Q. I’m scheduled to have chemotherapy. The doctor says it’s AC and Taxol [or Taxotere]. What does that mean, exactly?
A. Among the five most common types of chemotherapies for breast cancer, AC is probably the MOST common drug combination given to women whose cancer hasn’t spread to the lymph nodes. The treatment includes two drugs: doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan). You don’t have to remember the names, just the initials since anyone who needs to know will recognize what the letters stand for.
The “A” part of this “chemo cocktail” blocks DNA production in your cells, and inhibits the enzymes responsible for repairing DNA. Cells can’t live without DNA and die off when they’re deprived of it. In fact, some even kill themselves when their DNA is damaged. While “A” doesn’t distinguish between cancer cells and normal cells, it has a greater negative effect on cancer cells since those cells are dividing so rapidly.
The “C” part of this chemo combo stops cancer cells from replicating. So between them, you have some pretty powerful agents working to destroy 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, once every three weeks. The entire treatment should take a little over two months barring any complications that might slow down the process.
Each AC treatment is given by IV into the hand or arm and should last about two hours. Factor in the time it takes to get to and from the hospital, take preliminary blood tests to make sure your white cells are at appropriate levels as well as the inevitable waiting around and you’re looking at half a day each visit. To kill time, bring stuff to distract or amuse yourself such as books, knitting or a friend or family member. You don’t want to just sit around and twiddle your thumbs the entire time.
Q. You mentioned complications…
A. One of chemo’s side effects is that it lowers your white blood cell count since it kills off some of the cells that help fight infection. That’s why each time you begin AC chemo treatment, you’ll have blood drawn first. If your white cell count isn’t high enough to keep you healthy, the doctor will delay your next chemo treatment until the white cells build themselves back up to an acceptable level.
Q. And the side effects of the AC chemotherapy regimen?
A. Here’s what you hate to ask about but need to know, right? It’s like putting your hands over your eyes during the scary part of a movie, but peeking out and looking anyway.
- Nausea and vomiting: These 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 to reduce, if not eliminate, any queasiness. However, you may be one of the unfortunate few who gets sick anyway. In this case, take heart that you should start feeling better in about three days
- Hair loss: It’s likely that you’ll lose some or all of your hair. This usually happens two to four weeks after your first injection. Prepare ahead of time by deciding on a wig, head gear, or if you’re simply going to “go naked.” It can also sometimes help 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 because the drugs will destroy some of them, along with the cancer cells. The most susceptible period starts ten days after treatment, and extends to the next treatment. So you’ll get a blood test before each AC treatment to make sure your white blood cells aren’t too depleted as to put you at an unacceptable risk of infection. What can you do about this? Only the usual things you would do during the winter to prevent a cold such as avoiding crowds, washing your hands often and staying away from people who are sick. Remember that 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! But keep in mind that these may pop up within a few days of treatment. You can try to prevent them by chewing on ice chips during the first five minutes or so of your injection. Avoid spicy food or anything that might irritate your mouth, including strong mouthwash. If you do get these sores, ask for some medication. It’s best to try and knock them out before they get a good foothold.
- Fatigue: As you progress through your two months of AC chemo treatment, you’ll probably find yourself feeling increasingly tired. Fatigue can range from mild things such as increased difficulty climbing stairs to major exhaustion that requires you to stay in bed all day. No matter how bad you feel, try some gentle exercise. Even walking helps. And eat enough to keep your strength up. Not eating and not exercising can make you feel tired even when you’re not going through chemo, so going hungry and being inactive can exacerbate chemo fatigue even more.
- Eye irritation: You may find you can’t wear contacts during chemo or that your eyes are sore and watery. Wear sunglasses if you’ll be outdoors in bright weather and try “artificial tears” eye drops to reduce any soreness.
- Heart damage: In rare cases, “A” may temporarily damage your heart muscles, which interferes with its pumping action. Doctors know this and they’re very careful to make sure to give you a heart test before starting chemo. There’s a maximum amount of “A” you can receive in your lifetime before it causes permanent heart damage. Your doctors will make sure you don’t approach that limit.
- Bladder irritation: “C” will possibly cause some bladder irritation that may feel like a mild bladder infection. Drink plenty of fluids as 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 undergoing treatment. Whether or not you resume getting your period afterward depends largely on age. Studies show that about 60 percent of women over 40 will end up 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 about whether you might be done with your periods for good. “Chemical menopause” exhibits all the symptoms of normal menopause, but condensed into a smaller timeframe. So 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 during chemo. And for about 15 percent of women, it lingers for years. Imagine your brain as a blackboard and chemo brain as the eraser. Short-term memory loss and difficulty concentrating are its main characteristics. You may forget basic things like your best friend’s name, your phone number or which way to turn a doorknob. Any number of simple tasks are now more difficult simply because you’ve 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 experience chemo brain, try not to stress. If it doesn’t disappear quickly once you finish chemo, it should lessen over time.
These are the most common side effects from undergoing AC chemo. You may very well have your own. But whatever you experience, be sure to ask your doctor for something to treat it, especially if it irritates you.
Oh, and one more thing: Don’t panic if your urine turns red! This will disappear within 24 hours after treatment.
Updated On: May 17, 2016
PJ Hamel is senior digital content editor and food writer at King Arthur Flour, and a James Beard award-winning author. A 16-year breast cancer survivor, her passion is helping women through this devastating disease. She manages a large and active online survivor support network based at her local hospital and shares her wisdom and experience with the greater community via HealthCentral.com.