Chemotherapy
The goal of chemotherapy
is to kill cancer cells that are growing or dividing quickly. It’s a powerful tool to treat cancer and to protect you from a recurrence.
Unlike surgery or radiation, chemotherapy affects all quickly dividing cells, even healthy ones. This is what causes some of the common side effects that often go along with treatment.
Every person is unique, so whether you receive chemotherapy depends on many factors.
These include:
- The specific type of cancer cells
- Your age and whether you have gone through menopause
- The size of the primary tumor
- Whether you have cancer in your lymph nodes
- The details of the breast cancer, as explained by pathology tests and sometimes by genomic tests
How Chemotherapy Works
Chemotherapy involves taking anti-cancer medicines by injection into a vein (intravenously) or as a pill. These medicines travel throughout the body, where they destroy cancer cells that may have entered the bloodstream.
Even in early-stage breast cancer, tiny cancer cells can break away from the original tumor. Typically, these cells are so small that they don’t show up on any tests. Chemotherapy lowers the risk for recurrence, or the cancer coming back, by killing these tiny cancer cells.
Often, two or more chemotherapy medicines are given together. Intravenous chemotherapy is given in cycles, with a day (or days) of treatment followed by a period of “off” days. The exact schedule varies depending on the medicines. Most breast cancer chemotherapy regimens are given every 2 or 3 weeks. They sometimes can be given weekly. An entire course of chemotherapy for breast cancer usually takes from 3 to 6 months.
How Do You Know if You Need Chemotherapy
Your doctor will recommend chemotherapy if the cancer has a significant risk of developing outside your breast or has traveled outside the breast already. Chemotherapy is given if you have a large tumor, cancer in the lymph nodes or a tumor with features that make it aggressive.
Sometimes it’s unclear whether you should receive chemotherapy. Your doctor can request a genomic test to help you decide. Genomic tests look at groups of genes in breast cancer cells to see whether they are present, absent or too active. These factors help to predict how likely it is that the cancer will come back after treatment.
Genomic tests are only used for certain kinds of early-stage breast cancers. Your doctor may ask for a genomic test if
- the tumor is small
- the cancer has not traveled to the lymph nodes
- has hormone receptors on it and
- doesn’t have too many HER2 receptors
Chemotherapy Side Effects
Many people have scary images of chemotherapy, and associate cancer with chemotherapy’s side effects. These can include hair loss, nausea and vomiting, weight gain or loss, fatigue and insomnia, dry mouth, dry skin, mouth sores and even something called chemobrain, which is connected to problems with memory and concentration. Other side effects associated with chemotherapy include low blood counts and diarrhea.
The truth is that while some people have a rough time with chemotherapy, others manage quite well. Many continue to work, and others report feeling only mild discomfort. Today, there are many effective treatments to manage some of these side effects. Everyone has their own individual response.
If you become uncomfortable during treatment, there are many medicines and methods to help you. Let your doctors and nurses know about your concerns before you start treatment. Your team has many options to lessen, manage or stop side effects.
Neoadjuvant vs. Adjuvant Chemotherapy
Chemotherapy for breast cancer can be given either:
- before surgery, which is called neoadjuvant therapy, or
- after surgery, which is called adjuvant therapy.
So far, research has found both options to be just as effective at lowering the risk of cancer return and prolonging life.
Most chemotherapy for breast cancer is given as adjuvant therapy, after and in addition to surgery. Therapy usually begins about a month after surgery, once you have had a chance to heal.
Your doctor also may offer you the option of neoadjuvant treatment, which means chemotherapy before surgery.
There are two possible benefits of neoadjuvant treatment:
- It may shrink the cancer so you have to have less extensive surgery.
- If the cancer is very big when you are diagnosed, you may need treatment to reduce it before it can be removed.
- Or you may have the option of having lumpectomy instead of mastectomy
- Getting chemotherapy before surgery gives your doctors information about how the cancer responds to treatment. If one chemotherapy medicine doesn’t shrink the cancer, your doctor will have information to use when choosing which medicine to try next.
Common Questions About Chemotherapy
Here are some questions to ask when you are considering chemotherapy treatment:
- Is the cancer HER2-positive? Trastuzumab (Herceptin) has been proved very effective in clinical trials when given with chemotherapy.
- Is the cancer hormone receptor-positive?
- If it isn’t, you will not benefit from hormonal therapy.
- If it is, ask your doctor how much chemotherapy could lessen your risk of recurrence.
- If it isn’t, you will not benefit from hormonal therapy
- Is the cancer triple-negative? Chemotherapy has been shown to be very effective for this diagnosis.
- Is the cancer in more than three lymph nodes?
- This suggests an aggressive cancer. Chemotherapy is very likely to benefit you.
- This suggests an aggressive
- Do you have other serious health problems? Share all past and ongoing health concerns with your doctor.
- How much will chemotherapy improve the odds the cancer will not return?
- Even if chemotherapy lessens the chances for recurrence by 1 or 2 percent, that might be meaningful to you.
- How much risk can you tolerate? Consider how you feel about risk in other parts of your life.
- You can’t completely rid yourself of cancer risk, but taking chemotherapy might be personally important for you.
- Do some medicines have more side effects than others? Some medicines work equally well but have different side effects.
- Will having chemotherapy make you less worried about you risk for recurrence?
- You know yourself best. Consider what worries you most: The risk for recurrence or the risk of side effects.
