Breast cancer chemotherapy: everything you need to know

Chemotherapy or often abbreviated as chemo, is one of the main treatments for breast cancer. Chemo can effectively kill and eliminate cancer cells in the breast so they don't come back. However, quite a number of women are hesitant to undergo breast cancer chemotherapy because of the risk of side effects that may arise. Is that always true? Read more here.

What is breast cancer chemotherapy?

Chemotherapy is a cancer treatment using special drugs that kill cancer cells, in this case breast cancer.

Breast cancer chemotherapy drugs are usually injected into a vein through a needle, IV line, or catheter in the hand or wrist. A catheter port may also be implanted in the chest before starting breast cancer chemo.

This catheter port will continue to be inserted as long as the chemotherapy series is still ongoing. Therefore, you should be careful, including if you want to travel by plane. Explain to the officer about your condition.

However, sometimes chemotherapy drugs can also be taken directly or given by injection into the spinal fluid that surrounds the brain and spinal cord.

Through these pathways the drug will flow in the bloodstream to reach the cancer cells around the breast tissue.

When do breast cancer patients need chemotherapy?

Not all women with breast cancer need chemotherapy immediately. Usually this procedure will be recommended under certain conditions and times, namely:

After surgery (chemo adjuvant)

Chemo is usually needed after surgery to kill breast cancer cells that may remain or spread, but are not visible on imaging tests. If allowed to grow, cancer cells can form new tumors in other parts of the body.

In addition, this procedure can also reduce the risk of breast cancer growing back. This chemotherapy is usually given to those of you who are at high risk of recurrent cancer, or if cancer cells have spread to other parts of the body.

Before surgery (chemo neoadjuvant)

Chemotherapy is also usually done before breast cancer surgery to reduce the size of the breast tumor, making surgical removal of the tumor easier.

Neoadjuvant chemotherapy can also help doctors see how the cancer responds to a given drug. If the first course of chemotherapy doesn't shrink the tumor, this is a sign that you need another, stronger drug.

In addition, chemotherapy can also reduce the risk of breast cancer recurrence. Neoadjuvant breast cancer chemo is usually used for patients with certain types of breast cancer, such as

• Inflammatory breast cancer.
• HER2-positive breast cancer.
• Triple negative breast cancer.
• Cancer that has spread to the lymph nodes.
• A large tumor.
• Tumors that are aggressive or spread easily and quickly.

Advanced breast cancer

Chemotherapy is usually done for cases of breast cancer that has spread beyond the breast, including the armpits. Usually, chemo is done in conjunction with other breast cancer treatments, namely targeted therapy.

However, in this condition, chemotherapy is done not to cure, but to improve the quality of life and extend the patient's life expectancy.

Medicines used in breast cancer chemotherapy

Breast cancer chemotherapy is most effective when several combinations of drugs are used. Several types of drugs are usually given in chemotherapy, namely:

• Anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence).
• Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere).
• 5-fluorouracil (5-FU).
• Cyclophosphamide (Cytoxan).
• Carboplatin (Paraplatin).

Usually doctors most often combine 2-3 drugs or this regimen in breast cancer chemotherapy.

Meanwhile, for advanced breast cancer, breast cancer chemotherapy drugs are used, namely:

• Taxanes, such as paclitaxel (Taxol), docetaxel (Taxotere), and albumin-bound paclitaxel (Abraxane).
• Anthracyclines (Doxorubicin, pegylated liposomal doxorubicin, and Epirubicin).
• Platinum agents (cisplatin, carboplatin).
• Vinorelbine (Navelbine).
• Capecitabine (Xeloda).
• Gemcitabine (Gemzar).
• Ixabepilone (Ixempra).
• Eribulin (Halaven).

Although a combination of drugs is often used, advanced breast cancer is more often treated with chemotherapy alone. However, there is still chemo with a combination of drugs, such as paclitaxel plus carboplatin to treat advanced breast cancer.

For HER2-positive breast cancer, the doctor will administer one or more HER2-targeted drugs to be combined with chemo.

Preparations before breast cancer chemotherapy

Before undergoing chemo breast cancer, you may need to do blood tests and several other tests, such as a CT scan, to make sure this treatment procedure is safe. The doctor will also check your height and weight as well as your general health condition to determine the dosage of the drug.

Reporting from Cancer Research UK, blood tests will be done a few days before or on the same day when chemo starts. Blood tests will also be done at each chemo cycle, before the treatment is started.

These tests are needed to check your liver, kidney, and heart function. If problems arise in these organs, chemotherapy treatment may be postponed or the doctor will choose the drug and chemotherapy dose according to your condition.

Steps to improve health

Breast cancer chemotherapy can affect healthy cells, such as white blood cells, platelets, and red blood cells. Therefore, you need to keep your body fit before and after chemotherapy, to minimize side effects, by:

• Get plenty of rest.
• Stay active and exercise regularly for breast cancer patients.
• Eating nutritious foods, such as fruits, vegetables, and foods for other breast cancer sufferers.
• Reduce stress by doing fun things.
• Avoid various infections, such as flu, by wearing a mask and washing your hands diligently.
• Go to the dentist to check the teeth and gums for signs of infection.

Before doing chemotherapy for breast cancer, you also need to tell your doctor about the drugs and supplements you are taking. This is because certain drugs can interfere with chemotherapy drugs.

Apart from doing things related to the condition of the body, the doctor will also provide a form to be signed. This form usually contains your willingness to take chemotherapy along with an explanation of its benefits and risks.

In addition, the doctor or nurse will also tell you what foods and drinks can and should not be consumed while undergoing chemotherapy.

How long does chemotherapy for breast cancer take?

Breast cancer chemo usually includes a course of treatment that can consist of 4-8 cycles. Each cycle can last for 2-3 weeks.

The schedule for administering the drug depends on the type and dose of drug used. For example, chemo drugs may only be given on the first day of the cycle, on several consecutive days, or once a week, while the remaining days are used to recover from the effects of the drug.

After the first cycle is complete, the next cycle will be carried out with the possibility of repeating schedules. However, each time you want to start a new cycle, your doctor will check your condition and how well the previous treatment worked. The doctor can then adjust the further treatment plan so that the recovery process is smooth.

In general, a series of chemo can last for 3-6 months, or longer, depending on the stage of your breast cancer.

Chemotherapy side effects are the most common

Breast cancer chemotherapy has some common side effects. The side effects you experience depend on the type and dose of medicine you receive, the length of your treatment, and your overall health, including how your body responds to the drugs.

The side effects felt by each patient may be different even though they are given the same regimen.

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

Short term side effects

Short-term side effects are almost certainly felt by everyone undergoing chemotherapy, including for breast cancer. Breast cancer chemo drugs will spread throughout the body so that they generally also damage other healthy cells in the body.

In general, chemotherapy for breast cancer has various effects such as:

• Hair loss.
• Fatigue, due to a low red blood cell count.
• Loss of appetite.
• Nausea and vomiting.
• Constipation or diarrhea.
• Mouth sores.
• Nails are more brittle.
• The risk of infection increases because there are fewer white blood cells that fight infection.
• Nerve damage or neuropathy, such as numbness of the hands and feet, pain, tingling, sensitivity to cold or heat, and weakness.
• Problems with cognitive function that affect memory and concentration.
• Easy bruising or bleeding, due to a low platelet count.
• Eye pain, such as dry, red, or itchy eyes, watery eyes, or blurred vision.

Always tell your doctor about any side effects you feel. If the effects are too severe, the doctor will give you an antidote to minimize side effects.

Long term side effects

Chemotherapy drugs for breast cancer can also cause various long-term side effects, such as:

• Infertility or fertility problems

Some anticancer drugs can damage the ovaries and make women infertile. This effect can cause menopausal symptoms, such as hot flashes and vaginal dryness. In addition, menstruation can also be irregular or even stop completely. If ovulation stops, pregnancy becomes impossible.

• Osteopenia and osteoporosis

Women who experience premature menopause due to chemo breast cancer are at high risk of experiencing bone loss. Bone loss is a factor that causes osteopenia and osteoporosis.

• Heart damage

Breast cancer chemotherapy risks weakening the heart muscle and causing other heart problems. Even though the risk is small, you still need to be vigilant and see a doctor if there are any unusual symptoms in the heart.

• Leukemia

Chemo for breast cancer can also trigger the appearance of other cancers, such as leukemia. This condition often appears several years after chemotherapy is finished.

Apart from various physical complaints, chemotherapy for breast cancer can also cause serious mental problems. Anxiety to depression is often a mental problem experienced by people with breast cancer.

For that, consulting a psychologist or joining a group with breast cancer can be a solution that is worth a try. In addition, you also need to always consult a doctor if you have certain plans, such as pregnancy.

What needs to be done after chemotherapy?

After breast cancer chemotherapy, the doctor will ask you to have regular checkups every 4-6 months. This is done to monitor the conditions and long-term side effects that you experience. Doctors will also continue to monitor the presence of cancer cells whether there is a risk of reappearing or not.

During consultation, the doctor will generally perform a physical examination, such as a breast examination and other symptoms that you experience, including when breast cancer symptoms come back. You are also advised to have a mammography every year, or other breast cancer tests if needed.

If you feel any unusual symptoms, you can write them down and report them to the doctor concerned. Don't hesitate to see a doctor if you find a variety of worrisome symptoms during breast cancer chemotherapy recovery.