Chemotherapy 101 -- Marisa Weis, MD

By Marisa Weiss
WebMD Live Events Transcript

Chemotherapy can conjure mixed emotions of hope and fear for those with cancer. Understanding how anticancer drugs work, knowing what to expect and what questions to ask your doctor can help you feel more at ease about your treatment regimen. Marisa Weiss, MD, co-author of "Living Beyond Breast Cancer," joined us to answer your chemo questions.

The opinions expressed in this transcript are those of the health professional and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Hello, Dr. Weiss. Welcome back to WebMD.

Weiss: Well thank you for having me.

Member: Found out yesterday: right breast, cancer. One large mass and one small satellite. Surgeon said, "I also feel the lymph gland" (is that the way you say it?). Said, "mastectomy" because too large for lumpectomy. Said I could also use chemo for two to three months to try to shrink mass and then do lumpectomy. I'm 43, what is the success rate of that?

Weiss: You seem to be dealing with two separate issues. First is the question of whether it is possible to keep your breast rather than have to sacrifice your breast. Your doctor is concerned that there are two separate cancers in the same breast. Whenever there is more than one cancer present, mastectomy is usually recommended. Lumpectomy and radiation therapy are usually only offered to women with only one site of cancer that can be removed with clear margins.

The second issue you mentioned is the size of the cancer. If you are dealing with one cancer that is relatively large, like 4-5 cm or greater, then your situation may not be ideal for breast preservation therapy. Under these circumstances, if a woman wants to keep her breast if at all possible, there may be a role for up front chemotherapy (otherwise known as "neoadjuvant" chemotherapy) with a purpose of shrinking the tumor down to a small enough size (under 4 cm) so that you could be treated with lumpectomy and radiation as an alternative to mastectomy.

For some women who have an irregularly shaped cancer in one part of the breast that may be one cancer process or possibly two lumps huddled together, you may want to have additional studies to distinguish between these two presentations. An MRI scan and sometimes an ultrasound or mammogram can help figure this out. Good luck with your situation. Read further at www.breastcancer.org regarding all these tough decisions.

Member: Are there any standards regarding selection of the particular type of chemo used for small primary breast cancers?

Weiss: Yes. Every woman's situation is unique and different from anyone else's. We try to use current guidelines to pick the best treatments possible. The selection of chemotherapy can depend on the specific tumor characteristics found in your pathology report. For example, if you have a cancer that is HER2 positive, your doctor may select an adriamycin-based chemotherapy rather than CMF chemo. For women whose cancers have estrogen or progesterone receptors present, anti-estrogen therapy usually has an important role. There are other considerations like this that your doctor may use in guiding you. Also if you are perimenopausal, and want to preserve fertility, if possible, most doctors would avoid using CMF.

Member: Why would doctors avoid using CMF?

Weiss: Both chemotherapy treatments are generally very effective. In general they are almost equally effective, depending on subtle differences in an individual's situation. CMF is usually given over a six-month period. It is associated with minimal hair loss and that's why many women prefer this approach. It is also associated with a slightly higher risk of infertility in premenopausal women. AC chemotherapy is given over a three-month period and is associated with complete hair loss. In the US, most doctors prefer AC for young women. AC is also better for cancers that are HER2 positive.

Member: I had a lumpectomy and only one lymph node had cancer. Will I still need chemo or is there an alternative? I am also past menopause. If I receive chemo, am I likely to receive a dose less than someone who might have had cancer in several nodes?

Weiss: These are excellent and interesting questions. The role for chemotherapy depends on a number of different features about the cancer including:

  • Tumor size
  • Tumor growth rate
  • Hormone receptor status
  • Presence of lymphatic or vascular invasion
  • HER2 status
  • Lymph node involvement



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