Q. My doctor tells me I have to have chemotherapy. I'm not looking forward to it, and I'd at least like to understand what I'm getting into. What's this CAF he's referring to?

A. CAF (sometimes called FAC) is an acronym for the three-drug "cocktail" you'll be getting. This particular combination is unusual in that it's been found effective for women with both node-negative, and node-positive breast cancer.

First off, here're the names of the drugs that make up the acronym: cyclophosphamide (Cytoxan); doxorubicin (Adriamycin); and fluorouracil (5FU). DO NOT TRY TO REMEMBER THIS. Knowing you're getting "CAF" is all the info. you'll ever need.

How do these three drugs work together to kill cancer? Basically, each attacks your cancer cells in a slightly different way. "C" attaches itself to the cancer cell's DNA, which then gets tangled up and is unable to replicate itself (take that, cancer!). "A" 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). "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. "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 they can't function, they die.


Q. So, what's the schedule? How long will it take to get through CAF chemo?

A. Delivery methods and schedules vary, as the pharmacology is constantly changing. That said, typically you'll take "C" orally for 14 days, while "A" and "F" are given together, intravenously into your hand or arm, on days 1 and 8 of that 2-week period. You'll go through this schedule a total of four to six times, and it happens every 4 weeks. So it takes a total of about 4 to 5 months, barring any complications that slow down the process.

Another way of receiving CAF is all three drugs being given simultaneously, via a drip into your arm or hand. This treatment is repeated every three weeks, four to six times, making a total of 2 to 3 1/2 months of chemo-again, barring any complications.


Q. Like, what kind of complications?

A. Each time you begin 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.