What is breast cancer?
Normal tissues are made up different types of cells, 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. Breast cancer is when these changes and mutations occur in the breast.


What is chemotherapy?
Chemotherapy is a form of treatment using medicines called cytotoxic drugs which kill or control cancer cells.


How does chemotherapy work?
The administered cytotoxic drugs enter the bloodstream and travel to all parts of the body. The drugs destroy breast cancer cells by interfering with their ability to grow and divide. Several drugs are given in combination and each drug damages the cells at some point in their reproductive cycle. Unfortunately, chemotherapy cannot differentiate between breast cancer cells and healthy cells within the body, which 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 as healthy cells recover.


What are the benefits of chemotherapy?

Chemotherapy is used to:

  • Cure the cancer by destroying all of the cancer cells.
  • Prevent recurrence of breast cancer in the future, by destroying all cancer cells.
  • Reduce the size of the breast cancer tumour before surgery is carried out.
  • Control the growth and spread of the cancer.


Who decides on chemotherapy as a treatment?
The decision to offer and administer chemotherapy, as well as the most appropriate combination, will be made by a breast cancer patient’s oncologists after discussion with the patients. Several factors are taken into consideration including the grade and size of the tumour, or if there has been any involvement of the lymph glands in the axilla. In addition, the tumour biological characteristics like receptors status are also important factors.


How is chemotherapy administered?
Chemotherapy drugs can be administered by mouth (orally) or by injections, depending on the type of chemotherapy. Chemotherapy medications via the bloodstream route can be administered in several different ways:

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


Common side effects of chemotherapy
Hair loss or thinning
Hair loss usually happens 2 to 3 weeks after the first cycle of chemotherapy. It is likely that all body hair will be lost. However, the hair will grow back after the treatment is completed.

Nursing tips:

  • A hat or wig can be prepared before starting the treatment.
  • Keep the scalp and hair clean.
  • Use a soft brush or hair comb.
  • Wear a scarf around the head when sleeping.
  • Wear sunglasses to protect the eyes if the eyelashes fall 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 session are needed to monitor the blood cells count. The risk of infection will be high if the white blood cells are low. White blood cells are usually at their lowest 7 to 14 days after chemotherapy. Any infection that happens during chemotherapy can 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
  • a burning sensation during urination
  • a raised temperature above 38°C (100.5 °F)

Nursing tips:

  • Maintain high levels of personal hygiene: wash hands frequently and take shower daily, change clothes and bedding frequently. Do not share towels or toothbrushes.
  • Keep the home environment clean.
  • Wear a mask during periods of low white blood cell count.
  • Avoid going to crowded areas.
  • Avoid contact with people with coughs and/or flu-like symptoms.
  • Be more aware of your body and look out for signs and symptoms of infection.
  • Take your temperature if you are feeling unwell.
  • Contact your doctor or go straight to hospital if your temperature rises above 38.5°C.
  • Go for a dental check before commencing chemotherapy.

Mouth Sores
Mouth ulcers can occur inside the mouth and on the lips. Symptoms can include redness of the mouth, soreness and discomfort. The mouth can also become infected. Patients are advised to take special oral care during chemotherapy treatment. Please consult your doctor or dentist for ways of maintaining teeth and gum health.

Nursing tips:

  • Maintain oral hygiene at all times.
  • Brush the teeth using a soft toothbrush twice a day.
  • Drink plenty of fluids to keep the mouth fresh and moist.
  • Rinse the mouth with salt water 4 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 please consult a doctor for gargle and medication prescriptions.
  • Consult your healthcare team before doing any dental work during chemotherapy.

Nausea 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 and vary from patient to patient. 

Nursing tips:

  • Before chemotherapy treatment take food that is easily digested such as toast and congee.
  • Take small but frequent meals in the first few days after chemotherapy.
  • If you vomit, clean the mouth after each time.
  • Anti-emetics can be prescribed by your healthcare team.
  • Take the prescribed anti-emetics regularly as they are more effective for prevention than treatment.
  • If the anti-emetic is not working for you please consult your doctor who may adjust your medication.

It is common to feel excessively tired or even exhausted. This feeling of this fatigue may not be relieved by rest or sleep, and may get worse when undergoing chemotherapy treatment.

Nursing tips:

  • Listen to your body and rest if needed.
  • Carry out normal activities only if you feel you are able to do so.
  • Take gentle exercise as well as taking rest.

Change in appetite
Chemotherapy treatment can affect the appetite cause weight loss. This symptom may last for a few days. The sense of taste may alter as well but this will usually return to normal within 2 to 3 months of treatment completion.

Nursing tips:

  • Continue to eat and drink as normally as possible during treatment.
  • Take small but frequent meals during periods of appetite loss.
  • Adjust your regular meal menu to provide some changes.
  • Take nutritional supplements if necessary.

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

Nursing tips:

  • Be more aware of your body and observe for changes in bowel movements.
  • Increase your fluid intake.
  • Change your diet: take simple and easily digested foods if you have diarrhoea and increase fruit and vegetable consumption if you have constipation.
  • Consult your doctor for advice.


Other side effects of chemotherapy

Adriamycin and Epirubicin

  • Adriamycin and Epirubicin may occasionally cause heart problems. You must inform your doctor about any heart condition or medication you have been prescribed before commencing chemotherapy treatment.
  • Adriamycin and Epirubicin will harmlessly colour the urine red for a day or two. Consult your doctor if the symptom lasts longer than 48 hours.



  • A small number of patients develop an itchy rash between treatments with Taxol and Taxotere. You should report these symptoms to your doctor if they occur.
  • Taxotere may cause fluid retention which can result in mild swelling of ankles and legs. This usually subsides once treatment is completed.
  • Taxotere/Taxol may cause muscle or joint pain that usually lasts a few days. This is most likely to occur 2 to 3 days after each treatment. You can take a prescribed analgesia if the symptoms are severe.
  • A small number of patients may have an allergic reaction to Taxol /Taxotere which will usually occur 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 are experienced. Dexamethasone tablets are usually prescribed to reduce the chance of an allergic reaction. It is very important to take this medication exactly as instructed.
  • Taxol/Taxotere can affect the nerves in the hands and feet. This may lead to a loss of sensation, tingling or pins and needles. It is important to be extra careful when exposing hands and feet to hot or cold temperatures. These symptoms may increase as more cycles of chemotherapy are received but usually go away within a few months of completing treatment.
  • Taxotere may cause discolouration and ridging of finger- and toenails. Hands and feet may become dry and flaky. This can usually be managed by using a non-perfumed moisturiser.
  • Taxotere can cause discolouration and ridging of finger and toe and 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, wear a hat and use a sun block when outdoors.
  • Women sometimes find that chemotherapy treatment can affect their menstruation. The menstrual flow may become heavier, lighter or even stop altogether.


Special thanks to Dr. Lawrence Li for editing