Chemo Regimen FAQs: AC Chemotherapy

Patient Expert

Q. I'm scheduled to have chemotherapy. The doctor says it's AC. I can't remember all the details...

A. AC is one of the five most common types of chemotherapy given to women with breast cancer. And it's probably the MOST common drug combination given to women with node-negative (hasn't spread to your lymph nodes) cancer. AC includes two drugs: doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan). 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. So between them, you have some pretty powerful agents working to destroy those cancer cells.

Q. How long will it take to get AC treatment?

A. Delivery methods and schedules vary, as the pharmacology is constantly changing. That said, you'll probably have four treatments, one every three weeks, so the whole thing will take just over two months, barring any complications that slow down the process.

Each AC treatment is given by IV into your hand or arm, and should last about two hours. 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 AC chemo 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. And the side effects of the AC chemotherapy regimen?

A. Ah, here's what you hate to ask about but need to know, right? It's like putting your hands over your eyes at the scary part of a movie, then peeking out and looking anyway.

  • 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 AC 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 three days.

  • Hair loss: Sorry. No two ways about it, you'll lose some or all of your hair. This will probably happen two to four 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 ten days after treatment, and extending to the next treatment. In fact, you'll get a blood test before each AC 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.

  • 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 five 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 two months of AC chemo 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: studies show about 60 percent of women over 40 will be permanently infertile (menopausal); while only 15 percent of women under 40 will remain infertile. 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. The bad news is, it's more intense. The good news is, you get through it faster!

  • 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.

These are the most common side effects attached to AC chemo. You may have your very own (lucky you!); but whatever you experience, if it irritates you, be sure to ask your doctor for something to treat it.

Oh, and one more thing: Don't panic when your urine turns red! This will disappear within about 24 hours from treatment.