Q. I’ve just found out I have to have chemotherapy. The doctor said it’s AT. What does that mean, exactly?
A. AT is one of the types of chemotherapy given to women with breast cancer that’s node-positive (i.e., the cancer has spread to one or more lymph nodes). It includes two drugs: doxorubicin (Adriamycin), and Paclitaxel (Taxol) or docetaxel (Taxotere). But you don’t have to remember the names; just the initials, because anyone who needs to know will recognize what the letters stand for.
The “A” part of this AT “chemo cocktail” both blocks DNA production in your cells and inhibits the enzymes responsible for repairing DNA. Cells can’t live without DNA; thus when they’re deprived of it, they die (in fact, some even kill themselves when their DNA is damaged). “A” can’t distinguish between cancer cells and normal cells; but because cancer cells are dividing so rapidly, it has a greater negative effect on them than on your normal cells.
As for “T,” it slows or stops cell division, or keeps enzymes from making the proteins cells need in order to grow. So between both of these drugs, you have some pretty powerful agents working to destroy those cancer cells.
Q. And how long will I be getting AT chemo? Weeks, months…?
A. You’ll probably be getting six injections of “AT.” Since this drug combination is still fairly new, it’s undergoing a lot of experiments concerning the exact frequency of delivery. Your doctor will outline the whole program for you.
Q. And how are the side effects of AT chemo? Pretty bad?
A. Well, there’s a whole range of them. But you may or may not get any or all of them; despite all the studies and statistics in the world, there’s no telling how YOU will react to chemo. Here’s a rundown of possible challenges you may face:
• Nausea and vomiting: These can occur–CAN occur–but aren’t nearly as prevalent a side effect as they once were. Usually you’ll be given medication to take directly after your treatment, and this should reduce this nasty symptom to general queasiness, if not eliminate it completely. You may be one of the unfortunate women who gets sick anyway, but take heart; you should start feeling better after about three days.
• Hair loss: Sorry. No two ways about it, you’ll lose some or all of your hair. This will probably happen two to four weeks after your first injection. Prepare by deciding on a wig, head gear, or if you’re simply going to “go naked.” It also helps to cut your hair short before it falls out. Somehow, going from short hair to no hair is easier than long hair to bald. And remember: hair loss means ALL of your hair. So you can put away the razor for awhile, your legs and underarms won’t be needing it.
• Increased risk of infection: You’ll be losing white blood cells; the drugs will destroy some of them, along with the cancer cells. You’ll be at your most susceptible starting ten days after treatment, and extending to the next treatment. In fact, you’ll get a blood test before each treatment to make sure your white blood cells aren’t TOO depleted, putting you at too great a risk of infection.
What can you do about this? The usual things you do all winter to prevent a cold; avoid crowds, wash your hands often, stay away from people who are sick. Remember, an infection you get now will be more serious than a cold, so use your common sense. Don’t put yourself at unnecessary risk.
• Loss of appetite/metallic taste in your mouth: Women undergoing AT chemo commonly report having a metallic taste in the mouth after treatment. 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…
• Sores in your mouth, on your lips, or in your throat: Imagine cold sores inside your mouth–OUCH! These may crop up within a few days of AT treatment. Try to prevent them by chewing on ice chips during the first five to ten minutes or so of your injection; this works for some women. Avoid spicy foods, or anything that might irritate your mouth–including strong mouthwash. If you do get these sores, don’t figure you have to just live with them; ask for some medication. It’s best to try to knock them out before they get a good foothold (or mouth-hold, as it were).
• Fatigue: As you advance through your treatments, you’ll probably find yourself feeling more and more tired. This fatigue can range from mild (increased difficulty climbing stairs) to major (staying in bed all day). Try some gentle exercise, no matter how bad you feel; even walking helps. And eat enough to keep your strength up. Not eating and not exercising make you feel tired even when you’re not undergoing chemo, so going hungry and being inactive exacerbate chemo’s fatigue even more.
• 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!
• Susceptibility to sunburn: This is a special side effect of “A.” You’ll be more likely than usual to get a sunburn, so wear a hat, slather on the sunblock, and just plain stay out of the sun as much as possible.
• Bruising or bleeding more easily: You may notice you bruise more easily after AT treatment. Or maybe your gums bleed when you brush your teeth, your nose bleeds when you blow it, you see some spotting in your underwear… your bone marrow is producing fewer platelets, which is what helps your blood clot. This isn’t a serious problem–it’s not like having hemophilia–it’s more an annoyance, something to be aware of. And, along these same lines, don’t panic when your urine suddenly turns reddish-pink directly after your treatment: it’s not blood, it’s from the drugs. This particular side effect should go away in about 24 hours.
• You may have pretty significant joint pain that (hopefully) lasts just a couple of days, but may stretch beyond that. Ibuprofen, taken at fairly high doses, usually helps with this. Ask your doctor how much to take.
• You may also have tingling in your hands and feet. Not much you can do about that; it’s annoying, and can affect your balance, if it’s in your feet (since it feels like your feet are asleep); but it should go away once you’re done.
• Heart damage: In rare cases, “A” may temporarily damage the muscles of your heart, and thus interefere with its pumping action. But doctors know this, and they’re very, very careful to keep a good eye on you, and to give you a heart test before starting chemo. There’s a maximum amount of “A” you can receive in your lifetime, before it does permanent heart damage; the docs will be sure you don’t approach that limit.
• Chemo brain: This rather disheartening side effect is experienced by many women as they go through chemo. And in about 15 percent of women, it 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.
One more note: Be aware that Taxotere, which is another form of Taxol, comes with the potential for more side effects than Taxol. With Taxotere, you’re more likely to feel some pretty significant weakness; if you do, rest! And you’re also more susceptible to infection, due to low white blood cell count. You know the routine; stay away from crowds, wash your hands… make believe it’s flu season. Because for you–it is.
So that’s the rundown. It all looks fairly daunting, I know; but if you stay on top of any side effects, and try to head them off before they become severe, you should be OK. DO NOT tough it out! Chemo is no time to prove how strong you are. If you start to feel bad–nausea, mouth sores, whatever–tell your doctor, find out what to do, and DO IT!