Chemotherapy is the use of one or more drugs to destroy cancer cells that may be present in the body. It is often used after surgery for breast cancer to kill any cancer cells that may be left undetected in the breast or lymph nodes or that may have spread to other parts of the body. Chemotherapy can lower the risk of breast cancer coming back.
Chemotherapy can also be used before surgery to reduce the size of a large tumour so that the surgeon has the best possible chance of removing all the remaining tumour during surgery.
Will I need chemotherapy?
Many women with breast cancer will be referred to a medical oncologist to discuss whether or not chemotherapy is an appropriate treatment for them. Chemotherapy is offered to some women as an additional treatment to surgery, radiotherapy, and/or hormonal therapy.
Oncotype DX is a test that can help determine whether or not you may benefit from chemotherapy treatment. This specialised test analyses 21 genes within your tumour to make a prediction about the likelihood of your breast cancer recurring. If the test shows you have a high risk of recurrence, chemotherapy may be recommended for you. If the test shows you have a low risk of recurrence, you may be able to avoid chemotherapy.
The test is not currently covered by Medicare and is quite expensive at $4000.
For further information about Oncotype DX testing, visit the Breast cancer pathology page or talk to your surgeon or medical oncologist.
How does chemotherapy work?
Chemotherapy attacks the fast-growing cells in your body, including cancer cells. There are many different types of chemotherapy and not all of them will suit you. Your medical oncologist will discuss with you the best options for you. Sometimes two treatments might be considered equally effective and you will be asked to decide which one to have.
Some questions to consider in making this decision include:
- What are the potential side effects of each treatment?
- Is the treatment given intravenously or orally?
- How long is the course of each treatment?
- How will the treatment fit in with your lifestyle and personal circumstances?
Chemotherapy is usually administered intravenously (by needle into a vein in the arm or hand), so drinking plenty of fluids, relaxing and keeping your hands and arms warm can help with finding your veins. Some chemotherapy drugs are given in tablet form.
What are the side effects?
Unfortunately chemotherapy attacks healthy cells as well as cancer cells. This can result in unwanted side effects, such as fatigue, nausea and hair loss. Your doctor or nurse can give you information on ways to manage any side effects you may experience.
It's important to discuss your side effects with a member of your medical team, especially if they are affecting your daily life. It may be possible for your oncologist to change your chemotherapy drug to one that has fewer side effects. Chemotherapy drugs all work a little differently, so have different side effects. Not all women will suffer side effects from chemotherapy - this doesn't mean the drugs aren't working.
"Discuss every side effect to your treatment with your oncologist. Treatments are improving all the time and most side effects can be managed to minimise your discomfort." --Julia
Because it's visible to others, hair loss (alopecia) can be one of the more distressing side effects of chemotherapy. The hair loss page contains information and strategies on how to deal with hair loss.
Nausea and vomiting are common side effects of chemotherapy. You may be given anti-nausea medication before your chemotherapy to take home with you, just in case. If you have nausea and/or vomiting that lasts for more than 24 hours, let your doctor know. It’s easy to become dehydrated quickly, and your doctor can help with this.
During chemotherapy, women sometimes experience changes in taste and mouth ulcers. Some have found that Rinsing your mouth regularly with bicarbonate of soda can help to prevent ulcers, even before you begin chemotherapy. If they do develop, using a child’s toothbrush is gentler on the gums. A supply of soft mints can help get rid of the metallic taste, and chilled blended drinks can help you with nutrition and soothe a sore mouth.
In some women chemotherapy can reduce the level of oestrogen and cause periods to stop temporarily or altogether. This is called early menopause. You may experience some of the symptoms of menopause, such as hot flushes and night sweats. BCNA’s Menopause and Breast Cancer booklet provides practical tips to help manage the symptoms of menopause. Download a copy from our fact sheets and booklets page, or order a free copy from our online shop.
Chemotherapy reduces the level of oestrogen in your body, which can reduce your bone density and increase your risk of bone fractures. The bone health page provides more information on how to improve bone health.
Nail changes are a common side effect of some chemotherapy treatments. The nail health page provides more information on the changes that may occur to your nails, and what you can do help prevent or manage nail changes.
Fatigue is very common during chemotherapy. Women describe it as being quite different to normal tiredness. Light exercise can boost your energy levels.
A less common side effect of chemotherapy is a condition many people refer to as 'chemo brain' or 'chemo fog'. It is described as feeling vague. Some women say they have trouble remembering things and find they aren't as organised as they used to be. The page on Chemo brain has some suggestions on how to manage the effects.
Loss of fertility
The impact of chemotherapy may reduce a woman’s fertility and chance of having children in the future. There are a number of factors which contribute to this issue, including a woman’s age, and the type of treatment she has and how it affects her ovaries. There are a number of methods for preserving fertility. BCNA’s webpage for young women provides more information on this issue.
- The free My Journey Kit contains more information on Chemotherapy.
- BCNA's free menopause booklet provides practical tips to help manage the side effects of menopause. Download a copy from our fact sheets and booklets page, or visit our online shop to order a free copy.
- The Beacon 43 (Winter 2008) has an article on Fatigue and 'Chemo brain' in the 'Issues of Concern' section.
- The BCNA resources list on fatigue and 'chemo brain' (Issue 43) contains links to additional information and resources.
- Read more about how chemotherapy drugs are subsidised on the PBS, and how to access breast cancer medicines in other ways.
- Join our online network if you think talking to others online and sharing experiences will help
- Contact the Cancer Council on 13 11 20 for a copy of their booklet Coping with Chemotherapy
- The Westmead Breast Cancer Institute has a Chemotherapy for Breast Cancer brochure you can order free of charge through their website.
- The Bone Health for Life website offers practical advice to improve bone health in order to prevent and manage osteoporosis.
- Cancer Australia's website section Effects of Menopause on Long-term Health offers Australian information on bone health, and a list of suggestions on how you can reduce your risk of osteoporosis.
- The Australasian Menopause Society website has fact sheets on treatment of menopausal symptoms in breast cancer, early menopause due to chemotherapy, osteoporosis and managing life with menopausal symptoms.