Q. Unfortunately, I’ve just found out I need to have chemo. With no node involvement I thought I’d avoid it, but my Oncotype score is in the moderate range, so my oncologist is prescribing TC. What can I expect?
A. TC is currently one of the most common types of chemotherapy given to women with early-stage breast cancer. It’s gradually replacing AC, the Adriamycin-based “gold standard” of chemo for many years. TC comes with fewer serious side effects than AC, and studies have shown it’s more effective for women with node-negative (hasn’t spread to your lymph nodes) cancer; or cancer where three or fewer nodes are involved.
TC includes two drugs: a taxane, paclitaxel (Taxol) or docetaxel (Taxotere); and cyclophosphamide (Cytoxan). (Interestingly, taxanes are one of the few “natural” chemo drugs; they’re made from the bark of the Pacific yew tree.) Anyway, don’t worry about remembering the names; just focus on the initials, because anyone who needs to know will recognize what the letters stand for.
The "T" part of this chemo combo slows or stops cell division, and keeps enzymes from making the proteins cells need in order to grow. The “C” part stops cancer cells from replicating. So between them, you have some pretty powerful agents working to destroy your cancer.
Q. How long will chemo take?
A. You’ll probably have four treatments: one every three weeks, so the whole thing will take about 2 ½ months. Some women have six treatments; if that’s your schedule, you can add another 6 weeks to that estimate. Each treatment is given by IV into your hand or arm, and should last about 2 to 3 hours.
Q. And the side effects?
A. Thankfully, TC is generally better tolerated than many other types of breast cancer chemo. Still, there are a range of side effects you may experience.
•One immediate (and scary) side effect can be an allergic reaction. You’ll be monitored closely as you receive your first infusion; and if you experience this allergic reaction, the IV drip will be slowed down while you receive drugs to treat it. If it turns out you’re allergic to the taxane, you’ll be given corticosteroid drugs prior to any succeeding treatments; these will prevent a reaction.
•Nausea and vomiting: These can occur – CAN occur – but with the wide array of anti-nausea medications now available, they 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 these nasty symptoms to general queasiness, if not eliminate them 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, Cytoxan will see to it that you 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.
•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.
You’ll probably be offered Neulasta, which is a drug given by injection 24 hours after each chemo treatment. This “white-cell booster” works to keep your white-cell counts up. However, it can come with very debilitating bone pain; some women choose to take their chances with infection, rather than go through the side effects of Neulasta.
How can you stay infection-free during chemo? Take the usual measures you would during a flu outbreak: 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.
•Fatigue: As you advance through your 2 to 3 months of 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.
•Loss of appetite/metallic taste in your mouth: 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. And now that we mention it...
•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 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 become well established.
•Infertility/stopping your period: Your ovaries will probably stop producing eggs while you’re being treated. Depending on how old you are, among other factors, this infertility may be temporary or permanent.
Broadly speaking, a woman of 45 has an 80% chance of going into permanent menopause, while a woman of 35 has only a 20% chance; you can place yourself on this continuum to get an idea of whether you might be done with your periods for good. “Chemical menopause” has all the possible range of symptoms of normal menopause, but condensed into a smaller timeframe.
•Nail loss. This is a less common reaction to a taxane, and actually happens after chemo is finished, usually within a month or so. You may find your fingernails and/or toenails are very weak and prone to damage. Your nails may become ridged and loose; they may detach about halfway down; or you may even lose them entirely. But don’t worry; this generally isn’t painful, and you’ll find new nails growing in underneath.
•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.
•Susceptibility to sunburn: You may 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: Cytoxan may 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.
•Pain: 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.
•Tingling: Some women experience tingling (neuropathy) in their 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. Some women experience lasting neuropathy, finding it takes many months for it to subside; hopefully you’ll avoid this outcome!
•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 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.
These are the most common side effects attached to TC chemo. You may have your very own; but whatever you experience, if it irritates you, be sure to ask your doctor for something to treat it. Suffering in silence, keeping a stiff upper lip (choose your favorite axiom) are NOT words to live by during chemo!