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Chemotherapy for breast cancer

Chemotherapy 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.

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 or 4 weeks. 

Before surgery

You’re likely to have chemotherapy before surgery if you have a large tumour or if it has spread into the surrounding tissue. You might also have it if you have a type of breast cancer called inflammatory breast cancer.

Chemotherapy before surgery is called neo adjuvant therapy. The aims are to:

  • shrink the tumour down - this can mean having less surgery, for example you might be able to have just the tumour removed (breast conserving surgery or a lumpectomy) instead of the whole breast (mastectomy)
  • lower the risk of the cancer coming back

After surgery

Doctors use chemotherapy after surgery when 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 in the future.

Your specialist may recommend that you have chemotherapy 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 didn't have hormone receptors and so hormone therapy is not likely to work well

Chemotherapy after surgery is called adjuvant therapy.

Advanced cancer

Chemotherapy drugs circulate in the bloodstream around the body. They can help treat cancer cells that have broken away from the breast cancer and spread to other parts of the body (advanced cancer).

Having chemotherapy can help control or shrink the cancer and relieve symptoms.

Other treatments

Your treatment plan might include other cancer treatments as well as chemotherapy. For example, you might have:

  • a targeted drug such as trastuzumab (Herceptin) alongside chemotherapy, or before or after chemotherapy
  • radiotherapy – you usually have this after your chemotherapy
  • hormone therapy – you might have this once your chemotherapy has finished

Types of chemotherapy

There are a number of chemotherapy drugs used to treat breast cancer. You usually have a combination of 2 or 3 drugs together, but you might just have one.

The type of drugs you have depends on different factors. These factors include your risk of the cancer coming back and whether you have other medical conditions, such as heart problems.

Examples of chemotherapy for early and locally advanced breast cancer include:

  • Docetaxel - Cyclophosphamide
  • Epiribicin - Cyclophosphamide (also known as EC)
  • Docetaxel
  • Eribulin
  • Paclitaxel
  • Doxorubicin - Cyclophosphamide (also known as AC)
  • Cyclophosphamide - Methotrexate - Fluorouracil (5FU) (also known as CMF)
  • Fluorouracil (5FU) - Epirubicin - Cyclophosphamide (also known as FEC)

Check what the name of your regimen is with your doctor or nurse, then take a look at our A to Z list of cancer drugs.

Examples of chemotherapy for advanced breast cancer include:

  • Capecitabine
  • Cyclophosphamide with or without Methotrexate
  • Epirubicin
  • Gemcitabine - Paclitaxel
  • Paclitaxel - Carboplatin
  • Nab-paclitaxel - Carboplatin
  • Vinorelbine

How you have chemotherapy

You usually have treatment into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line you might have treatment through a thin short tube (a cannula). The cannula goes into a vein in your arm each time you have treatment.

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 newspapers, books or electronic devices to 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.

Before you start chemotherapy

COVID swab test

Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.

To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.

At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.

This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.

Check with your team about when you’ll have the test as there are some differences between hospitals.

Blood tests

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.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

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.

Early menopause

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. 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.

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 or if you have been prescribed anything by alternative or complementary therapy practitioners.

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.

Information and help