Q. I’ve been diagnosed with node-positive breast cancer, and the doctor says I’ll be having chemotherapy: AàCMF, is how he wrote it down. What’s it all about?
A. AàCMF is an acronym for the drug doxorubicin (Adriamycin), followed by a three-drug “cocktail” of cyclophosphamide (Cytoxan); methotrexate (Amethopterin, Mexate, Folex); and fluorouracil (5FU). You don’t have to remember these chemical names! Just remember the initials “AàCMF,” and that’s sufficient for anyone who asks.
How do these drugs work in tandem to kill cancer? Basically, each attacks your cancer cells in a slightly different way. The “A” part of this AàCMF “chemo cocktail” both blocks DNA production in your cells, and also 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).
The “A” chemo drug 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. “C” attaches itself to the cancer cell’s DNA, which then gets tangled up and is unable to replicate itself (sneaky!). “M” prevents cells from using folic acid, a vitamin that’s critical for their growth and development; without it, they die. And “F” is made up of molecules that look very much like the molecules in normal cells, but they’re structured slightly differently; this very small difference is enough to keep cells from functioning properly, once “F” makes its way into them. And when cells can’t function, they die.
Q. OK, what’s the schedule for AàCMF chemotherapy? How many times, and how often, will I get treatment?
A. AàCMF is usually given intravenously, via a drip into your hand or arm. You’ll probably receive “A” alone, once every three weeks for four cycles. After that, you’ll receive “CMF”, given on day 1 and again on day 8 of a four-week cycle, the cycle repeating a total of four to eight times. So the whole treatment should take about five to nine months, barring any complications that slow down the process.
Don’t worry if your AàCMF schedule is somewhat different than this. Researchers are always testing slightly different ways of delivering these drugs, and hopefully you’ll receive them on the most effective schedule currently known.
The AàCMF treatment itself will probably take between one to three hours, depending on whether you’re getting “A” or “CMF.” 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 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. Each time you begin AàCMF treatment, you’ll have blood drawn first. 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 chemo until your white cells have built themselves back up to an acceptable level.
Q. Now, how about side effects of AàCMF? Let’s hear the bad news…
A. The bad news is, Adriamycin’s side effects can be pretty bothersome. The good news is, the side effects that come with CMF aren’t QUITE as troublesome as those of other chemotherapy treatments. Here’s what you might expect:
• Hair loss due to AàCMF Chemotherapy. Sorry. No two ways about it, you’ll lose some or all of your hair. This will probably happen 2 to 4 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.
• Unpleasant taste in your mouth. Have you heard anyone mention “tin-can mouth”? You may develop a metallic taste in your mouth; not much you can do about this one. 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 five to ten minutes of each 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.
• Nausea/vomiting/diarrhea: All three of these are a possibility with CMF. 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.
• Irritated eyes/stuffy nose: Your nose may feel a bit stuffy as you receive the drugs. And afterwards, your eyes may feel sore, they may burn, or they may feel “gritty.” Try using “artificial tears” eye drops before going to bed at night. Also, you may find you can’t wear contacts during treatment.
• 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.
• Heart damage: In rare cases, “A” may temporarily damage the muscles of your heart, and thus interfere 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.
• 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. 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 chemo, you’re likely to get REALLY sick, perhaps even require 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.
• Susceptibility to sunburn: This is a special side effect of “F.” 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.
• Weight gain: GRRRRRR! Wouldn’t you know you’re having one of the few chemo treatments that can actually promote weight gain? Don’t try to starve yourself, or even to diet, during chemo; you need to stay healthy. So eat right: low fat, lots of fruits and vegetables, plenty of fluids. Don’t worry, you can work on taking the weight off, if you do gain, once you’re through with treatment.
• 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.
WOW! All that information on AàCMF chemotherapy is a lot to deal with, isn’t it? But remember: you’ll follow your own path. You may experience none of these AàCMF side effects (lucky you!); you may have some personal side effects of your very own, ones not listed here. The most important thing to remember: let your doctor or chemo nurse know how and what you’re feeling. They want you to feel better, and they’ll work with you towards that goal. Repeat after me: I will not suffer in silence! Best of luck.