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About Breast Cancer > Treatment > Chemotherapy

Chemotherapy for Breast Cancer

What is breast cancer?
Normal tissues are made up of cells of different types that are arranged to form an organ such as a breast. Cancer develops when the DNA in the cells changes or mutates, which causes the cells to grow out of control.

What is chemotherapy?
Chemotherapy is a treatment with medicines called cytotoxic drugs that are given to kill or control cancer cells.

How does chemotherapy work?
The cytotoxic drugs enter the bloodstream and go to all parts of the body. They destroy the breast cancer cells by interfering with their ability to grow and divide. Several drugs are given in combination and each drug damages the cell at some point in its reproductive cycle. Unfortunately, chemotherapy cannot differentiate between breast cancer cells and healthy cells within the body. These cells include those in the lining of the mouth, the bone marrow, the hair follicles and the digestive system. This may cause unpleasant side effects but these are usually temporary because healthy cells can grow back to normal.

What are the benefits of chemotherapy?

  • To cure the cancer by destroying all of the cancer cells.
  • To prevent recurrence of the breast cancer in the future.
  • To reduce the size of the breast cancer tumour before surgery or radiotherapy is carried out.
  • To control the growth and spread of the cancer to relieve possible symptoms.

Who decides the chemotherapy?
The decision to offer chemotherapy as well as the most appropriate combination will be made by the oncologists after discussion with the patients. Several factors will be taken into consideration such as the grade and size of the tumour, or if there has been any involvement of the lymph glands in the axilla.

How is chemotherapy given?
Chemotherapy drugs can be given by mouth (orally) or by injections, depending on the types of chemotherapy medications are given by bloodstream route, they can be done in several different ways:

  • By injection through a peripheral cannula
  • Indwelling port
  • Central line

Common side effect of chemotherapy
Hair loss or thinning
Hair loss happens two to three weeks after the first cycle of chemotherapy. It is likely that all the body hair will be lost. However, the hair will re-grow when the treatment is finished.

Nursing tips:
  • A hat or wig can be organized before starting the treatment.
  • Keep the scalp and hair clean.
  • Use soft brush and hair comb.
  • Use scarf for sleep.
  • Wear sunglasses to protect the eyes if the eyelashes come off.

Increased risk of infection
The three main types of blood cells, namely white blood cells, red blood cells and platelets, can be lowered by chemotherapy treatment. Regular blood tests before each chemotherapy are needed. Risk of infection will be high if the white blood cells are low. The white blood cells are usually at their lowest 7 to 14 days after chemotherapy. Any infection happens during the treatment may be serious and hospitalization for infection treatment may be required. Common symptoms of an infection include:

  • feeling hot then cold and clammy
  • shivering and shaking attacks
  • sore throat
  • increased cough or sputum (phlegm) production
  • burning sensation during urination
  • a raised temperature above 38 oC (100.5 o F)
Nursing tips:
  • Keep personal hygiene: wash hands and take shower daily, change clothes and bedding frequently. Do not share towel or toothbrush.
  • Keep home environment clean.
  • Wear mask during low white blood cells period.
  • Avoid going to crowded area.
  • Avoid contacting people with cough, flu like symptoms.
  • Observe for signs and symptoms of infection.
  • Take temperature if feeling unwell
  • Contact doctor or go straight to hospital if temperature goes above 38.5oC
  • Check the teeth with dentist before commencing chemotherapy

Sore mouth
Mouth ulcers can occur inside the mouth and on the lips. The mouth may be red, feel sore, uncomfortable and can become infected. It is advised to take special oral cavity care to look after the mouth during the treatment. Consult your doctor or dentist for ways of keeping your teeth and gums healthy.

Nursing tips:
  • Maintain cleanness of the mouth all the time.
  • Clean the teeth by using a soft toothbrush twice a day.
  • Drink plenty of fluids to keep the mouth fresh and moist.
  • Rinse the mouth with salt water four times a day (dissolve 1/4 teaspoon of salt in a glass of warm water, rinse the mouth then spit out).
  • If mouth ulcers or oral thrush develop, gargle and medication will be prescribed by doctors.
  • Consult your healthcare team before any dental work is done.

Nauseas and vomiting
Chemotherapy treatment can cause nausea or vomiting. Some chemotherapy treatments are more likely to cause sickness than others. The symptoms can persist for 3 to 5 days. It also varies among individuals.

Nursing tips:
  • Before chemotherapy treatment, take food such as toast and congee that can be easily digested.
  • Take frequent small meals in the first few days after chemotherapy.
  • Clean the mouth after each vomiting.
  • Anti-emetics should be taken before/after the chemotherapy treatment.
  • Take the prescribed anti-emetics regularly as they work more efficiently as a preventative rather than a treatment once vomiting has started.
  • If the anti-emetic is not effective, consult the doctor and medication may need to be readjusted.

It is common to feel excessively tired or even exhausted. This tiredness is not relieved by rest or sleep and may get worse when going through treatment.

Nursing tips:
  • Listen to the body and rest if needed.
  • Carry out normal activities if feeling able to do so.
  • Take gentle exercise as well as taking rest.

Change in appetite
Chemotherapy treatment can affect the appetite causing weight loss. The symptom may last for a few days. The sense of taste may alter as well, but this will usually return to normal within two to three months upon completing treatment.

Nursing tips:
  • Continue to eat and drink during the treatment.
  • Take small but frequent meals during anorexic period.
  • Change menu.
  • Take nutritional supplement if necessary.

Change of bowel habit
Some chemotherapy can affect the bowels causing diarrhoea or constipation.

Nursing tips:
  • Observe for symptoms.
  • Increase fluid intake.
  • Change of diet: takes simple and easily digested food for diarrhoea and increase fruit and vegetable intake for constipation.
  • Consult the doctor for advice.

Other side effects of chemotherapy

  • Adriamycin and Epirubicin may occasionally cause some heart problems. It is necessary to inform the doctor about the heart condition or medication taking before beginning the chemotherapy.
  • Adriamycin and Epirubicin will harmlessly colour the urine red for a day or two. Consult the doctor if the symptom lasts longer than 48 hours.
  • A small number of patients develop an itchy rash between treatments with Taxol and Taxotere. Report to doctor if it occurs.
  • Taxotere may cause fluid retention which can result in mild swelling of ankles and legs. It will be reversed when the treatment is completed.
  • Taxotere/Taxol may cause muscle or joint pain that usually lasts for a few days. Take prescribed analgesia if the symptoms are severe. This is most likely to occur 2-3 days after each treatment.
  • A small number of patients have an allergic type reaction to Taxotere/Taxol. It usually occurs while the drip is infusing. Symptoms include feeling hot and flushed, itchy, light headed or generally unwell. Inform the nurse immediately if any of these symptoms is experienced. Dexamethasone tablets are usually prescribed to reduce the chance of allergic reaction. It is very important to take the medication exactly as instructed.
  • Taxol/Taxotere can affect the nerves of the hands and feet. This may lead to a loss of sensation, tingling or pins and needles. These symptoms may increase as more cycles of chemotherapy are received. It is important to be extra careful when exposing hands and feet to hot or cold temperatures. These symptoms usually go away within a few months after finishing the treatment.
  • Taxotere may cause discolouration and ridging of finger and toe nails. Hands and feet may become dry and flaky. This can usually be managed by using a non-perfumed moisturiser.
  • Taxotere can increase skin’s sensitivity to the sun. It is best to avoid strong sunlight and wear a hat and use a sun block when in the sun.
  • Women sometimes find that chemotherapy treatment can affect their menstrual periods. The flow could become heavier, lighter or even stop altogether.

Special thanks to Dr. Lawrence Li

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