Chemotherapy for breast cancer in men
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
The drugs travel through the bloodstream and can reach cancer cells anywhere in the body.
When chemotherapy is given
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Chemotherapy may be given after surgery to reduce the risk of breast cancer coming back. This is called adjuvant treatment. Your cancer specialist will explain what the benefits are and what side effects you’re likely to get.
Adjuvant chemotherapy may be given after surgery when the cancer:
has spread to the lymph nodes
is HER2 positive (chemotherapy is often given with Herceptin).
Occasionally, chemotherapy can be given to shrink a large cancer before surgery (neo-adjuvant treatment). If it shrinks the cancer successfully only part of the breast may be removed, avoiding the need for a mastectomy.
Chemotherapy can also be used to control breast cancer that has come back (recurrent cancer) or spread to another part of the body (secondary breast cancer). If a man has had previous chemotherapy for breast cancer he will generally be treated with a different combination of drugs if further treatment is needed.
Cancer research trials are looking at improving the effectiveness of chemotherapy and how side effects can be reduced. You may be asked to take part in a research trial comparing different types of chemotherapy.
How chemotherapy is given
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Chemotherapy drugs are given into a vein (intravenously), as injections or drips (infusions), or as tablets to take at home. You’ll usually have your treatment in the chemotherapy day unit. Occasionally the drugs are given through a soft, plastic line called a central line into a vein in your chest or through a thin tube inserted into your upper arm (a PICC line).
Chemotherapy is usually given as a session of treatment.
After each session, you’ll usually have a rest period of a few weeks before the next session. This allows your body to recover from the side effects. The chemotherapy session and the rest period make up a cycle of treatment. Your doctor or nurse will explain how many cycles of treatment are planned for you and how you’ll be given your chemotherapy.
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There are many different chemotherapy drugs used to treat breast cancer, and they’re often used in combination (chemotherapy regimen). Some commonly used combinations are listed here, although other combinations may also be used.
Adjuvant chemotherapy usually includes a type of drug called an anthracycline, such as epirubicin or doxorubicin. If there’s a high risk of the cancer coming back, the drug Taxotere is also usually included. Your oncologist may offer you a choice of chemotherapy treatments, as different combinations have different side effects.
Other drugs that may be used to treat breast cancer include:
Side effects of chemotherapy
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Chemotherapy drugs may cause unpleasant side effects, but these can usually be controlled well with medicines and will usually go away once treatment has finished. Not all drugs cause the same side effects and some people may have very few.
You can talk to your doctor or nurse about what to expect from the treatment that’s planned for you. The main side effects are described here, as well as some ways to reduce or control them.
Side effects can be hard to deal with, but they usually disappear gradually when your treatment finishes.
Risk of infection
Chemotherapy can reduce the number of white blood cells, which help to fight infection. If your number of white blood cells is low you will be more prone to infections. The number of white blood cells will increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact the hospital straight away and speak to a doctor or nurse if:
your temperature goes above 38°C (100.4°F) – some hospitals use a lower temperature than this.
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising and bleeding
Chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
Chemotherapy can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Before each chemotherapy session you will have a blood test called a full blood count (FBC). This test counts the numbers of white blood cells, red blood cells and platelets in your blood. Occasionally it may be necessary to delay your treatment if your red or white blood cell count or platelet count is low.
Feeling sick (nausea) and being sick (vomiting)
Some of the chemotherapy drugs used may make people feel sick or even be sick. This can be helped by taking anti-sickness drugs (anti-emetics), which your doctor can prescribe. If they don’t work for you let your doctor know as there are different drugs that can be used. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
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. For a dry mouth, some people find sucking on ice soothing. 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.
You may notice that food tastes different. Some people describe having a metallic taste in their mouth. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Some chemotherapy drugs may cause hair loss. Some people may have complete hair loss including eyelashes and eyebrows; others may only experience partial hair loss or thinning. It depends on what chemotherapy drugs you’re having - your doctor or nurse can tell you more about what to expect. If you do experience hair loss, your hair should start to grow back within about 3-6 months of treatment ending. Your nurse can give you advice about coping with hair loss and how to look after your scalp.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Chemotherapy can cause constipation or diarrhoea. Constipation can usually be helped by drinking plenty of fluids, having more fibre in your diet and doing some gentle exercise. You may need to take medicine to help (laxatives). Your doctor can prescribe these or you can buy them at a pharmacy. Diarrhoea can usually be easily controlled with medicine but tell your doctor if it’s severe or continues. It’s important to drink plenty of fluids if you have diarrhoea.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This may be mild and only last a few days.
If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Numbness or tingling in hands or feet
This is due to the effect of certain chemotherapy drugs on nerves and is known as peripheral neuropathy. Not all drugs cause this. You may notice that you have difficulty with buttons or doing other similar fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. It’s important to report symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug. This side effect usually improves slowly, a few months after treatment finishes. Sometimes it can persist - talk to your doctor if this happens.
Risk of blood clots
Cancer can increase your risk of developing a blood clot (thrombosis) and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you have any of these symptoms.
Most clots can be successfully treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Some people have an allergic reaction to chemotherapy drugs while they’re being given. Signs of this include flu-like symptoms (such as a headache, high temperature or chills); feeling sick; skin rashes and itching; breathlessness; or pain in your back, tummy or chest. You’ll be monitored closely during your infusion but it’s important to tell your nurse or doctor if you feel unwell or have any of these symptoms. If you do have a reaction, it can be treated quickly. Sometimes a reaction can happen a few hours after treatment. If you develop these symptoms or feel unwell after you get home, contact the hospital straight away.
It’s not advisable to father a child while having chemotherapy, as it may harm the developing baby. It’s important to use effective contraception while having chemotherapy, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen. To protect your partner, it’s safest to use a condom for about 48 hours after chemotherapy.
Some chemotherapy drugs can affect your ability to father a child. If chemotherapy is likely to make you infertile and you want to have children, it may be possible to store sperm before treatment begins. Your doctor or nurse can talk to you about whether the treatment you’re having could cause this and what options may be available if you would like to have children.
Rob talks about the treatment he had to preserve his fertility when he was diagnosed with Hodgkin lymphoma.