Chemo Regimen FAQs: AC + Taxol/Taxotere chemotherapy (ACT, TAC)
Q. I've just found out I have to have chemotherapy. The doctor said it's AC and Taxol [or Taxotere]. What does that mean, exactly?
A. AC is one of the five most common types of chemotherapy given to women with breast cancer. It includes two drugs: doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan). Paclitaxel (Taxol) or docetaxel (Taxotere) is added to AC for women with node-positive cancer, or in women who've had a recurrence; it's delivered after you've finished the AC. 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 "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). "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. The "C" part of this chemo combo stops cancer cells from replicating. As for "T," it slows or stops cell division, or keeps enzymes from making the proteins cells need in order to grow. So between all of these, you have some pretty powerful agents working to destroy those cancer cells.
Q. How long will it take to get it?
A. Delivery methods and schedules vary, as the pharmacology is constantly changing. That said, you'll probably have eight treatments, one every three weeks, so the whole thing will take about 5 months, barring any complications that slow down the process. Each treatment is given by IV into your hand or arm. The first four treatments are AC, and should last about 2 hours each. The next four will be Taxol (or Taxotere), and will last about 3 1/2 hours each. Taxol/taxotere takes longer, because there's a bigger risk of an allergic reaction; this risk is lessened by delivering the drug very slowly. In addition, you'll probably get a Benadryl injection first, again to lessen the chance of a bad reaction.
Note that you MAY receive both the AC and taxol/taxotere on an accelerated schedule. This is called "dose dense" chemo, and is thought to be a more aggressive way to deliver the drugs, when aggressive measures are necessary.
Q. You mentioned 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, give me the bad news: what side effects can I expect from AC + Taxol?
A. Well, the "good news" is that the worst of the side effects will come from the AC, so you can get them over with first. Here's what you can expect from AC:
• 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 3 days.
• Hair loss: 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. 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 10 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: After AC + Taxol treatment, many women 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 treatment. Try to prevent them by chewing on ice chips during the first 5 to 10 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!
• 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.
• 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.
• 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.
• 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.
Now, once you've finished AC, you'll start "T". In general, most women report that the side effects of Taxol/Taxotere are much more "doable" than those from AC. So once you get through the AC, consider yourself on the home stretch. Here's what you might encounter with "T":
• 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.
• 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. 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. Since you've already been through AC, 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!