EC

EC is the name of a combination of chemotherapy drugs used to treat breast cancer. It is made up of the drugs

• Epirubicin
• Cyclophosphamide

The links above take you to information about the individual side effects of each drug.

You usually have EC chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks. Depending on your needs, you may have up to 6 cycles, taking 3 to 4 months in total.

You have EC drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You can have EC chemotherapy as a day patient. You have both drugs every 3 weeks. Before you have the treatment you will need a blood test to check that your level of blood cells is normal. You have epirubicin as an injection into your bloodstream through a cannula. Epirubicin is a red colour. At the same time you have a drip (infusion) of salt water. You then have cyclophosphamide as an injection or a drip. Treatment usually takes just over an hour but with the blood test beforehand you will be at the hospital for a few hours.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with EC are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Tiredness during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick can be severe but is usually well controlled with anti sickness drugs – if yours aren’t working tell your doctor and they can change them to ones that work better for you
• Loss of appetite
• Hair loss – most people have complete hair loss but the hair will grow back once the treatment ends
• Your urine may become a pink or red colour for about one day after treatment – this is nothing to worry about
• These drugs may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you could become pregnant
• Women may stop having periods (amenorrhoea) but this may be temporary
• Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk with your doctor before starting treatment if having a baby is important to you
• Reddening of the skin in areas where you have had radiotherapy in the past. The skin may get dry and flaky and feel sore and hot – this goes away on its own but keep affected areas out of the sun

Between 1 and 10 in every 100 people have one or more of these.

• Diarrhoea – drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days
• A sore mouth including mouth ulcers
• Nails may become darker, have white lines on them, or become ridged
• Sore eyes – your doctor or nurse can prescribe eye drops
• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Allergic reactions can happen while the drugs are going into your bloodstream and your nurse will monitor you for signs of an allergic reaction – tell your nurse if you have skin rashes and itching, a temperature, shivering, redness of the face, a feeling of dizziness, headaches, breathlessness, anxiety, or a need to pass urine
• Inflammation of the bladder (cystitis) can cause pain and occasionally bleeding when passing urine. Contact your doctor straight away if you see blood in your urine. You should drink 8 to 12 cups of fluid a day and will also have extra fluids through the drip
• Damage to heart muscle which is usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment

Fewer than 1 in 100 people have these.

• There is a small risk that you may get a second cancer some years after this treatment
• Changes in lung tissue may lead to a cough or breathlessness
• Fluid retention leading to swelling of the legs and sometimes arms

Not everyone will get these side effects. You may have one or two or several. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Let your doctor, nurse or pharmacist know about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.