No one has ever died of breast cancer in his or her breast. Patients die of breast cancer when it has spread beyond the breast, therefore chemotherapy plays a crucial role in breast cancer care as its target is the entire body, not just the breast.
In breast cancer treatment, chemotherapy refers to the use of various medicines to kill or halt the growth of rapidly multiplying cells.
Chemotherapy usually includes a combination of drugs, since this is more effective than a single drug given alone. Many combinations of drugs are used to treat breast cancer and your doctors will determine which combination of chemotherapy is appropriate for you.
Recent studies have shown that individuals with early stage breast cancer may benefit from adjuvant (additional) therapy following primary treatment (mastectomy or lumpectomy with radiation therapy). Studies indicate that many breast cancer patients whose underarm lymph nodes show no signs of cancer (known as node negative) may benefit from chemotherapy or hormonal therapy after primary treatment. We now recognize that the biological behavior of a tumor is as important as the stage at diagnosis.
Prior to the initiation of your chemotherapy, your doctors may want a test to evaluate your heart function as some of the drugs can affect your heart ability to pump blood using echocardiography.
You may also be requested to have a catheter or infusaport placed to administer the drugs, which may be toxic to your arm veins and to allow for ease of blood drawn for testing.
Adjuvant chemotherapy
Adjuvant chemotherapy refers to the use of drugs to kill cancer cells that may be present in the body, but outside of the breast. It is given after surgery and the duration of treatment. Types of drugs selected and interval between treatments will be determined by several factors.
When breast cancer cells have spread to the lymph nodes under the arm, chemotherapy is offered to treat the cancer. Chemotherapy may be given through the vein or occasionally just by mouth. Factors such as age, underlying medical conditions and tumor biology are used to create your treatment plan.
The use of chemotherapy in node negative patients will be determined by your age at diagnosis, stage of the cancer, tumor markers, tumor biology and future risk of systemic recurrence. (These findings do not apply to individuals with pre-invasive or in-situ breast cancer).
For years, patients whose underarm lymph nodes were free of cancer usually received no additional therapy because they have a relatively good chance of surviving the disease after primary treatment. However, scientists know that cancer may return in about 30 percent of these individuals. Adjuvant therapy can potentially prevent or delay the return of cancer.
The type of chemotherapy and duration of chemotherapy are determined by your health care team and there are many factors that they will take into consideration:
- Stage – size of the tumor, lymph node involvement and whether or not cancer has spread to other body regions
- Grade – aggressiveness of the tumor
- Prognostic indicators – whether your tumor expresses estrogen and progesterone sensitivity
- Her 2 neu over expression – A sign of aggressiveness of the tumor
Genomic testing
Genomic testing may be used to determine if chemotherapy can safely be avoided or is a tumor is considered at high risk for recurrence and chemotherapy should be considered. This testing will be discussed with you at your post-operative appointment and with the medical oncologist.
Neo-adjuvant chemotherapy
The term neo-adjuvant means chemotherapy is being given before the surgical treatment of the breast cancer to shrink a tumor. This may be done to allow for breast preservation or if your doctors feel shrinking your tumor may positively impact your surgery or avoid delays in surgery or recovery time. It may also be indicated in additional clinical situations.
Your surgeon will discuss the pros and cons of performing a sentinel lymph node biopsy you start chemotherapy. He or she may perform an ultrasound-guided fine needle biopsy of the lymph node.
Frequently asked questions
Can I continue working?
Yes. Most people can continue working while they are being treated with chemotherapy for their breast cancer. It may be possible to schedule your treatments later in the day or right before the weekend so they don’t interfere as much with your work schedule. You may have to adjust your work schedule while receiving chemotherapy, especially if you have side effects.
Is the chemotherapy working?
Chemotherapy given while the tumor is in place will cause the tumor to shrink. You may undergo repeat ultrasound or breast MRI in addition to clinical breast exams. Some people may think their chemotherapy treatment is not working if they do not experience side effects, but this is not the case. If your tumor does not appear to be responding by shrinking, your doctors may decide to change drugs or re-biopsy the tumor and send it for evaluation for chemotherapeutic sensitivity. Alternatively, you may need surgery.
Will chemotherapy make me lose my hair?
Of all the treatments for breast cancer, the loss of your hair is by far the most visible. With the right guidance, feeling good about how you look can be maintained through chemotherapy.
The goal of chemotherapy is to kill rapidly dividing cells, such as cancer cells. Unfortunately, your body hair falls into the category of rapidly dividing cells. The loss of your hair is simply a sign the chemotherapy is working.
Be prepared to lose your hair by day 14 after your first treatment.
By following a few steps, you can keep your power and take control of your treatment instead of letting your treatment take control of you.
- Skull ice caps may be suitable for use to decrease hair loss, but there are limitations to their usefulness.
- Accept the fact that you will lose your hair temporarily.
- Plan to cut your hair short and get a wig cut to match your new short hairdo. The change in style just before you begin to wear your wig will keep people guessing.
- Buy a wig that works for you.
- Shave your head by day 14 or visit your hairdresser and let them do it for you. Do not delay this shave, as you do not want your hair to fall out in clumps and give the cancer your power.
- Remember, your true beauty is from within and no hair loss or surgery will take that away.
Questions?
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