Surgery, radiation, chemotherapy, hormone therapy: these are the tools our doctors use to fight cancer. Of the four, chemotherapy (“chemo”) is probably the most fraught with patient anxiety. Will my hair fall out? Will I spend months vomiting? Here are the facts you need to know before you start chemotherapy.
What is chemotherapy?
Chemotherapy is a drug or, more likely, combination of drugs administered to cancer patients to kill cancer cells. It’s usually injected, but is sometimes given orally, in pill form.
Typically, chemotherapy is given over several months, with the patient receiving “chemo” on a set schedule (every 10 days, every 3 weeks, etc.) until a certain number of treatments have been reached.
What does chemotherapy actually do?
Chemotherapy interferes with cancer cells so that they can’t reproduce. Some drugs alter the structure of the cancer cells’ DNA; some prevent them from dividing; some don’t prevent but disrupt cancer cells’ dividing; and some interfere with their metabolism. Some drugs disrupt cancer cells’ blood supply, a newer form of treatment using drugs called angiogenesis inhibitors.
There are many drugs used to treat breast cancer; but the wider range are used in metastatic breast cancer (cancer that’s spread), while localized breast cancer (cancer that hasn’t spread beyond the breast/underarm lymph nodes) relies on fewer drugs; the most common are listed below. These are usually given in combination, often two or three in tandem.
•Cyclophosphamide (Cytoxan, “C”);
•Docetaxel (Taxotere, “T”);
•Doxorubicin (Adriamycin, “A”);
•Epirubicin (Ellence, “E”);
•5-fluorouracil (Efudex, Carac, Adrucil, Fluoroplex, “F”);
•Methotrexate (Trexall, Maxtrex, Rheumatrex);
•Paclitaxel (Taxol, “T”);
Your doctor will work with your tumor’s specific characteristics, as noted in the pathology report, to determine the drug combination that will be most effective for you.
For complete information on a number of these drug combos, including side effects, see Chemotherapy Regimens for Breast Cancer.
Chemo drug shorthand names
Don’t worry about remembering all the complicated chemical names you’ll hear. Your doctor will use shorthand when referring to these drugs. For instance, s/he may recommend you receive AC, or CAF, or EC; or perhaps AC > T. if you want to remember what kind of chemo you’re having, that’s probably the level of detail you’ll need.
Gauging heart health
Before chemotherapy starts, you’ll most likely have an ECG (electrocardiogram), which assesses the strength and health of your heart. This precautionary test helps makes sure you can receive certain drugs that, in rare cases, can cause heart damage.
Maintaining white blood cell counts
Throughout the course of chemotherapy, your oncologist will monitor your white blood cell count, the number of infection-fighting white cells in your blood. During chemotherapy, many of your white cells will be destroyed, putting you at increased risk for illness and infection.
If the oncologist deems your cell count too low prior to any particular treatment, your appointment will be rescheduled. This will give your body time to build up its white cells to fight colds, the flu, and the other illnesses you’re exposed to every day.
Many doctors prescribe an injection of Neulasta, a drug that increases the number of circulating white cells and strengthens your immune system, 24 hours after you complete each treatment.
How to pick a chemo schedule
Insider tip: If you’re given a choice of what day you want to receive chemo – take it.
Do you work outside the home, and intend to keep working? You may want to schedule chemo for a Friday, giving you the weekend to recuperate.
Are you a mom with school-aged kids? You may opt for a Monday, so you’re able to relax while the kids are in school, rather than try to recover on a busy weekend.
If it doesn’t matter to you, choose the least popular day of the week; the scheduler will let you know what day that is. You’ll be helping those women who really need to choose a particular day.
See more helpful articles:
"Chemotherapy." Accessed December 6, 2015. http://www.drsusanloveresearch.org/chemotherapy.
Breast cancer survivor and award-winning author PJ Hamel_, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network. _