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.
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
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.
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.
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)
- Doxorubicin - Cyclophosphamide (also known as AC)
- Cyclophosphamide - Methotrexate - Fluorouracil (5FU) (also known as CMF)
- Fluorouracil (5FU) - Epirubicin - Cyclophosphamide (also known as FEC)
Examples of chemotherapy for advanced breast cancer include:
- Cyclophosphamide with or without Methotrexate
- Gemcitabine - Paclitaxel
- Paclitaxel - Carboplatin
- Nab-paclitaxel - Carboplatin
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
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.
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
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.
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
- 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. 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.
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.