Chemotherapy for breast cancer in women
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Cytotoxic means toxic to cells. These drugs disrupt the way cancer cells grow and divide but they also affect normal cells.
When you have chemotherapy
Back to top
Your cancer specialist may recommend you have chemotherapy after surgery to reduce the risk of breast cancer coming back. This is called adjuvant chemotherapy. Your doctor or nurse will explain the benefits of this to you and the likely side effects.
You are usually offered chemotherapy if the cancer is:
Some women have chemotherapy before surgery to shrink a large cancer (neo-adjuvant treatment). If it works well, you may only need part of the breast removed instead of a mastectomy. Women with inflammatory breast cancer usually have chemotherapy before their surgery.
Your cancer specialist may ask you to take part in a research trial that compares different types of chemotherapy.
How you have chemotherapy
Back to top
You usually have chemotherapy in the chemotherapy day unit and go home after it. The drugs are usually given into a vein (intravenously) and some are taken as tablets.
When you have intravenous chemotherapy, the nurse will give you the drugs into a vein by injection or as a drip (infusion).
You usually have them through a small tube (cannula) in your hand or arm. Sometimes they are given through a soft plastic tube called a central line or PICC line. These lines go into a large vein in your chest. Chemotherapy can also be given into a thin, soft plastic tube with a rubber disc (port), under the skin on your upper chest.
Chemotherapy is given into the vein as one or more sessions of treatment. Each session takes a few hours. After the session, you will have a rest period of a few weeks. The chemotherapy session and the rest period is called a cycle of treatment.
The length of a cycle depends on the chemotherapy drugs you’re taking, but most cycles are 1–3 weeks long. Your doctor or nurse will explain more about this. Most, but not all, courses of chemotherapy consist of six cycles.
You will have a combination of different chemotherapy drugs. Some commonly used combinations include:
Adjuvant chemotherapy for breast cancer usually includes an anthracycline drug, such as epirubicin or doxorubicin. If there is a higher risk of the cancer coming back, docetaxel is also usually included. Your doctor may offer you a choice of chemotherapy treatments.
If you have HER2 breast cancer, you may have trastuzumab (Herceptin) along with your chemotherapy.
Chemotherapy drugs can cause side effects. Many of these can be controlled well with medicines and will usually go away when your treatment finishes. Your doctor or nurse will tell you more about what to expect. Always tell them about your side effects, as there are usually ways in which they can be controlled.
Risk of infection
Chemotherapy can reduce your number of white blood cells, which help fight infection. If the number of white blood cells is low, you’ll be more prone to infections. A low white blood cell count is called neutropenia.
Always contact the hospital immediately on the 24-hour contact number you’ve been given and speak to a nurse or doctor if:
you develop a high temperature, which may be over 37.5˚C (99.5˚F) or over 38˚C (100.4˚F) depending on the hospital’s policy – follow the advice that you have been given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you feel shivery and shaky
you have any symptoms of an infection such as a cold, sore throat, cough, passing urine frequently (urine infection) or diarrhoea.
If necessary, you’ll be given antibiotics to treat an infection.
You’ll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered. Occasionally, your treatment may need to be delayed if your number of white blood cells is still low.
Your nurse may give you injections of a drug called G-CSF under the skin. It encourages the bone marrow (where blood cells are made) to make more white blood cells.
Bruising and bleeding
Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. If you develop any unexplained bruising or bleeding such as nosebleeds, bleeding gums, blood spots or rashes on the skin, contact your doctor or the hospital straight away.
Anaemia (low number of red blood cells)
Chemotherapy may reduce the number of red bloods cells (haemoglobin) in your blood. A low level of red blood cells is known as anaemia, which can make you feel very tired and lethargic. You may also become breathless. Let your doctor know if you get these effects.
Feeling sick (nausea)
Some chemotherapy drugs can make you feel sick (nauseated) or possibly be sick (vomit). Your cancer specialist will prescribe anti-sickness (anti-emetic) drugs to prevent this. Let your doctor or nurse know if your anti-sickness drugs are not helping, as there are several different types you can try. We can send you more information about nausea and vomiting.
You’re likely to become tired and have to take things more slowly. Try to pace yourself and save your energy for things that you want to do or that need doing. Balance rest with some physical activity. Even just going for a short walk will help increase your energy.
This is a common side effect of the drugs used to treat breast cancer. Ask your nurse what you should expect. Some women may lose all their body hair including eyelashes and eyebrows. If you do experience hair loss, your hair should start to grow back about 3–6 months after treatment.
Your nurse can give you advice about coping with hair loss and how to look after your scalp. They will let you know if scalp cooling – a way of reducing hair loss during chemotherapy – would be appropriate.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. If it doesn’t improve, you can ask to see a dietitian.
Your mouth may become sore (or dry), or you may notice small ulcers during treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Some chemotherapy drugs can cause diarrhoea. This often starts several days after treatment. If you’re taking chemotherapy tablets or capsules at home, it’s important to let your doctor or nurse know if you have diarrhoea, as your treatment may need to be interrupted. Medicine can be prescribed to help. It’s important to drink plenty of fluids if you have diarrhoea.
Effects on the nerves
Some chemotherapy drugs can affect the nerves in your hands or feet. This can cause tingling or numbness, a sensation of pins and needles or muscle weakness (peripheral neuropathy).
It’s important to let your doctor know if this happens. They may need to change the chemotherapy drug if it gets worse. Usually, peripheral neuropathy gradually gets better when chemotherapy is over, but sometimes it’s permanent. We can send you more information about peripheral neuropathy.
Your doctor will advise you not to get pregnant while having chemotherapy. This is because the drugs may harm an unborn baby. It’s important to use effective contraception during your treatment.
You’re usually advised to use condoms if you have sex within the first 48 hours after chemotherapy. This is to protect your partner from the drugs in case they’re present in the vaginal fluid.
Younger women may find chemotherapy brings on an early menopause, which can be difficult to cope with.
If you’re worried about the effect chemotherapy may have on your fertility, it’s important to talk this over with your cancer specialist before treatment starts.