Neoadjuvant And Adjuvant Systemic Therapy
For women who have a hormone receptor-positive breast cancer, most doctors will recommend hormone therapy as an adjuvant treatment, no matter how small the tumor is. Women with tumors larger than 0.5 cm across may be more likely to benefit from it. Hormone therapy is typically given for at least 5 years.
If the tumor is larger than 1 cm across, chemo after surgery is sometimes recommended. A woman’s age when she is diagnosed;may help in deciding if chemo should be offered or not. Some doctors may suggest chemo for smaller tumors as well, especially if they have any unfavorable features .
After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to 1 year.
Many women with HER2-positive cancers will be treated with trastuzumab followed by surgery and more trastuzumab for up to 1 year. If after neoadjuvant therapy, residual cancer is found during surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. If hormone receptor-positive cancer is found in the lymph nodes, your doctor might recommend one year of trastuzumab followed by additional treatment with an oral drug called neratinib for 1 year.
Possible Side Effects Of Chemo For Breast Cancer
Chemo drugs can cause side effects. These depend on the type and dose of drugs given, and the length of treatment. Some of the most common possible side effects include:
- Hair loss
Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:
- Increased chance of infections
- Easy bruising or bleeding
These side effects usually go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.
Other side effects are also possible. Some of these are more common with certain chemo drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting.
Expectations And What To Avoid
Radiation therapy should not cause pain or discomfort during the procedure. However, minor side effects are common in the days or weeks afterward. Before beginning radiation therapy, an individual should schedule a consultation with their doctor to work out the details.
People should also take some precautions while they are receiving radiation therapy. For example, they should avoid direct sun exposure by using sunscreen and covering up areas of bare skin when outside.
Also, taking antioxidant supplements, such as vitamins A, C, D, and E, can interfere with radiation therapys effectiveness. People should, therefore, focus on eating a well-balanced diet so that their body can absorb the nutrients and vitamins it needs from food.
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Internal Breast Cancer Radiation
Internal breast cancer radiation is also known as brachytherapy. You doctor will place a device that contains radioactive seeds in the area of the breast where the cancer was found. For a short time, internal radiation targets only the area where breast cancer is most likely to return. This causes fewer side effects. The treatment takes a week to complete.
If youve had breast-saving surgery, a doctor may treat you with both internal and external radiation to increase the boost of radiation. Doctors may only perform internal radiation as a form of accelerated partial breast radiation to speed up treatment.
Potential side effects of internal radiation include:
Will The Nhs Fund An Unlicensed Medicine
It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.
Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
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How Will I Know If The Chemotherapy Treatments Are Working
Some people may think that their chemotherapy treatment is not working if they do not experience side effects. However, this is a myth.
If you are receiving adjuvant chemotherapy , it is not possible for your doctor to directly determine whether the treatment is working because there are no tumor cells left to assess. However, adjuvant chemotherapy treatments have been proven helpful in studies in which some women were given chemotherapy, while others were not. If you are receiving chemotherapy for metastatic disease, the effects will be monitored, routinely, by blood tests, scans, and/or other imaging studies. These may include CT scans, bone scans, and/or X-rays).
After completing adjuvant chemotherapy, your doctor will evaluate your progress through periodic physical examinations, routine mammography, and appropriate testing if a new problem develops.
Last reviewed by a Cleveland Clinic medical professional on 09/05/2013.
Menstrual Changes And Fertility Issues
For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and may be permanent. Some chemo drugs are more likely to cause this than others. The older a woman is when she gets chemotherapy, the more likely it is that she will go through menopause or become infertile as a result. When this happens, there is an increased risk of bone loss and osteoporosis. There are medicines that can treat or help prevent bone loss.
Even if your periods have stopped while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you are pre-menopausal before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best in your case. Women who have finished treatment can safely go on to have children, but it’s not safe to get pregnant while on treatment.
If you think you might want to have children after being treated for breast cancer, talk with your doctorbeforeyou start treatment. Learn more from our section on fertility concerns for women with cancer.
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Cancer Researchers Worry Immunotherapy May Hasten Growth Of Tumors In Some Patients
Depending on characteristics such as how many tumor cells, blood vessel cells, and immune cells are touching each other, the tumor microenvironment can nearly triple the chance that a common type of breast cancer that has reached the lymph nodes will also metastasize, Condeelis and colleagues showed in a 2014 study;of 3,760 patients. The discovery of how the tumor microenvironment can fuel metastasis by whisking cancer cells into blood vessels so impressed Dr. Francis Collins, director of the National Institutes of Health, that he featured it in his blog.
The new study took the next logical step: Can the tumor microenvironment be altered so that it promotes or thwarts metastasis?
To find out, Einsteins George Karagiannis spent nearly three years experimenting with lab mice whose genetic mutations make them spontaneously develop breast cancer, as well as mice given human breast tumors. In both cases, paclitaxel changed the tumor microenvironments in three ways, all more conducive to metastasis: The microenvironment had more of the immune cells that carry cancer cells into blood vessels, it developed blood vessels that were more permeable to cancer cells, and the tumor cells became more mobile, practically bounding into those molecular Lyfts.
Pre-op chemo may have unwanted long-term consequences in some breast cancer patients, the Einstein researchers wrote.
When Is Chemotherapy Given For Breast Cancer
Chemotherapy is sometimes given before surgery in order to shrink the tumor so it can be removed more easily or so that a lumpectomy can be performed instead of a mastectomy. When breast cancer is localized only to the breast or lymph nodes, chemotherapy may be given after a lumpectomy or mastectomy. This is known as adjuvant treatment and may help reduce the chance of breast cancer recurrence.
Chemotherapy may also be given as the main treatment for women whose cancer has spread to other parts of the body outside of the breast and lymph nodes. This spread is known as metastatic breast cancer and occurs in a small number of women at the time of diagnosis or when the cancer recurs some time after initial treatment for localized breast cancer.
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Can I Still Work While Receiving Chemotherapy Treatments For Breast Cancer
Yes. Most people are able to continue working while they are being treated with chemotherapy. You may have to adjust your work schedule while receiving chemotherapy, especially if you have side effects. 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.
Choosing A Chemo Combination
Your doctor will probably talk to you about combining different chemo drugs. They may refer to them by abbreviations for their names. Some of the most common include:
- AC: Adriamycin and Cytoxan
- CMF: Cytoxan, methotrexate, and fluorouracil
- FAC: Fluorouracil, Adriamycin, and Cytoxan
- CAF: Cytoxan, Adriamycin, and fluorouracil
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Longer Term Side Effects
Tiredness is commonly reported during treatment. This may be a direct effect of the drugs or may be due to other factors such as disrupted sleep patterns.
- Try to get adequate rest but also try to exercise regularly. Go for a walk outside each day as this can actually give you more energy.
- Find something that you actually enjoy doing and also try to incorporate exercise into your usual day, e.g. walk upstairs rather than taking the lift, park further away from where you want to go and walk the extra distance. Build this up gradually.
- Your GP, practice nurse or a physiotherapist can work with you to devise a specific exercise plan for you.
- Let others help when your energy levels are low.
If your fatigue doesn’t allow you to exercise, discuss this with your GP.
Usually energy levels recover after treatment finishes but this commonly takes time. In some cases full recovery may take 12 months or more.
Some people notice they are having concentration and short-term memory problems following their chemotherapy. This is often referred to as chemo brain. The severity and duration of symptoms differ from person to person. For some people the symptoms are very mild and resolve soon after treatment stops, but others may find their daily life is noticeably affected for a much longer period, restricting their ability to return to work in their pre-treatment capacity.
What To Expect After Chemo
Once youâre home, you need to take care of yourself and take steps to manage chemo side effects. These include:
- Take medications the doctor prescribed for side effects.
- Stay away from anyone with a cold or infection — chemo makes it harder for your body to fight germs.
- Drink lots of fluids for the first 8 hours to move the medicine through your body.
- Manage bodily fluids and waste that may have traces of chemo. Usually, this means flushing the toilet twice.
Youâll see your doctor every 4 to 6 months for the next 5 years after treatment ends.
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What If I Have Side Effects
You will see your doctor regularly while you are having treatment. Before each dose of chemotherapy you will have a blood test and a consultation with your medical oncologist to review your treatment. You will be able to discuss any side effects you have experienced and to ask questions. If necessary, the treatment can be adjusted for the next cycle.
Brachytherapy Via Implantable Device
There are two common types of internal radiation treatment: interstitial brachytherapy and intracavitary brachytherapy.
During interstitial brachytherapy, a doctor will insert several small tubes into your breast where the cancer was removed. The tubes deliver radioactive pellets to that area a few times each day over several days. This procedure is not commonly used today.
Intracavitary brachytherapy is the most common type of internal breast cancer radiation. Your doctor will place a tube-like device into your breast to send radiation to the location of the cancer. The end of the device expands in the breast to keep it in place, while the other end sticks out of the breast. Outpatient treatment sessions happen twice a day for five days.
Side effects of intracavitary brachytherapy may include:
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Changes To Taste And Appetite
Chemotherapy may cause changes in the taste of food, and even alterations to the taste of coffee and water.
Often women describe food as having a metallic taste. These changes to taste are called dysgeusia. This problem may be difficult to counteract. Changes in taste, combined with nausea or uneasiness in the stomach, may cause cravings for unusual foods, rather like the symptoms of pregnancy. Care must be taken to avoid high calorie snacks as weight gain often occurs during chemotherapy.
It is important to keep your strength up by eating frequent small meals and trying different foods. Talking to a dietician or an experienced chemotherapy or breast nurse can be very helpful.
What Happens Before Chemotherapy
Each chemotherapy treatment plan is created to meet a patient’s unique needs. But before treatment starts, you can expect to take these general steps.
Meet with your oncologist. The doctor will look over your medical records and do a physical exam. You will also have tests done to help plan treatment. Your exact treatment depends on the type, size, and location of the cancer. Your doctor will also consider your age, your general health, and other factors, such as previous cancer treatments.
Learn about your chemotherapy treatment schedule. Your health care team will explain when and how often you need chemotherapy. Most chemotherapy treatments are given in repeating cycles. The length of a cycle depends on the drug you receive. Most cycles range from 2 to 6 weeks. The number of treatment doses scheduled within each cycle also depends on the prescribed chemotherapy.
For example, each cycle may contain only 1 dose on the first day. Or, a cycle may contain more than 1 dose given each week or each day. Often, your doctor will check if the treatment is working after you finish 2 cycles. Most people have several cycles of chemotherapy. Sometimes, chemotherapy treatment is ongoing as a maintenance therapy.
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How Long Is A Cycle Of Chemo
Chemotherapy often involves several sessions or cyles of treatment. A cycle of chemotherapy is the amount of time that elapses between the start of one round of chemotherapy to the start of the next.
Cancer Research UK states that it is very important for a person to receive their chemotherapy treatment in cycles. While chemotherapy drugs kill cancer cells, they also kill fast-growing healthy cells within the body. Receiving chemotherapy in cycles helps to effectively kill off the cancerous cells, while allowing the persons body time to replenish its healthy cells.
A single course of chemotherapy will typically involve four to eight chemotherapy cycles. For instance, a 4-week cycle could involve someone taking medications on the first, second and third days, then no further medication until the 29th day.
A doctor will decide the length and structure of a persons chemotherapy cycles.
Chemotherapy treatment typically lasts between 36 months. However, some people will receive chemotherapy for shorter or longer periods of time.
Treatment Modalities Of Tnbc
Patients with TNBC do not benefit from hormonal or trastuzumab-based therapy because of the loss of target receptors such as ER, PGR, and HER-2. Hence, surgery and chemotherapy, individually or in combination, appear to be the only available modalities. However, some studies have identified certain receptors as targets for new therapeutic drugs.
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Side Effects Of Breast Cancer Chemotherapy
Chemotherapy usually works by attacking rapidly dividing cells. This means that chemotherapy can harm not only cancer cells but also healthy cells that are dividing rapidly, like the ones that cause your hair to grow.
Whether you have side effects from breast cancer chemotherapy will depend on the details of your treatment plan. The care teams at MSK are committed to helping you feel your best during and after treatment. During treatment, well watch carefully for your reaction to the drugs and adjust the drugs or dose as necessary. Well also continue to monitor you for possible long-term effects after your treatment ends.
We offer a variety of other specialized services to support you during your treatment. Many MSK patients find that our Integrative Medicine Service can be a valuable part of their treatment plan. Programs include massage, acupuncture, hypnotherapy, meditation, visualization, music therapy, and nutritional counseling.
One side effect of chemotherapy can be hair loss. MSK offers scalp cooling to help minimize hair loss. Learn more about scalp cooling, or ask your care team for more information.
External Beam Breast Cancer Radiation
External beam radiation is the most common kind of radiation treatment for breast cancer. Its a painless treatment, like getting an X-ray. A doctor will place a machine on the outside of your body and aim the radiation beams at the area of the cancer. Your doctor will figure out where to aim the rays and how much radiation to use before each treatment. They will mark the area with temporary or permanent ink.
Each treatment only lasts a few minutes. The session setup will take longer. External radiation treatment happens five days a week for about five to seven weeks. Its the longest type of radiation treatment available.
Short-term side effects of external radiation include:
- swelling and pain in the arm or chest
- weakened and fractured ribs
- future cancer in the inner lining of your blood vessels
External radiation does not leave radiation in your body. You will not be radioactive during or after treatment.
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