Chemotherapy is a systemic approach to breast cancer treatment, in which chemicals are introduced into your bloodstream with the intention of killing cancer cells. But chemotherapy is not selective in which cells are affected, so healthy noncancerous cells may be damaged as well. Chemotherapy affects other fast-growing cells in the body. This contributes to the hair loss that is one of the most feared and thought about side effects of chemotherapy. More importantly, chemotherapy also affects the rapidly dividing cells of the bone marrow, which is where your red blood cells, white blood cells, and platelets are manufactured on an ongoing basis. These make up the life force of your blood and influence your health in many ways.
In Her Own Words
Before chemo treatments begin, you'll be given a prescription for anti-anxiety meds, the filling of which is optional. In my opinion, it should be mandatory. Granted it is different for everyone, but in my experience taking these drugs was extremely helpful until two months after treatment.
— Mary, age 51, 4-year survivor
Red blood cells are the oxygen-carrying cells that circulate in your body's system and keep it working. A low red-cell count contributes to feelings of low energy and weakness. A low white blood cell count affects your body's ability to fight infection. Conversely, if the white blood cell counts are high, it shows that the body is fighting some type of foreign body, such as an infection. Because chemotherapy affects normal cell division, it is given in cycles, so that the blood-producing cells in the bone marrow can recover (and you can begin to recover as well) before the next cycle of treatment.
Routinely, prior to receiving chemotherapy, blood work is done in the doctor's office to monitor your cell counts, to make sure you are well enough to receive your next infusion or injection. During your course of chemotherapy, your treatment may be delayed because your blood counts have not been given enough time to recover.
It may come as a surprise to you that if your chemotherapy is delayed because of your blood counts, you may be disappointed rather than relieved. This is because you want things to go as scheduled. Remember that the immune system varies from individual to individual and the goal is to kill cancer cells, but not at the expense of your immune system being so depleted that the bone marrow isn't able to recover.
The concept behind chemotherapy is to interfere with cancer cell growth at various stages of its growth. The term chemotherapy refers to the infustion of drugs that can kill cells, hopefully more cancer than normal cells. Chemotherapy drugs are classified based on how they work. Some of the main types of cytotoxic (cell-killing) chemotherapy are:
Alkylating drugs kill cancer cells by directly attacking DNA, the genetic makeup of the genes. (Example: cyclophospha-mide, brand-name Cytokan)
Antimetabolites interfere with production of DNA and keep the cells from growing and multiplying. (Example: 5-fluorouracil; also referred to as 5-FU)
Antitumor antibiotics which are made from natural substances, interfere with cell functions, production of DNA, and cell proteins. (Examples: doxorubicin and bleomycin)
Plant alkaloids prevent cells from dividing normally. (Examples: vinblastine and vincristine)
This list gives an indication of why combination chemotherapy recipes are used — each drug affects the cancer cells differently. One may interfere with the DNA in the cell and cell division while another drug may act on how fast cells divide. Another way to think of chemotherapy is to refer to treatment with drugs as the “medical” therapy of breast cancer. There are now multiple categories of medicines used, including cytotoxic chemotherapy, hormonal approaches, and antibodies such as trastuzumab and bevacizumab. There will be more categories of medicines as understanding of cell biology increases.
What to Expect at Your Treatments
Once the combination recipe has been decided on, you will be scheduled for your chemotherapy treatments. Chemotherapy is administered by infusion or injection, and usually requires a course of treatments over a period of weeks. Infusion treatment can take a long time, and you might need to prepare to spend the better part of or an entire day at the clinic (see Appendix D for a list of what to bring to your chemotherapy appointments).
The Decision to Have Chemotherapy
Early stage breast cancer offers many options for treatment and treatment recommendations are based on lymph node involvement, the size of the tumor, the grade of the tumor, and other cell characteristics seen under the microscope that suggest the behavior of the cancer (for instance, it is likely to have already spread to other parts of the body). However, you are an equal partner in the decision to have chemotherapy and you need to carefully review your options with your doctor, along with your support system or family, and then make your own decision after these detailed discussions.
Age, life goals, medical history, family history, philosophy, and personal needs are all important considerations that may weigh into the decision on whether to have adjuvant chemotherapy. When there is no lymph node involvement, some chemotherapy choices considered are four cycles of AC, which is short for the combination of doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan); or six cycles of CMF, which is short for the combination of cyclophosphamide (Cytoxan), methotrexate, and 5-fluorourcal (5-FU). These chemotherapy regimes occur about every three weeks. However, chemotherapy regimens are changing all the time. Coauthor Dr. Stewart favors an approach that encourages participation in national clinical trials or use of a “standard” regimen that has been validated in national clinical trials.
In Her Own Words
Adequate hydration is the key to managing chemotherapy. Drink as much water as you can, start the day before chemo and continue for three days after your treatment. Staying hydrated prevents many side effects and helps circulate the medications to every area of the body. Antiemetics are medications to prevent nausea and vomiting; they are extremely effective. Take these medications with the first signs of nausea.
— Suzanne, age 52, one-year survivor
Chemotherapy is an option with node-positive breast cancer, especially if the tumor is estrogen-receptor negative. The chemotherapy is given in addition to other treatment, such as radiation, and hormone therapy, depending on the situation. Also, an individual's age or medical status may prohibit chemotherapy treatment. An oncologist may recommend surgery first for a case of advanced local breast cancer disease. And in metastatic breast cancer that has spread to other organs, whether the tumor is estrogen-receptor positive or negative may determine the treatment regimen recommended.
Whatever treatment you choose, once the decision is made, keep your goals in mind.
Side effects of chemotherapy can include hair loss, yellowing of the skin, brittle nails, susceptibility to infection, nausea and vomiting, headaches, depression, loss of appetite, mouth sores, and fatigue. (This is not a complete list. Consult your doctor if you experience other serious side effects of your chemotherapy.) You may experience some or all of these side effects, but fortunately most of these are temporary. The most common are mouth sores, fatigue, and vomiting. Mouth sores can be treated with a non-alcohol mouthwash to avoid irritation of the lining of the mouth, but fatigue might be the result of anemia, and may indicate that you'll need medication to get more iron into your blood. You might find that stomach upset and vomiting can exacerbate the dehydration also typically experienced by chemotherapy patients, and so you'll need to request anti-nausea medication from your doctor. Other homeopathic approaches will be discussed in Chapter 11.