When, where and how you have chemotherapy for breast cancer, and the possible side effects.
What chemotherapy is
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
When you have it
You usually have chemotherapy every 3 or 4 weeks. You have the drugs between 1 and 5 days and then have a break. Each 3 or 4 week period is called a cycle. You may have up to 8 cycles of chemotherapy.
You’re likely to have chemotherapy before surgery if you have a large or locally advanced tumour, or you have a type of breast cancer called inflammatory breast cancer.
Chemotherapy before surgery is called neo adjuvant therapy. The aims are to:
- reduce the size of the tumour - this can mean having less surgery, for example you may be able to have just the tumour removed (a lumpectomy) instead of the whole breast (mastectomy)
- lower the risk of the cancer coming back
Doctors use chemotherapy after surgery when there is a risk that cancer cells could have broken away from the breast tumour and spread to another part of the body.
The aim is to reduce the risk of the cancer coming back.
Your specialist may recommend it for one or more of the following reasons:
- the lymph nodes under your arm contained breast cancer cells
- you had a large tumour in your breast
- the breast cancer cells were high grade (grade 3)
- the cancer cells did not have hormone receptors and so you are not likely to benefit from hormone therapy
Chemotherapy after surgery is called adjuvant therapy.
You may also have chemotherapy if you have breast cancer that has spread to another part of the body (advanced cancer).
Types of chemotherapy
There are a number of chemotherapy drugs that doctors use to treat breast cancer. You usually have a combination of 2 or 3 drugs together.
The types of drug you have depends on different factors, including your risk of the cancer coming back and any medical conditions you have, for example heart problems.
How you have chemotherapy
You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You’ll sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
The pharmacists make chemotherapy for each person individually. They do this once your blood test results have come through. It’s worked out based on your weight, height and general health.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- a lower resistance to infections
- bleeding and bruising easily
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for the few days that you’re having the chemotherapy drugs. The team caring for you can help to reduce your side effects.
If you are still having periods (pre menopausal), chemotherapy can stop your ovaries from making the hormone oestrogen. This means you may have an early menopause and become infertile. This can be very difficult to cope with if you wanted to have a child in the future.
For some women, the ovaries begin to work again after treatment. This depends on your age when you have treatment, and the types of chemotherapy drugs you have. If you haven’t had a period a year after your treatment, unfortunately it’s not likely that your ovaries will recover.
Your doctor will talk to you before starting treatment about possible ways of preserving fertility.
When you go home
Chemotherapy for breast cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.