Chemo Regimen FAQs: FEC Chemotherapy

Patient Expert

Q. I'm having FEC chemotherapy, which all I know involves three barely pronounceable words. What is it?

A. Have you heard about FEC in the news? Well, that's the Federal Election Commission, reporting on political finagling. Your FEC stands for fluorouracil (5FU); epirubicin (Ellence); and cyclophosphamide (Cytoxan). Don't worry, there won't be a quiz on this! Just remember the initials, and you'll be fine.

Why three drugs? This is a common combination of drugs given to women with node-positive breast cancer: i.e., the cancer has traveled to one or more of your lymph nodes. So, what does each of these drugs each do?

Basically, each attacks your cancer cells in a different way. "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.

"E" has lots of tricks up its sleeve. It stops the enzymes that support cell reproduction; it damages the cell by altering its membranes; and it stops cell reproduction by attaching itself to the cell's DNA, which then gets tangled up and is unable to replicate itself (pretty sneaky, huh?).

Finally, "C" sticks to the cell's DNA, like "E," preventing it from replicating. And that, really, is what killing cancer is all about: stop the cells from dividing, and you stop the cancer.

Q. What's the timeframe here for FEC treatment? How long does it take?

A. Delivery methods and schedules for FEC treatment vary, as the pharmacology is constantly changing. That said, the majority of women being treated with FEC get it intravenously, every three weeks, for six treatments. So, basically it takes fifteen weeks, barring any complications that slow down the process. And the FEC treatment itself takes between two and three 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 for each FEC treatment. 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 to FEC"

A. Each time you begin FEC treatment, you'll have blood drawn first. One of chemo�s side effects is lowering your white blood cell count by 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 FEC chemo treatment until your white cells have built themselves back up to an acceptable level.

Q. Hate to ask, but what are the side effects of FEC?

A. Be strong; you might as well know what you're facing, so you can be prepared. And anyway, isn't it better having an idea what's in store? Sometimes what you imagine is worse than the reality! So here goes:

  • Hair loss: "F and "C" thin your hair, but "E" really does a number on it. Yup, you're going to lose it: not just the hair on your head, but a lot of your body hair, too (pubic, under your arms, legs, perhaps your eyelashes and eyebrows") Losing the hair on your head, obviously, is what you'll find most disturbing; but there's lots you can do to cope, including a wig, head scarves or hats, or just saying the heck with it and going bald. Believe me, waiting to lose your hair (it'll take 3 to 4 weeks, probably, after your first treatment) is the toughest part. Once it's gone, you just deal. And, just think: you can put away the safety razor for months. No more shaving your legs or under your arms!
  • Metallic taste in your mouth/Decreased appetite: Many women experience a metallic taste in the mouth after FEC treatment; to me, if tasted like licking the lid of a tin can. 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"

  • 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. Chewing on ice chips the first five to ten minutes of each FEC treatment can help; 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.

  • Nausea/vomiting/diarrhea: All three of these are a possibility with FEC. The good news is, this unpleasant side effect of FEC 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 5 years ago and how sick they were! TIMES HAVE CHANGED.

You'll probably get some anti-nausea drugs right along with your FEC 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. And remember, not everyone gets every side effect; you may dodge the bullet on this one, like I did.

  • Eye Irritation: Your eyes may feel sore, they may burn, or they may feel "gritty." Try using "artificial tears" eye drops before going to bed at night. Also, you may find you can't wear contacts during treatment.

  • 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!

  • Fatigue: This is pretty much a given with any kind of chemo. You're losing a fair number of red blood cells, the cells that carry oxygen around your body. You'll find it harder than usual to do just about anything, from getting out of bed in the morning to climbing a flight of stairs to simply doing the dishes. Be good to yourself; rest when you need to. On the other hand, don't just lie around constantly; exercise, even if it's only a short walk around the yard, will make you feel better.

  • Susceptibility to infection: Like your red blood cells, some of your white blood cells will be destroyed, too. These are the cells that fight off infections, so be extra-careful; act like it's the height of flu season. Wash your hands, avoid crowds, stay away from sick people" If you get sick during FEC chemo treatment, you're likely to get REALLY sick, perhaps even require hospitalization. So take extra precautions; it's not a great idea to go shopping at the mall, work out at the gym, or go swimming in a public pool.

  • 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. 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.

That wraps up the high points. If you're feeling totally bummed at the prospect of FEC, please, don't be. Not every woman gets every side effect; about all you can absolutely count on is losing your hair. When I went through FEC, I felt only mildly queasy, and had enough energy to work full time. It's true, I didn't feel great; but it wasn't nearly as bad as I'd imagined. I wish the same for you!