Chemotherapy is anticancer or cytotoxic medication. It is the use of drugs to kill cancer cells.
Adjuvant chemotherapy is chemotherapy that is used after surgery to destroy any cancer cells that may have escaped into the bloodstream. These cells are usually too small to be seen on preoperative scans of the body or in blood tests.
Chemotherapy works by stopping the growth of fast-growing cells. It can also act on normal cells. Normal cells however will usually recover from the chemotherapy treatment but cancer cells do not recover as effectively. As normal cells can also be affected, some patients will have side effects associated with this.
Chemotherapy is usually offered when there is a chance that the cells may have moved past the breasts and the lymph glands into the rest of the body. The medical oncologist will look at the size of the tumour, the grade of the tumour, the number of lymph nodes involved, and the age of the patient in order to determine if chemotherapy is recommended.
Surgery and radiotherapy may be effective alone if the probability that the cancer cells have not spread outside the breast and lymph gland is low.
Chemotherapy medicine can be given in many different forms and there are many different types. It could be given as oral medications or intravenously for a drip. Some women that will be required to have prolonged chemotherapy and have poor quality veins in their arms will be offered a special arm port. This is a permanent port that will be placed in the arm and accessed to deliver the intravenous medication. It can be removed at the end of treatment. Arm ports are more cosmetically appealing to patients. In the past, patients would have ports placed in their chest wall. This can be associated with scarring on the décolletage.
Chemotherapy is usually given in a specialised chemotherapy unit with special medical oncology nurses under the care of medical oncologist. It is usually an outpatient procedure and normally requires the patient to be in the hospital for a few hours on a single day. It is recommended that patients have someone to drive them home after the treatment. Patients may also be admitted overnight after their chemotherapy treatment, in particular after the 1st treatment.
A Chemotherapy session is termed a cycle and usually chemotherapy for breast cancer will be given in 4-6 cycles. The patient will attend every 3 weeks over 4 sessions or 6 sessions and some patients will be required to come on a weekly basis for 8 or 12 weeks.
Infusion of the chemotherapy itself does not cause pain. Many different regimes will be tailored to individual patients. Patients will have an education session before undergoing chemotherapy.
Most patients worry about the side effects of chemotherapy. There are a variety of side effects. Some patients will have no side effects and will continue to be active on days surrounding their chemotherapy day. Some women will have minor side effects and will require a few days off work. Other women will have significant side effects and will have time off work. It is impossible to predict how patients will tolerate medication or what side effects they will have. There are however a variety of modern medications that are used to counteract the side effects of chemotherapy.
The most common side effect reported during chemotherapy is tiredness. Usually this will resolve a few days after the treatment and patients are encouraged to rest for a few days after the treatment and then try and get back to their normal activities. There is evidence to suggest that regular exercise will reduce fatigue associated with chemotherapy.
Some patients will have alterations in the way food smells and tastes to them. Some will describe this as a metallic taste. These changes are called dysgeusia.
Nausea and vomiting are common side effects of chemotherapy however there are excellent anti-nausea treatments that control these side effects. Some patients will not experience nausea and vomiting as a side effects at all. If patients are going to experience it, it usually occurs 6 hours after chemotherapy and can last from hours to days. All patients will routinely receive anti-nausea medication to prevent nausea before it develops.
Hair loss (alopecia) is a common side effect of all chemotherapy agents used for breast cancer. It is usually the most feared side effect. It usually starts within a few weeks of the 1st dose of chemotherapy and the pattern of hair loss can be gradual thinning to complete loss of hair. Hair loss will also be experienced on other parts of the body and will usually begin to regrow after the treatment finishes at approximately 1 cm each month. The hair may be different colour or texture when it returns.
Most major specialist chemotherapy centres around Australia will offer their patients access to a scalp cooling machine. This scalp cooler will be used during delivery of chemotherapy. The device will be left on the head for approximately another hour after the chemotherapy has been infused and therefore it does slightly prolong the chemotherapy session but there have been good results for women that have used it in maintaining their hair particularly women that have thick hair before undergoing chemotherapy. The device can be uncomfortable as it causes vasoconstriction to the blood vessels of the scalp and it therefore may not be well tolerated by women that have intolerance of the cold.
A Variety of medications can be used to improve
the comfort of wearing the scalp cap. Not all of the hair may be maintained but enough hair may be maintained such that women do not feel the need to wear any headwear when in public.
Chemotherapy can also affect the blood count and patients will be required to undergo a variety of blood tests during their treatment. Patients may have a fall in their red blood cells and therefore have anaemia. Patients may also have a drop in their white blood cells. These are cells that help fight infection and may be more susceptible to infection. Patients may also have a drop in their platelets meaning that they will bruise more easily and bleed for longer than normal after a minor injury. A special medication called pegfilgrastim (Neulasta) may be given on the day after chemotherapy to support the blood count if the patient has been prone to a drop in their blood cells. Chemotherapy dose may also need to be adjusted and occasionally antibiotics may need to be prescribed. A drop in blood cells can be life threatening and therefore any patient that has a fever (temperature greater than 38 degrees) may be related to a low white blood cell count and patients should contact their doctor immediately. This can be a medical emergency as the body is unable to fight infection in the usual way.
Some chemotherapy drugs can give sore mouth, mouth ulcers, or mouth infections, therefore oral hygiene is very important. This will include using special soft toothbrushes and a mouthwash.
Skin sensitivity may be a side effect. The skin may be more sensitive to sun or it may become dry and itchy or there may be a change in pigmentation. It is important to keep the skin moist by using moisturising creams such as Sorbolene and try and avoid daylight sunlight, use SPF50+ sunscreen when in the sun.
Chemotherapy can impact on fertility and cause periods to stop. This may be temporary or permanent and chemotherapy can bring on early menopause. This depends on how old the patient is when they undergo the chemotherapy and what medications have been used. It is important that young women have a chance to see a fertility specialist before undergoing chemotherapy so that they can be given the opportunity to have eggs or embryos frozen before undergoing chemotherapy.
It is also important that patients do not become pregnant during chemotherapy. It is recommended that barrier contraceptive method such as a condom is used.
Indigestion and heartburn are often made worse during chemotherapy. One of the medications known as dexamethasone can increase the acid production in the stomach. This is commonly used as an anti-nausea tablet. There are a variety of medications that can be used to treat heartburn or indigestion.
Patients may also report change in bowel habits such as diarrhoea or constipation. Constipation can be easily controlled with medications such as laxatives though it may occur as a side effect of some of the medications.
Some women will be able to work during their chemotherapy and others will not. A supportive workplace with flexible work hours is helpful and a doctor can always provide a medical certificate for patients that require time off. In the initial days after chemotherapy, it is important to drink plenty of fluids and get some rest.
