Chemo Regimen FAQs: EC Chemotherapy

PJ Hamel Health Guide

  • Q. I wish it weren’t so, but I’ve been diagnosed with breast cancer that has spread to my lymph nodes, and I need to have chemotherapy. The doctor says I’ll be getting EC. What does that mean? What’s in store for me?

    A. EC stands for e
    pirubicin (Ellence) and cyclophosphamide (Cytoxan), the two drugs that will team up to attack your cancer cells. (Don’t worry, there won’t be a written quiz on this; all you have to remember is EC.)

    What exactly do these drugs do? Well, each attacks your cancer cells in a slightly different way. First off, “E” has lots of tricks up its sleeve. It stops the enzymes that support cell reproduction; it damages the cell by altering its membranes; and it stops cell reproduction by attaching itself to the cell’s DNA, which then gets tangled up and is unable to replicate itself (pretty sneaky, huh?). “C” sticks to the cell’s DNA, like “E,” preventing it from replicating. And that, really, is what killing cancer is all about: stop the cells from dividing, and you stop the cancer.
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    Q: And how long does EC chemotherapy treatment take?

    A. Though EC delivery methods and schedules vary, as the pharmacology is constantly changing, the majority of women being treated with EC get it intravenously, every three weeks, for four to six treatments. It takes about three to four months to complete an EC chemotherapy regimen, barring any complications that slow down the process. And the EC treatment itself takes between one and two hours. Add to that the ride to and from the hospital, the blood tests before (to make sure your white cells are up to the battle), and the inevitable waiting around, and you’re looking at up to half a day each time. Bring stuff to distract or amuse yourself: books, knitting, a friend or family member. You don’t want to just sit around and twiddle your thumbs the whole time.

    Q. You mentioned complications…

    A. You'll have blood drawn first before you start each EC treatment. One of chemo’s side effects is lowering your white blood cell count; i.e., killing off some of the cells that help fight infection. If your doctor decides your white cell count isn’t high enough to keep you healthy, he or she will delay your next EC chemo treatment until your white cells have built themselves back up to an acceptable level.

    Q. Well, three to four months… OK, but next question: just how miserable are the side effects of EC chemo going to make me?

    A. It depends. Every woman has a different reaction to chemo. Some women breeze through it with very little discomfort; for others, it’s very challenging. Here’s a roundup of the main side effects you MAY experience. Remember, you may face very few, or possibly all of these. Please don’t look for trouble, but you may as well understand what MIGHT happen.

    Hair loss: “C” thins your hair, but “E” really does a number on it. Yup, you’re going to lose it: not just the hair on your head, but probably a lot of your body hair, too (pubic, under your arms, legs, perhaps your eyelashes and eyebrows…) Losing the hair on your head, obviously, is what you’ll find most disturbing; but there’s lots you can do to cope, including a wig, head scarves or hats, or just saying the heck with it and going bald. Believe me, waiting to lose your hair (it’ll take 3 to 4 weeks, probably, after your first treatment) is the toughest part. Once it’s gone, you just deal. And, just think: you can put away the safety razor for months. No more shaving your legs or under your arms!

  • Loss of appetite/metallic taste in your mouth: These two are allied. Many women report having a metallic taste in the mouth after EC treatment; to me, if tasted like licking the lid of a tin can. This can certainly cut back on your appetite! Not much you can do about this one. Try to eat small meals if that’s what you can manage, enough to keep you going. Don’t eat spicy foods in an attempt to “drown out” the metallic taste; it won’t work, and may give you mouth sores. Speaking of…

    Mouth and throat sores: These feel like a series of cold sores inside your mouth and partway down your throat. Obviously, it makes eating a pain–literally. Try chewing on ice chips the first 5 to 10 minutes of each EC treatment; some women have reported success with this method of preventing sores. If sores develop, ask for medication from your doctor. They have stuff that can help. Oh, and don’t use harsh mouthwash or eat spicy foods when you have mouth sores; either of those will exacerbate the situation.
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    Nausea/vomiting/diarrhea: All three of these are a possibility with EC. The good news is, this unpleasant side effect is much, MUCH better controlled than it used to be, via medication. So don’t listen to anyone’s awful stores about when they had chemo 5 years ago and how sick they were! TIMES HAVE CHANGED.

    You’ll probably get some anti-nausea drugs right along with your treatment, plus some to take home, just in case. If you feel nauseous, and you’ve taken your medication, don’t suffer in silence! Call the doctor and get a prescription for something else. There are all kinds of anti-nausea drugs they can try; it’s not one-size-fits-all. They’ll keep trying till they find what works best for you.
    Bladder irritation: “C” will possibly cause some bladder irritation, which may feel like a mild bladder infection. Drink plenty of fluids; this will help allay the discomfort. And mention to your doctor that you’re feeling uncomfortable; he or she may want to check to make sure you don’t in fact have a bladder infection.

    Loss of fertility: Your ovaries will stop releasing eggs while you’re having treatment. Whether or not you get your period back once you’re done depends a lot on age: the closer you are to natural menopause, the more likely you are to be permanently infertile (menopausal). “Chemical menopause” caused by chemotherapy has all the possible range of symptoms of normal menopause, but condensed into a smaller timeframe. The bad news is, it’s more intense. The good news is, you get through it faster!

    Fatigue: This is pretty much a given with any kind of chemo, including EC. You’re losing a fair number of red blood cells, the cells that carry oxygen around your body. You’ll find it harder than usual to do just about anything, from getting out of bed in the morning to climbing a flight of stairs to simply doing the dishes. Be good to yourself; rest when you need to. On the other hand, don’t just lie around constantly; exercise, even if it’s only a short walk around the yard, will make you feel better.

  • Susceptibility to infection: Like your red blood cells, some of your white blood cells will be destroyed, too. These are the cells that fight off infections, so be extra-careful; act like it’s the height of flu season. Wash your hands, avoid crowds, stay away from sick people… If you get sick during EC chemo treatment, you’re likely to get REALLY sick, perhaps even requiring hospitalization. So take extra precautions; it’s probably not a good idea to go shopping at the mall, work out at the gym, or go swimming in a public pool.
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    Chemo brain: This rather disheartening side effect is experienced by many women as they go through chemo. And in about 15 percent of women, chemo brain lingers for years. Imagine your brain is a blackboard: chemo brain is the eraser. Short-term memory loss and difficulty concentrating are its main characteristics. You may forget your best friend’s name, your own phone number, or which way to turn a doorknob… any number of heretofore simple tasks are made more difficult, simply because you’ve (temporarily, hopefully) lost some short-term memory. Until very recently, this side effect wasn’t officially recognized, nor taken seriously. But now, as more and more women experience it, researchers are trying to figure out just what’s going on, and how to provide relief. If you do run up against chemo-brain, try not to stress; if it doesn’t disappear pretty quickly once you finish chemo, it should lessen over time.

    So, are you scared of EC chemo? Not surprising! Try to take it all one step at a time. It’s daunting, but remember: not every woman gets every side effect. About all you can absolutely count on is losing your hair. Beyond that, stay positive, and hope for the best. Also, don’t “tough it out.” There’s no reason to feel miserable, and not say anything to the doctor or nurse in charge of your chemo treatment. There are many wonderful drugs available these days to lessen the discomfort of side effects; and it’s up to you to let someone know how you’re feeling, and to ask for help.

    P.S. One more thing: don’t panic when your urine suddenly turns reddish-pink directly after your treatment: it’s not blood, it’s from the drugs. This particularly “vivid” side effect should go away in about 24 hours.
Published On: July 03, 2007