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Chemotherapy Chemotherapy is a form of treatment using anti-cancer (cytotoxic) drugs. The aim is to destroy any cancer cells that may have spread from the original tumour to other parts of the body. This is known as a systemic treatment because the whole body is exposed to the drugs. Standard tests or scans may not be able to detect very small numbers of cancer cells so systemic treatment is often given where there is a risk of cancer cells remaining, even though the tests for these cells may be negative. Many different types of chemotherapy are used to treat breast cancer and the drugs can be given in different ways and in different combinations, according to each person's situation. How does chemotherapy work? Cancer cells grow by dividing in a disorderly and uncontrolled way. Chemotherapy destroys cancer cells by interfering with their ability to divide and grow. Different chemotherapy drugs work in different ways and attack the cancer cells at different phases of their growth. This is why a combination of drugs is often used. What should I expect? Chemotherapy for breast cancer is most commonly given as a series of treatments at three to four weekly intervals over a period of four to six months. This can vary, depending on factors such as the type and stage of your cancer, your general health and the combination of drugs used. The period between each course of treatment gives your body time torecover from any short-term side effects that might occur. Your treatment will be tailored to suit you. You will normally be given your treatment as an outpatient so you will be able to go home the same day. Expect to be at the hospital for at least half a day to allow for waiting time and the treatment. How is chemotherapy given? Chemotherapy can be given in several ways. For breast cancer the drugs are most commonly fed into a vein (given intravenously) by a drip or injection in the hand or arm or given by mouth (orally) as a tablet or capsule. Intravenous chemotherapy This involves inserting a fine tube called a cannula into the vein and injecting the diluted drug over a period of several minutes. Alternatively, if a large volume of liquid needs to be given, it would need to be dripped in via the cannula over a period of several hours. Sometimes a special intravenous line is used, for example a Hickman line, which stays in place throughout the course of treatment. Hickman line A Hickman line is a special catheter or fine tube, which is inserted into a large vein through a small cut in the chest wall. It can stay in place for several months, which means that you don't need to have a cannula put into the vein each time you have a course of treatment. Blood samples can also be taken from the line. The line can be put in under a local or general anaesthetic. A tunnel is made under the skin and the line is inserted into a large vein that leads to the heart. Attached to the Hickman line is a small cuff that lies immediately under the skin at the exit site. Tissue eventually grows around the cuff, which helps to keep the line firmly in place. Care must be taken to keep the entry site clean to minimise the risk of infection. Your chemotherapy nurse will explain what you need to do to take care of your line. After the treatment has finished the line will be removed under a local anaesthetic. Who might be offered chemotherapy Whether or not you are offered chemotherapy depends on your individual situation. Various factors are taken into consideration. You will usually be offered chemotherapy if the cancer cells have been found in the lymph glands (nodes) under the arm. Even if there is no spread to the lymph glands, chemotherapy may be offered if the tumour is over a certain size (over 2cm) or if the cancer cells are dividing rapidly, which means that the risk of them spreading is greater. How much benefit might I expect? Research now shows that many women of all ages can benefit from chemotherapy. The degree of benefit will vary from woman to woman and again will depend on several factors. These include what type of breast cancer you have, the size of the tumour, the stage of the cancer (extent of spread) and the grade of the tumour (potential to spread). In some circumstances the benefits of chemotherapy are clear-cut. In other circumstances the benefits are less clear. It can be difficult to decide whether or not to have the treatment and you may need to weigh up the likely benefits against the potential side effects. Your decision may be influenced by factors such as your personal priorities, your family and your work commitments. It is important for you to feel you can discuss these issues openly with your cancer specialist or breast care nurse, who will help and support you with your decision. When is chemotherapy given? Chemotherapy is increasingly given in addition to surgery and/or radiotherapy, and this is called adjuvant chemotherapy. In most situations chemotherapy is given after surgery, and before radiotherapy, although this can vary depending on your individual circumstances. Chemotherapy usually starts between two and four weeks after surgery, giving your body some time to recover from the effects of the operation. In certain circumstances chemotherapy is given before surgery. This is known as primary chemotherapy. For example, it may be used for tumours that are growing rapidly or to shrink larger tumours before surgery. If you are offered primary chemotherapy your specialist or breast care nurse will explain the reasons. Chemotherapy may also be used to slow down the growth of secondary cancer (cancer that has spread from the original tumour to other parts of the body) and to help relieve symptoms such as pain (palliative treatment). What side effects might I experience? Chemotherapy drugs act by destroying cells, particularly cancer cells, which divide rapidly. Because normal cells are also constantly dividing and growing they can be affected too and this can cause side effects. The aim is to give a sufficient dose to kill the cancer cells while causing the least amount of damage to normal cells. Normal cells, however, can repair themselves quickly, which means that side effects are usually temporary. Chemotherapy affects people in different ways. Two people receiving the same combination of drugs may feel completely different during the course of their treatment. Some people experience few side effects and are able to continue with their usual activities while others find their lives are affected to varying degrees. Some of the most common symptoms are tiredness, nausea, vomiting, diarrhoea, sore mouth or ulcers and hair loss or thinning. Sometimes the treatment can affect your bone marrow. If you have any side effects they can usually be controlled. Talk to your chemotherapy nurse or cancer specialist about any particular concerns you may have so that you can both consider what might help you. Nausea and vomiting The likelihood of you experiencing nausea following your chemotherapy will depend on the type and the dosage of the drugs you receive. Other characteristics particular to you can also influence how you respond to treatment. For example, you may experience sickness if you are very anxious or if you are prone to seasickness, carsickness or morning sickness in pregnancy. Nausea can start immediately after chemotherapy or up to several hours later. For some it can last for several hours and or others it can persist for several days. Do tell your chemotherapy nurse or cancer specialist if this is a problem for you as nausea and vomiting can usually be controlled or at least lessened. Several types of anti-sickness drugs are available and these can be tailored to your individual needs. Sometimes it might be necessary to use a combination of drugs to get relief. This may include taking steroids for a short time. You may also want to try some form of complementary treatment such as relaxation therapy, hypnosis or aromatherapy. Some people find a sea-band helpful - this is a wristband which, when worn correctly, stimulates a particular acupuncture point in the wrist and may relieve the nausea. Sore mouth (mucositis) A small number of women may have a sore mouth or gums. In addition mouth sores can become ulcerated or infected so good mouth hygiene is important during treatment. If you already have adental problem (cavities or gum disease) see your dentist so that the problem can be sorted out before treatment begins. Hair loss or thinning Hair loss can be one of the most distressing side effects of chemotherapy but knowing it is a possibility can help you cope more easily. Not all chemotherapy drugs cause hair loss. Some only cause thinning while others may not affect the hair at all. Some drugs are more toxic than others so the likelihood of you losing your hair depends on the type of drugs you are given and the amount used. If you lose your hair it usually happens gradually and begins within two to three weeks of starting treatment. You may lose all your body hair, including eyebrows and eyelashes, which can be a shock. Remember that hair loss is temporary and your hair will grow back after treatment has finished. Sometimes regrowth starts before the end of treatment. Bone marrow suppression Bone marrow is the spongy material found in the hollow part of the bones. It is here that blood cells are madebefore being released into the bloodstream as: § white cells (responsible for fighting infections) § red cells (responsible for carrying oxygen around the body) § platelets (responsible for helping the blood to clot). Chemotherapy can affect the bone marrow, reducing its ability to make these cells. Before each course of chemotherapy begins you will have a blood sample taken to ensure that the levels of these cells are within safe limits. Between courses you need to let your specialist know about any signs that might mean you have a low blood count. If your white cells are low this means that you are more prone to infections. It is important to tell your GP about any sign of infection such as a high temperature or sore throat as soon as possible. Antibiotics can be prescribed if necessary. If your red cells are lowthis means that you are anaemic. The signs to look out for include tiredness, generally feeling low or shortness of breath. Although these symptoms can also be related to other causes it is important to report them to your specialist. The cells generally recover on their own, but if necessary you can be given a blood transfusion. If your platelets are low you might show signs of bruising or bleeding more easily, such as after brushing your teeth. A platelet transfusion can be given if required though this is not often necessary. For some people the blood cells can be affected to such a degree that treatment has to be postponed. This can be a worry or a frustration butit is important to remember that it should not affect the overall outcome of your treatment. The cells generally recover sufficiently within a week, at which point treatment can start again. Are there other side effects? Different drugs have different side effects: some of these side effects are less common than others. It is important to remember that no everybody is affected to the same degree. This section is from "Chemotherapy" one of Breast Cancer Care booklets and is used with permission. For further details go to www.breastcancercare.org.uk |