Chemotherapy for Breast Cancer

Written by : Dr.M.D.Mazumdar, MD

Chemotherapy is the process by which cancer-killing drugs are either injected into the body or are given as oral pills. Chemotherapy usually follows surgery for breast cancer. Sometimes it may be given together with surgery as well as radiotherapy. Hormone therapy may be used as a follow-up treatment.

Chemotherapy helps destroy any undetected cancer cells which may remain after surgery. This decreases the risks of the cancer recurring.

Drugs used in chemotherapy for breast cancer are similar to other cancers but the protocol for giving them may vary. The doctor decides the treatment plan for each individual. He/she will also determine how long and how often chemotherapy treatments must continue.

Chemotherapy usually is not recommended for non-invasive, in situ cancers such as DCIS because they have very little risk of spreading to other parts of the body. Generally, chemotherapy is given in cycles - which means that the drugs are given for 4-6 weeks and then a rest period of a few weeks is allowed. Then the treatment is repeated.

Specific treatment is based on:

  • Overall health of the patient.
  • Age
  • The type, size and stage of the tumor.
  • Number of lymph nodes involved and degree of involvement
  • Whether the tumor has metastasized or whether there are high risks of the tumor metastasizing.
  • Hormone receptors in the breast.
  • Whether the patient is still menstruating. More aggressive treatment is necessary in women who have not attained menopause.
  • Reactions to and tolerance of specific drugs.

Types of Chemotherapy: There are three types of chemotherapy:

  • Neoadjuvent Chemotherapy: This is a type of chemotherapy which is given before surgery to shrink the tumors. This can help make the operation easier for both the surgeon as well as the patient and allows the surgeon to remove the tumor completely. It also allows the surgeon to do a lumpectomy and preseve the breast, rather than go for a mastectomy and remove the breast completley.

    This type of chemotherapy decreases the risks of the recurrence of teh cancerous cells. It is often used for:

    • Inflammatory breast cancer.

    • HER2-positive breast cancer.

    • Triple-negative breast cancers

    • High-grade tumors

    • Cancers that have spread to the lymph nodes

    • Larger tumors

  • Adjuvent Chemotherapy: In this case, chemotherapy is given after the surgery to treat any cancer cells which may still be present in the body in the chest wall of lymph nodes or which has spread elsewhere in the body.

  • Palliative Chemotherapy: It is used to control (but not cure) the cancer in women in whom the cancer has spread beyond the breast and localized lymph nodes. It helps to control various symptoms like pain etc, and makes the remaining years of the life of the patient somewhat easier. It may be used in combination with targeted or immunotherapy.

Side Effects - Chemotherapy, often shortened to just "chemo," is a systemic therapy which means that the drugs pass though the blood stream and affects the whole body. It affects both cancer cells as well as normal body cells. This can cause a number of side effects.

Immediate side effects

  • Nausea and vomiting

  • Loss of appetite

  • Fatigue

  • Mouth soreness

  • Hair loss

  • Weight gain

  • Lowered resistance to infections

  • Easy bruising

Delayed side effects

  • Heart problems like Congestive heart failure and Arrhythmia (irregular heartbeat).

  • Lung damage like inflammation of the pleura (pleuritis), loss of elasticity of the lung tissues and difficulty in breathing.

  • Hormone issues like hot flashes, loss in libido, mood swings and premature manopause.

  • Bone and joint problems like Osteoporosis and Joint pain.