery (neoadjuvant therapy), generally to shrink large tumors and allow the surgeon the best opportunity of completely removing the tumor.In some situations, neoadjuvant therapy allows the surgeon to only remove the tumor, rather than the entire breast. This can also decrease the chances cancer will return at a later stage.
  • Chemotherapy as the primary treatment for advanced breast cancer: If breast cancer has spread to other parts of your body, and surgery is not considered an option for you, chemotherapy can be used as the primary mode of treatment for your cancer, it may also be used in conjunction with hormone therapy or targeted therapy, depending on the type of breast cancer you have.The main goal of chemotherapy for advanced cancer is general to improve quality and length of life rather than to cure the condition.
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3 Potential Risks

Chemotherapy potential risks are not uniform, they are different for everyone. This is due to differences among drugs and dosages and the body's unique reaction to these medicines.

Most side effects are temporary and subside after treatment is finished. However, in some cases, chemotherapy can have long-term or even permanent effects.

Short-term side effects

In the process of destroying cancer cells, chemotherapy drugs can also harm other rapidly dividing healthy cells, such as those in hair follicles, bone marrow, and digestive tract.

The results may include the following:

  • Loss of appetite
  • Nausea and vomiting
  • Mouth sores
  • Diarrhea
  • Hair loss
  • Fatigue (brought as a result of fewer red blood cells in blood)
  • Heart damage
  • Nerve damage
  • Increased risk of bruising or bleeding (due to fewer blood platelet cells that help blood clot)
  • Increase vulnerability to infections (due to fewer white blood cells that help fight infection)

Drugs that help reduce nausea and vomiting caused by chemotherapy are available. Also, doctors can sometimes adjust the dose of schedule of the chemotherapy drugs in order to minimize any side effects.

If chemotherapy damages your infection-fighting blood cells, a doctor may make an adjustment to your doses of chemotherapy or add any medication that will help your bone marrow recover more quickly. Most side effects do not last long.

Long-term side effects

A number of chemotherapy drugs for breast cancer can cause long-term side effects, including the following:

  • Infertility: One possible side effect that may not go away is infertility. Some anti-cancer cause harm to the ovaries. This can lead to menopause symptoms, such as hot flashes and vaginal dryness. Menstrual periods may become irregular or even stop (amenorrhea).If ovulation ceases, pregnancy becomes impossible. If you continue to menstruate, you may still be capable of pregnancy, even during treatment, but because the effects of chemotherapy are dangerous to the fetus, talk to your doctor about birth control option before engaging in treatment.
  • Nerve damage (neuropathy): Several chemotherapy drugs have the ability to affect nerve endings in your hands and feet, leading to numbness, pain, burning or tingling, sensitivity to cold or heat, or weakness in your extremities. These side effects often go away after treatment is finished. However, they can be long lasting in some cases.
  • Osteoporosis: Women who experience menopause early because of chemotherapy may have a higher risk of the bone-thinning condition known as osteoporosis. It is generally recommended that these women have periodic bone density test, and possibly, treatments to prevent bone loss.
  • Cognitive function: "Chemo brain," "chemo fog" and "chemo memory" are terms that are used to describe little understood short-term memory and concentration problems that might occur following chemotherapy. In most cases, these problems disappear in a few years.
  • Heart damage: When used for a long period of time, and in high doses, some drugs, such as epirubicin (Ellence), trastuzumab (Herceptin) and others can lead to permanent heart damage.
  • Leukemia: In rare cases, chemotherapy for breast cancer triggers secondary cancer, such as cancer of the blood cells (leukemia).
  • Other possible side effects: Feelings of fear, sadness, and isolation can compound the physical side effects of chemotherapy, both during and after the treatment. In fact, some women are unexpectedly sad after the treatment.During the procedure, women with breast cancer have regular contact with and support from oncologists and nurses. Everyone involved is working toward the same goal, completion of treatment with the best possible result.When it is over, some women feel lonely, with no one to help them return to their normal life or deal with fears of breast cancer recurrence. It may be helpful to talk to someone who has been in the same situation. Connect with others via a cancer-survivor hotline, support group or online community.

4 Preparing for your Procedure

You and your doctor may go through a number of steps in preparation for chemotherapy.

Assess the potential benefit of chemotherapy

Your doctor will make a consideration of the number of factors determine whether and what kind of chemotherapy would benefit you. The higher your risk of recurrence or metastasis, the more likely chemotherapy will be beneficial to you.
In some cases, characteristics of the breast cancer itself may suggest other more beneficial treatments. You can discuss your own treatment goals with your doctor.
The following are the factors that are mainly considered:

  • Tumor size and grade: The more advanced the tumor, the more likely the chemotherapy may be useful in destroying stray cancer cells.
  • Lymph node status: Breast cancer cells that are found in your lymph nodes before or during surgery signal a higher risk of metastasis. Your doctor is likely to recommend chemotherapy.
  • Age: Some studies have shown that breast cancer that occurs at a young age is more aggressive than that which develops later in life. So doctors may opt for adjuvant chemotherapy when treating younger women to decrease the chances of the cancer spreading.
  • Previous treatments: Whether you have had chemotherapy before may affect your current treatment regimen.
  • Chronic health conditions: Certain problems, like heart disease or diabetes, may affect chemotherapy drugs used to treat you.
  • Hormonal status: If your breast cancer is sensitive to hormones, such as estrogen and progesterone, hormone therapy with drugs such as tamoxifen (Soltamox), fulvestrant (Faslodex) or aromatase, inhibitors (Arimidex, Femara, Aromasisin) may be a better option for post-surgical adjuvant therapy. Or they may be considered in addition to chemotherapy.
  • HER2 status: If your breast cancer produces too much of a growth-promoting hormone known as HER2, our doctor mat recommends drugs that will specifically target this protein trastuzumab (Herceptin), lapatinib (Tykerb), other, in addition to chemotherapy.
  • Genetic profile: For particular types of breast cancer, some doctors may do genetic testing of tumor tissue to learn the genetic patterns that may be help predict the risk of recurrence. Some individuals still consider these tests experimental.

Take steps to improve your overall health

Because chemotherapy can affect fast-growing healthy cells such as your white blood cells, platelets, and red blood cells, it helps to be as healthy as possible before you begin treatment.
To minimize its side effects, you doctor may recommend you to take the following steps in order to optimize your overall health:

  • Get plenty of rest
  • Eat a balanced diet rich in fruits, vegetables, and whole grains
  • Minimize stress
  • Avoid infections, such as common cold and then flu
  • See your dentist for any signs of infection in your teeth or gums
  • Undergo blood tests to check your liver function and other tests to check your heart
  • Plan ahead for side effects
  • Ask your doctor what side effects you can expect during and after chemotherapy and prepare. For example, if your chemotherapy will cause infertility, you may wish to store sperm or fertilized eggs for future use.If your chemotherapy will cause hair loss, consider a wig or head covering.
  • Make arrangements for help at home and work. Most chemotherapy treatments are given in an outpatient clinic, which means most individuals are capable of continuing work and doing their usual activities, but it is difficult to predict just how you will feel.Prepare by asking for time off work or help around the house for the initial days after treatment. If you will be in the hospital during chemotherapy treatment, arrange to take some time off work, and find someone to take care of your children, pets or home.
  • Tell your doctor about any drugs or supplements you are taking. Be very sure that your doctor knows about any medications you are taking, including any herbal supplements, vitamins or over-the-counter drugs. These may affect the way the chemotherapy drugs operate.Your doctor may suggest alternative medications or that you not take the medications or supplements for a certain period prior to a chemo session.

The day of your treatment

Your doctor or nurse will let you know if you can or cannot eat or drink on the day of your procedure. It may help to take a family member or friend with you to the treatment session, for support and companionship.

5 What to Expect

Here’s what you can expect before, during, and after your chemotherapy.

Timing and frequency of chemotherapy sessions

Chemotherapy for breast cancer is given in cycles. The cycle of chemotherapy is not uniform, it can vary from once a week to once every three weeks. Typically, you will undergo chemotherapy treatments for a period of three to four months, but your doctor will adjust the timing to your circumstances.

If your cancer is advanced, treatment may continue beyond six months.

Common drug combinations

There is an array of chemotherapy drugs available. Because every individual is different, doctors tailor certain type and doses of medications (regimens), often a combination of chemotherapy drugs to the kind of breast cancer and the person's medical history.

Where chemotherapy is given

Most breast cancer chemotherapy sessions take place at one of these places: a doctor's office, or an outpatient unit in a hospital or clinic.

How chemotherapy is given

Chemotherapy can be given in several ways, including pills you take at home.

Most often they are injected into a vein (IV). This can be done through the following: An IV needle and tube (catheter) in your hand or wrist. A catheter implanted in your chest prior to the beginning of chemotherapy. This port stays in place for the entire duration of your chemotherapy treatment and eliminates the need to find a suitable vein at each treatment session.

A typical chemotherapy session

Not all chemotherapy sessions are alike, but a session might follow this order:

  • You meet with the health care provider who's administering your chemotherapy.
  • You undergo a brief physical exam to check temperature, pulse and blood pressure.
  • You have the IV catheter inserted.
  • You have a blood sample drawn for a blood count and other blood tests.
  • You meet with your doctor to review your blood test results and assess your overall health.
  • Your doctor orders the chemotherapy.
  • You receive medications to prevent side effects such as nausea, anxiety or inflammation.
  • You receive the chemotherapy drugs. This may take up to several hours.

After a chemotherapy session

Following a chemotherapy session, you may:

  • Has your catheter removed?
  • Have your vital signs checked?
  • Review side effects with your health care provider.
  • Receive prescriptions for medications you can take at home to help with side effects.
  • Be advised drinking a lot of fluids.
  • Receive instructions on proper handling of bodily fluids, such as urine, stool, vomit, semen and vaginal secretions, as these, may contain some of the chemotherapy drugs for the next 48 hours. This may simply involve flushing the toilet twice after use.

Some people feel fine after a chemotherapy session and can return to their schedules, but others may feel side effects more quickly. You may want to arrange for someone to drive you home afterward, at least for the first few sessions, until you see how you feel.

During the course of chemotherapy

After a few sessions, you may be able to predict more accurately when you'll feel fine and when you may need to cut back on activities. Marking your calendar or keeping a journal may help you track your general response to chemotherapy sessions and help you plan events accordingly.

Following your treatment plan closely is the best way to get the most benefit from your chemotherapy. If side effects become too bothersome, discuss them with your doctor. He or she may be able to adjust the dose or type of chemotherapy medication you're receiving or prescribe other medications to help minimize side effects.

6 Procedure Results

If you do not understand your chemotherapy results, consult with your doctor.

After chemotherapy treatment is completed, your doctor will schedule follow-up visits, usually every four to six months initially and less frequently over time.

This is done to monitor you for any long-term side effects and to check for the recurrence of the breast cancer.

Tests and procedures during the follow-up care include:

  • Asking you how you feel, including any new symptoms or physical problems you have.
  • Physical exam including a breast exam
  • Yearly mammogram
  • Bone density testing
  • Tests like tumor market test, liver function tests, bone scans and chest X-rays are generally not recommended unless there is a special need.

Additional imaging tests are typically needed only when recurrence is suspected or new symptoms or physical exam findings warrant.

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