Chemotherapy is a common treatment for breast cancer. It uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. They work by disrupting the growth of cancer cells.
Common types of chemotherapy drugs used for breast cancer include epirubicin and cyclophosphamide.
When you have it
You usually have chemotherapy as cycles of treatment. This means that you have one chemotherapy drug or a combination of drugs then a rest to allow your body to recover. Each cycle of treatment varies depending on what you are having. But usually, it's every 2 to 4 weeks.
Chemotherapy before surgery
Chemotherapy before surgery is called neo adjuvant treatment. The aim is to shrink the cancer before the operation. This means that some people may be able to have breast conserving surgery (lumpectomy), instead of a mastectomy.
You might have chemotherapy before surgery if you have:
- a large cancer
HER 2 positivebreast cancer triple negativebreast cancer
- a type of breast cancer called inflammatory breast cancer
Chemotherapy after surgery
Chemotherapy after surgery is also called adjuvant therapy. You might have this if your doctor thinks that there is a risk that cancer cells could have spread to another part of the body. The aim is to reduce the risk of the cancer coming back.
You might have chemotherapy after surgery for one or more of the following reasons:
- cancer cells were found in the
- the cancer cells don't have hormone receptors. These are called hormone receptor negative breast cancer
- the breast cancer cells are high grade (grade 3)
- you have a small HER 2 positive breast cancer
Chemotherapy for secondary breast cancer
Breast cancer can spread from where it started to other parts of the body. This is secondary or advanced breast cancer.
Chemotherapy is a common treatment for secondary breast cancer. It can help control or shrink the cancer and relieve symptoms. For some people, treatment can control the cancer for many months or years.
You might have other types of treatment alongside chemotherapy. For example, you might have:
radiotherapy. You usually have this after your chemotherapy
a targeted cancer drug called trastuzumab (Herceptin) alongside chemotherapy, or after chemotherapy
a targeted drug called pembrolizumab with paclitaxel chemotherapy
Types of chemotherapy
There are a large number of chemotherapy drugs used to treat breast cancer. You usually have a combination of 2 or 3 drugs, but you might also just have one.
The type of drugs you have depends on different factors. These factors include the risk of the cancer coming back and whether you have other medical conditions, such as heart problems.
Some examples of chemotherapy drugs you might have include:
epirubicin and cyclophosphamide (EC)
doxorubicin and cyclophosphamide (AC)
docetaxel and cyclophosphamide (TC)
This is not a complete list of all the types of chemotherapy drugs used to treat breast cancer. You can check what is the name of your regimen with your doctor or nurse, then take a look at our A to Z list of cancer drugs.
How you have chemotherapy
You have most chemotherapy drugs for breast cancer as a drip into your bloodstream (intravenously). You may also have some drugs as tablets that you swallow.
Drip into your bloodstream
You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.
Taking your tablets
You must take tablets according to the instructions your doctor or pharmacist gives you.
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Never stop taking a cancer drug without talking to your specialist first.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that 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.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
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, such as 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 usually have these 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.
Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.
Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- increased risk of getting an infection
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
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 a few days or so. Your treatment team can help to manage any side effects that you have.
If you are still having periods (pre menopausal), chemotherapy can stop your ovaries from making the hormone oestrogen. This means you might 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. 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.
If you have any questions about chemotherapy, you can talk to Cancer Research UK's information nurses on freephone 0808 800 4040, 9am to 5pm, Monday to Friday.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.