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Chemotherapy for Breast Cancer

Chemotherapy is a form of therapy that employs drugs to kill cancer cells. The drugs enter the bloodstream and travel through the body in order to kill cancer cells. The side effects from the chemotherapy come from the fact that it destroys normal cells as well as the cancer cells. Options for men may be more limited.

Chemotherapy Combinations

The type of chemotherapy you receive will depend on the type and stage of your cancer. New combinations of chemotherapy are constantly being designed as new information is discovered. The most common chemotherapeutic drug combinations are:

  • Cyclophosphamide, methotrexate, and 5-fluorouracil (CFM)
  • Cyclophosphamide, doxorubicin, and fluorouracil (CAF)
  • Doxorubicin and cyclophosphamide (AC)
  • Doxorubicin and cyclophosphamide followed by paclitaxel, docetaxel concurrent with AC, or docetaxel (TAC)
  • Doxorubicin, followed by CMF
  • Docetaxel and cyclophosphamide (TC)
  • Cyclophosphamide, epirubicin, and fluorouracil with or without docetaxel

Chemotherapy is usually given by vein, but some forms can be given by mouth as well. Your oncologist will tell you how many cycles or courses of chemotherapy are best for you. Usually there are between 4-8 cycles when the chemotherapy is delivered on its own.

The side effects and amount of time required in the doctor’s office depend on the type of chemotherapy you receive, as well as how many cycles you receive and how often. The most common chemotherapy-associated side effects are:

  • Nausea and vomiting
  • Fatigue or tiredness sometimes as a result of suppression by the chemotherapeutic drugs of the blood forming cells in the bone marrow
  • Hair loss
  • Chemo-brain, a term used to describe a fogginess that accompanies chemotherapy. It is usually mild and inconvenient, but usually not serious or permanent
  • Low blood cell counts (red cells, white cells, or platelets) that can lead to infection or bleeding

As a result of chemotherapy, you may experience premature menopause , with all its symptoms and effects, including the loss of fertility. Some chemotherapeutic drugs also may cause serious side effects later on, including damage to the heart muscle (doxorubicin), and very rarely, the development of leukemia much later on.

Hormone Blocking Therapy

Chemotherapy can be combined with estrogen-blocking drugs, such as tamoxifen or the newer class of drugs called aromatase inhibitors (AIs). Estrogen binds to the estrogen-sensitive cells and stimulates them to grow and divide. AIs prevent the binding of estrogen to stop the cells from growing. This also prevents or delays breast cancer recurrence. These drugs will produce symptoms of menopause, such as hot flashes or night sweats, in many women. They may also produce a condition called tumor flare in people with advanced cancer metastatic to bone, resulting in increased blood calcium. This may be a serious health threat that requires hospitalization.

Occasionally, deep venous thrombosis (clotting of the veins in the leg) can occur and can be life-threatening. There is also a reported increase in the risk of endometrial cancer in women who take tamoxifen.

Biological Therapy

Chemotherapy can also be combined with biologic therapy. Biologic agents can be used to alter or boost the immune system to improve the body's ability to fight cancer cells. They can be given prior to surgery to help shrink the tumor. If there is a concern the cancer has spread, or a high risk of occurrence exists, biological therapy can be used after surgery as well.

Revision Information

  • Breast cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf. Accessed January 6, 2014.

  • Breast cancer in men. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003091-pdf.pdf. Accessed January 6, 2014.

  • Breast cancer in men. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 1, 2012. Accessed January 6, 2014.

  • Breast cancer in women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 3, 2014. Accessed January 6, 2014.