Pink Ribbon for Breast Cancer Awareness Month

Introduction

In cancer treatment, chemotherapy refers to the use of drugs to kill or slow the growth of rapidly multiplying cells. Each of these rugs is forf mtrapy.

Chemotherapy includes many different drugs, given alone or incombination. There are many drugs used to treat breast cancer. Ask your doctor for specific information and side effects you can expect from your chemotherapy medications.

How Is Chemotherapy Given?

Chemotherapy drugs are given intravenously (directly into a vein) or orally (by mouth). Once the drugs enter the bloodstream, they travel to almost all parts of the body in order to reach cancer cells that may have spread beyond the breast -- therefore chemotherapy is considered a whole-body, or "systemic," form of breast cancer treatment.

Chemotherapy is given in cycles of treatment followed by a recovery period. The entire chemotherapy treatment generally lasts three to six months, depending on the type of drugs given. For example, a drug may be given alone or in combination with other drugs on the first day of a 21-day treatment cycle. Such cycles may then be repeated at 3-week intervals for a total of 4 cycles of chemotherapy treatment given over 3 months.

When Is Chemotherapy Given?

When breast cancer is found only limited to the breast or lymph nodes, chemotherapy may be still be given after a lumpectomy or mastectomy. If the analysis of the findings from such a surgery suggests that there is a risk that cancer cells may have escaped from the breast and may be as yet undetectable elsewhere in the body, then chemotherapy may be recommended. This is known as adjuvant treatment and may help reduce the chance of breast cancer breast cancer recurrence.

Chemotherapy is sometimes given before surgery (called neoadjuvant treatment) 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.

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 (non-metastatic) breast cancer.

Quick GuideBreast Cancer Diagnosis and Treatment

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Chemotherapy for Breast Cancer

Should I start chemotherapy before surgery?

The classical concept of breast-cancer treatment has been a sequence of tumor-removing surgery followed by chemotherapy and/or radiation therapy. The goal of surgery and radiation therapy is to destroy or remove the primary cancer. Follow-up chemotherapy is designed to eliminate any cancer cells, as yet undetectable, at remote sites.

Can I Still Work While Receiving Chemotherapy Treatments?

Yes. Most people are able to continue working while they are being treated with chemotherapy. 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. You may have to adjust your work schedule while receiving chemotherapy, especially if you have side effects.

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. This is just a myth. Chemotherapy does not have to cause side effects in order to be effective against cancer cells.

If you are receiving adjuvant chemotherapy (after surgery that removed all of the known cancer), it is not possible for your doctor to directly determine whether the treatment is working because there are no tumors left to assess. However, adjuvant chemotherapy treatments have proved helpful in studies in which some women were given chemotherapy while others were not. Women given adjuvant chemotherapy have had their cancers recur less often if they received such chemotherapy treatments. Recurrent breast cancer is virtually always incurable. Adjuvant chemotherapy is given to reduce the risk of a cancer recurrence. It attempts to increase the chance that a patient with breast cancer will be cured.

After completing adjuvant therapy, your doctor will evaluate your progress through periodic physical examinations, routine mammography, and appropriate testing if a new problem develops. If you are receiving chemotherapy for metastatic disease, progress will be monitored by blood tests, scans, and/or X-rays.

What Are The Potential Side Effects Of Chemotherapy Drugs?

The specific side effects you will experience depend on the type and amount of medications you are given and how long you will be taking them. The most common temporary side effects include:

Ask your healthcare provider about specific side effects you can expect from your specific chemotherapy medicines. Also, discuss with your provider any side effects that are troubling you, or that you feel unable to manage.

How Will Chemotherapy Affect My Menstrual Cycle?

Cancer and its treatment will undoubtedly cause many changes in your life. One change you may experience from chemotherapy if you receive it while you are still having your menstrual periods is alterations in your menstrual cycles - from irregular periods to the symptoms of menopause (the end of menstruation).

Experts don't fully understand all of chemotherapy's effects on the female reproductive system, but this article will begin to answer some of the questions you may have, including:

  • How does chemotherapy cause or contribute to the development of menopause?
  • Will chemotherapy affect my ability to get pregnant?
  • What are the symptoms of menopause and how can I deal with them?
  • How will I know if the way I am feeling is associated with menopause and not with my treatment, stress, or another factor?
  • What are some other conditions related to menopause?

What Is Menopause?

Menopause is a normal stage in a woman's life. The term menopause is commonly used to describe any of the changes a woman experiences either before or after she stops menstruating. As menopause nears, the ovaries produce less estrogen, causing changes in the menstrual cycle and other physical changes.

Technically, menopause is the end of the reproductive phase of a woman's life, when the ovaries no longer produce eggs and she has her last menstrual cycle. The diagnosis of menopause is not confirmed until a woman has not had her period for six consecutive months. is not pregnant, and has blood tests consistent with the ovaries having stopped working.

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How Does Chemotherapy Influence The Onset Of Menopause?

During chemotherapy, women may have irregular menstrual cycles or amenorrhea (disappearance of menstrual periods). Some medications used in chemotherapy may cause damage to the ovaries, resulting in menopausal symptoms or menopause.

Menopause triggered by chemotherapy may be immediate or delayed, permanent or temporary. Unfortunately, there is no way to accurately determine how or when chemotherapy or other cancer treatments will affect an individual's menstrual cycle.

However, menopause is rarely a sudden response to chemotherapy. When treatments begin, you may notice some menopausal symptoms, but usually the symptoms are delayed for several months after treatment is started. This is natural. Menopausal symptoms may last for years after treatment is completed.

The most common symptoms of menopause are hot flashes, emotional changes, changes in the vagina, sexuality changes, and weight gain.

Will My Menstrual Flow Be Different After Chemotherapy?

Menstrual cycles vary from woman to woman. Some women may experience less frequent cycles than they had prior to chemotherapy. They may skip a period or increase the number of days between periods. Other women may have more frequent periods.

Some women may not experience a change in the length of their menstrual cycles but the flow pattern may be different than it was before treatment (the number of days or amount of flow may diminish or the flow may be heavier). Mixed patterns are also common: some women may have shorter menstrual cycles with heavier bleeding, or infrequent cycles with many days of a very high flow.

Even though periods tend to be irregular around the time of menopause, it is important to be aware of bleeding that is not normal for you. It is very important to call your physician if you ever have very heavy bleeding that is associated with weakness or dizziness.

Will My Periods Return After Chemotherapy?

Many premenopausal women retain or recover ovarian function and their periods return after treatment is completed. Return of ovarian function may depend on the woman's age prior to treatment and the type of medication she received during treatment.

Can I Get Pregnant While I'm Receiving Chemotherapy?

Yes. It is safe to have sexual intercourse while on chemotherapy. Nonetheless, there is always a chance that you can get pregnant as long as you are menstruating. While on chemotherapy, your menstrual cycle may become irregular. As a result, you may never quite be sure where you are in your menstrual cycle and your period may take you by surprise. Some of your menstrual cycles may be non-egg producing, but you cannot rely on this.

Even if your periods seem to have stopped, you should use a safe and effective method of birth control for at least four to eight weeks after your chemotherapy treatment has ended.

What Is The Safest Type Of Birth Control During Chemotherapy?

A safe and effective contraception (birth control) method is necessary during your treatment. Guidelines for young women undergoing chemotherapy may include the use of barrier contraceptives such as a diaphragm or a condom. An IUD (intrauterine device) may be the most effective option to consider at this time. Oral contraceptives (birth control pills) may be acceptable for some women, but are generally not recommended for women with breast cancer.

What Happens If I Get Pregnant While Receiving Chemotherapy?

Becoming pregnant while receiving chemotherapy could result in a complicated pregnancy.

Some chemotherapy medicines to treat breast cancer are safely given during pregnancy.

Most chemotherapy drugs can be safely given after the first 13 weeks of a pregnancy. Prior to that time, chemotherapy drugs pose a risk to the developing fetus and are generally not used. If you think you might be pregnant, it is important to tell your physician right away so that steps can be taken to ensure the health of you and your baby.

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After I've Completed Chemotherapy, How Long Must I Wait Before Trying To Get Pregnant?

Pregnancies after chemotherapy are not uncommon, but need to be planned after you complete treatment. Consult your oncology physician about your plans to get pregnant. In many cases, pregnancy will not influence the return of cancer. But there are situations in which pregnancy should be considered with caution.

If infertility is an issue after your treatment is complete, there are alternative therapies. Discuss your options with your gynecologic doctor.

Are There Risks Of Chromosomal Abnormalities Or Cancer In Children Conceived After Chemotherapy?

No. There is no known risk of chromosomal abnormalities in a woman's children after she has had chemotherapy. There is also no evidence that chemotherapy treatment causes cancer in children conceived after the treatment is complete.

Reviewed by the doctors at The Cleveland Clinic Taussig Cancer Center.
Edited by Charlotte E. Grayson, MD, February 2004.

Portions of this page © The Cleveland Clinic 2000-2003

REFERENCE:

"Treatment protocols for breast cancer"
uptodate.com

Last Editorial Review: 1/31/2005

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Reviewed on 1/31/2005
References
REFERENCE:

"Treatment protocols for breast cancer"
uptodate.com

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