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.
Q. OK, here's the $64,000 question: what are the side effects of CAF?
A. Remember, as you read this, that it's an overview: not every woman gets every side effect. In fact, probably no one gets every side effect, and many women experience very few. Here are the highlights... er, lowlights of what you MIGHT experience:
• Nausea/vomiting/diarrhea: All three of these are a possibility. 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 five 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.
• Hair loss: Sorry. No two ways about it, you'll lose some or all of your hair due to CAF treatment. This will probably happen 1 1/2 to 2 weeks after your first injection (though this isn't a hard and fast schedule; some women lose their hair a bit later). 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.
• 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 midway through each cycle, and extending to the next treatment.
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.
• 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 5 to 10 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.
• Fatigue: As you advance through treatment, 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.
• Eye irritation: You may find you can't wear contacts during chemo. Or you may find your eyes are sore and watery. Wear sunglasses if you'll be outdoors in bright weather; and try "artificial tears" eye drops to reduce the soreness.
• 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.
• 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!
• 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.
• Bruising or bleeding more easily: You may notice you bruise more easily. 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.
• Chemo brain: This rather disheartening side effect is experienced by many women as they go through chemo. 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.
That wraps up the main possibilities. Remember: you'll follow your own path. You may experience none of this (other than the hair loss); you may have some personal side effects of your very own, ones not listed here. The most important things 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.