Chemotherapy Can Cause Side Effects
Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.
The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by
- asking someone to drive you to and from chemotherapy
- planning time to rest on the day of and day after chemotherapy
- asking for help with meals and childcare on the day of and at least one day after chemotherapy
There are many ways you can help manage chemotherapy side effects. For more information, see the section on side effects.
Is Chemo Right For You
Not all people who receive a diagnosis of breast cancer will need chemotherapy. Cancer can often be effectively treated with local therapies like surgery and radiation, without systemic treatment.
If youve received a diagnosis of larger tumors where the cells have spread to nearby lymph nodes, you may need a few rounds of chemo. In these cases, chemo is used as adjuvant therapy, or to prevent cancer from returning after the tumor has been removed.
If youve received a diagnosis of a stage 3 cancer and larger tumors, you may go straight to systemic treatment before getting surgery. This is called neoadjuvant treatment.
While the idea of chemotherapy may be intimidating, there have been significant improvements in how side effects are managed. Undergoing chemotherapy is much more tolerable than it used to be.
What Happens Before Chemotherapy For Breast Cancer
A few days before your chemotherapy treatment, youll have blood tests. The blood tests tell your oncologist and pharmacist how to tailor your treatment based on your laboratory values and body mass index .
You may receive chemotherapy through a large, sturdy tube called a central venous catheter . If your healthcare provider recommends a CVC, it will be surgically implanted before treatment. It stays in place until you finish chemotherapy. Types of CVCs include:
- Central line: Long, plastic tube inserted near your heart or in a neck vein.
- Peripherally inserted central catheter : A central line that goes in through an arm vein.
- Port-a-cath : A small, implantable chamber where your nurse gives drug injections.
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Which Types Of Cancer Does Chemotherapy Treat
Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy with other cancer treatments. The types of treatment that you need depend on the type of cancer you have, if it has spread and where, and if you have other health problems. To learn more about treatment for your cancer, see the PDQ® cancer treatment summaries for adult and childhood cancers.
When To Get Help
If it takes more than 30 minutes for you to fall asleep, or if youre up for at least 30 minutes in the middle of the night tossing and turning most days of the week for at least three months, you likely have insomnia, according to Zhou. Even if a breast cancer patient does not check off these boxes, feeling dissatisfied with the quality of their sleep, or not waking up feeling refreshed, are good reasons to consult with experts to explore what might be going on.
Sometimes people who struggle with sleep are not even aware of it. Other people in their life may be aware that they are not sleeping well, but do not realize the negative impact loss of sleep has on well-being, says Walsh. She notes that if you are experiencing an increase in irritability, fatigue, a depressed mood, and anxiety during the day, it may be time to get help.
Continued sleep disruption can contribute to the development of depression, Palesh confirms. If people have depression or other psychological symptoms, I would say treat insomnia symptoms early. The general recommendation, she explains, is symptoms that last anywhere between one to six months might resolve on their own. But there is a scientific debate about this, and I tend to recommend that patients treat symptoms early on so they dont take the risk of insomnia becoming chronic later on.
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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.
What To Expect During Chemotherapy Treatment
Some chemotherapy medicines for breast cancer can be taken orally as pills. But most chemotherapy medicines are given as an infusion into a vein through an IV, a port, or a catheter over a period of time.
Chemotherapy is given in cycles a period of treatment followed by a period of recovery. One cycle may include chemotherapy on the first day and then three weeks of recovery with no treatment.
A chemotherapy treatment regimen is made up of several cycles. The number of cycles in a regimen and the total time it takes to complete one regimen depends on the chemotherapy medicines you receive. But most regimens take three to six months to complete.
In some cases, if the cancer is considered aggressive, doctors may recommend a dose-dense chemotherapy regimen. Dose-dense chemotherapy means there is less time between cycles say every two weeks instead of every three weeks.
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Physical Emotional And Social Effects Of Cancer
In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Supportive care treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies.
Music therapy, meditation, stress management, and yoga for reducing anxiety and stress.
Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems.
Meditation and yoga to improve general quality of life.
Acupressure and acupuncture to help with nausea and vomiting from chemotherapy.
How Is Breast Cancer Chemotherapy Administered
Chemotherapy is commonly prescribed along with other treatment methods such as hormonal and targeted therapies. It can also be used to shrink a tumor before surgery for easier and safer removal, referred to as neoadjuvant chemotherapy.If you receive chemotherapy, your doctor will administer it in short courses with several weeks in between to allow your normal cells to recover. This treatment period can be a challenging time emotionally and physically. It is important for you to develop a support team of family or friends that can help comfort and encourage you in this time.
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Ovarian Ablation Or Suppression
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
Is Early Menopause A Risk Of Chemotherapy For Breast Cancer
Yes. If you have not gone through menopause, chemotherapy may stop your ovaries from producing estrogen. You may go into early menopause. If you want to have children in the future, discuss the risks of infertility with your healthcare provider.
Some womens ovaries begin working again after chemotherapy treatment. Women who want to bear children in the future may also choose fertility preservation before starting chemotherapy.
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Survival Rates Are Tripling For Lung Patients
When Dr. Roy Herbst of Yale started in oncology about 25 years ago, nearly every lung cancer patient with advanced disease got chemotherapy.
With chemotherapy, he said, patients would be sure to have one thing: side effects. Yet despite treatment, most tumors continued to grow and spread. Less than half his patients would be alive a year later. The five-year survival rate was just 5 to 10 percent.
Those dismal statistics barely budged until 2010, when targeted therapies began to emerge. There are now nine such drugs for lung cancer patients, three of which were approved since May of this year. About a quarter of lung cancer patients can be treated with these drugs alone, and more than half who began treatment with a targeted drug five years ago are still alive. The five-year survival rate for patients with advanced lung cancer is now approaching 30 percent.
But the drugs eventually stop working for most, said Dr. Bruce Johnson, a lung cancer specialist at Dana-Farber. At that point many start on chemotherapy, the only option left.
Another type of lung cancer treatment was developed about five years ago immunotherapy, which uses drugs to help the immune system attack cancer. Two-thirds of patients from an unpublished study at Dana-Farber were not eligible for targeted therapies but half of them were eligible for immunotherapy alone, and others get it along with chemotherapy.
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 Is Hormone Therapy
Hormone therapy slows or stops the growth of hormone-sensitive tumors by blocking the bodys ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.
Hormone therapy for breast cancer should not be confused with menopausal hormone therapy treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.
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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Talk To Your Doctor To Find Out What Your Breast Cancer Stage Is And How It Is Used To Plan The Best Treatment For You
After surgery, your doctor will receive a pathology report that describes the size and location of the primary tumor, the spread of cancer to nearby lymph nodes, tumor grade, and whether certain biomarkers are present. The pathology report and other test results are used to determine your breast cancer stage.
You are likely to have many questions. Ask your doctor to explain how staging is used to decide the best options to treat your cancer and whether there are clinical trials that might be right for you.
The treatment of breast cancer depends partly on the stage of the disease.
For treatment options for stage IIIB, inoperable stage IIIC, and inflammatory breast cancer, see Treatment of Locally Advanced Inflammatory Breast Cancer.
For treatment options for stage IV breast cancer or breast cancer that has recurred in distant parts of the body, see Treatment of Metastatic Breast Cancer.
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.
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Breast Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Breast
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes. Each lobe has many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.
Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless, watery fluid called lymph. Lymph vessels carry lymph between lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body. They filter lymph and store white blood cells that help fightinfection and disease. Groups of lymph nodes are found near the breast in theaxilla , above thecollarbone, and in the chest.
The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.
For more information about breast cancer, see:
Treatment Of Ductal Carcinoma In Situ
For information about the treatments listed below, see the Treatment Option Overview section.
- Breast-conserving surgery and radiation therapy, with or without tamoxifen.
- Total mastectomy with or without tamoxifen. Radiation therapy may also be given.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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For Metastatic Breast Cancer
Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.
After Breast Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Breast Or To Other Parts Of The Body
The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines thestage of the disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnosebreast cancer are also used to stage the disease.
The following tests and procedures also may be used in the staging process:
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Target Therapy In Tnbc
Mammalian target of rapamycin inhibitors
mTOR is one of the intracellular kinases. mTOR inhibitors have been shown to improve outcome in several cancer types including renal cancer. TNBC presents a high frequency of PTEN loss and mTOR activation. There is therefore a rationale to develop mTOR inhibition in patients with TNBC that show PTEN loss71. Interestingly, several reports say that mTOR activation could lead to cisplatin resistance, a phenomenon reversible by everolimus which is mTOR inhibitor72.
Beuvink et al.72 reported that adding everolimus to cisplatin could increase by 5-fold the loss of viability in vitro. These data suggest that there is a rationale to combine cisplatin and mTOR inhibitors in patients with TNBC.
FGFR inhibitors represent a new drug family. These drugs are either FGFR specific or target FGFR as part of their tyrosine kinase panel in addition to VEGFR inhibition. At least four compounds are currently under clinical trials on TNBC11.
EGFR signaling has been inhibited in other cancer types with clinical success either by using EGFR directed antibodies such as cetuximab or the inhibitors of receptor phosphorylation as gefitinib and erlotinib73. Cetuximab is a chimeric monoclonal antibody targeting EGFR, elicits little response to single-agent therapy in the setting of advanced TNBC74.