Chemotherapy

Chemotherapy is a treatment which uses anticancer (cytotoxic) drugs to treat cancer. It works by interfering with the cancer cells’ ability to divide and grow. In the treatment of early breast cancer, it can be used after or before breast cancer surgery.

After surgery

Chemotherapy is used after surgery for early breast cancer to reduce the risk of cancer returning or spreading. This is called adjuvant chemotherapy. You may have chemotherapy in combination with other treatments.

Before surgery

Chemotherapy can be used before surgery to slow the growth of a fast-growing breast cancer or to shrink a large tumour to allow for a smaller operation (e.g. breast conserving surgery instead of mastectomy). Chemotherapy before surgery is called neoadjuvant chemotherapy. People who have inflammatory breast cancer or breast cancer that is triple negative or HER2-positive may be more likely to have chemotherapy before surgery.

Chemotherapy to treat metastatic breast cancer

Chemotherapy is often used to treat metastatic breast cancer. It can help stop or slow cancer growth.

Chemotherapy to treat early breast cancer

Not everyone with early breast cancer will be recommended chemotherapy. Whether or not it is recommended for you will depend on your individual situation. Factors the doctors consider include the pathology of your breast cancer; the risk of the cancer coming back or spreading to other parts of the body; your general health and your preferences. Your medical oncologist will discuss whether chemotherapy is the right treatment for you and which combinations of medications are most appropriate.

Genomic (tumour profiling) tests

Some aspects of your type of breast cancer can influence whether chemotherapy is recommended for you. Your surgeon or medical oncologist may talk to you about genomic tests. Genomic tests can help predict the likelihood of an individual cancer recurring (coming back) and can provide information to help you decide whether you may benefit from chemotherapy or some other breast cancer treatments. 

Your doctor may talk to you about genomic tests currently available, including:

Oncotype DX
Endopredict
Prosigna
Mammaprint

These tests are not covered by Medicare and can be quite expensive – up to several thousand dollars. For further information about genomic testing, visit BCNA’s My Journey.

How does chemotherapy work?

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. Chemotherapy is called a systemic treatment – it treats the whole body, reducing the chance of the cancer coming back in the breast or elsewhere in the body.

Chemotherapy works by attacking fast-growing cells in your body, Cancer cells usually grow and divide faster than normal cells and are unable to repair themselves when damaged, making chemotherapy effective. There are several types of chemotherapy drugs used to treat early breast cancer.

Most chemotherapy drugs are given by intravenous (IV) drip through a cannula (thin plastic tube) into a vein in the arm or hand. Some chemotherapy drugs are given in tablet form. Sometimes a Port or PICC may be used which means you don’t need to have a cannula inserted each time. Ports and PICCs are venous access devices used to enhance access to veins for people having chemotherapy regularly.

What are the side effects?

As chemotherapy works by attacking fast-growing cells in the body, it also attacks some of the normal fast-growing cells in the body, including blood cells, hair follicles and cells inside the mouth, gut and reproductive organs. This causes side effects including: nausea, hair loss, fatigue and mouth and gut issues. Unlike cancer cells however, normal cells usually recover from the damage.

Not everyone has side effects from chemotherapy and most side effects stop when chemotherapy treatment stops. Your medical oncologist or oncology nurse can give you information on ways to manage these side effects.

If side effects are affecting your daily life, it’s important to discuss them with a member of your medical team. In some instances, your medical oncologist may be able to change your chemotherapy drug to one that has fewer side effects or reduce the dose of the chemotherapy.

Hair loss

Hair loss (alopecia) can be one of the most upsetting side effects of chemotherapy. Whether or not you lose your hair depends on the type of chemotherapy drugs prescribed for you.

As well as losing hair from your head you may also lose hair from other parts of the body, such as eyebrows and eye lashes.

To help prevent hair loss from your head, some oncology centres offer the use of scalp cooling machines. Scalp cooling works by chilling the scalp and reducing blood flow to the scalp to prevent chemotherapy from getting to the hair follicles. This means the hair is less likely to be damaged and fall out.

Your treating team will be able to tell you how chemotherapy treatment may affect your hair and the options available to help manage this.

Nausea

Nausea and vomiting are common side effects of chemotherapy, but can be managed with medication. You may be given anti-nausea medication before your chemotherapy and to take home with you in case you need it later. Let your doctor know if you have nausea and/or vomiting that lasts for more than 24 hours. It’s easy to become dehydrated quickly, and your doctor can help with this.

Mouth ulcers and taste changes

Some chemotherapy drugs cause mouth ulcers and changes in taste. Rinsing your mouth regularly with bicarbonate of soda, even before you begin chemotherapy, can help to prevent ulcers. Eating soft mints can help get rid of the metallic taste that you may experience as a result from the chemotherapy.

Talk to your treating team about what mouth care is required for the treatment you are having.

Diarrhoea or constipation

Some chemotherapy drugs and drugs taken to prevent nausea can cause diarrhoea or constipation. Uncontrolled diarrhoea can cause dehydration.

It is important to talk to your GP or treating team for advice and management if you are experiencing these side effects.

Menopausal symptoms

Chemotherapy can affect the ovaries reducing your oestrogen levels and cause periods to stop, either temporarily or altogether. This is called early menopause. You may experience some of the symptoms of menopause, such as hot flushes, aches and pains in the joints and night sweats.

Bone health changes

As chemotherapy reduces the level of oestrogen in your body, it can also reduce your bone density and increase your risk of osteoporosis and bone fractures. Read more about this on the bone health page of this website.

Nail health

Nail changes are a common side effect of some chemotherapy treatments. The Nail changes page provides more information on the changes that may occur to your nails, including what you can do manage nail changes.

Fatigue

Fatigue is very common during chemotherapy. Many people describe it as being quite different from normal tiredness.

The Fatigue page contains more information on how to manage fatigue. You can also find more information in our section on physical wellbeing.

'Chemo brain'

Some people who have chemotherapy say that they experience a side effect known as 'chemo brain' or 'chemo fog'. It is best described as feeling vague. Some people say they have trouble remembering things and find they aren't as organised as usual. The Chemo brain page includes suggestions on how to manage its effects.

Loss of fertility

Some treatments, especially chemotherapy, are known to reduce fertility.

If preserving your fertility is important to you, there are options that may be available to you. It is important to discuss your wish to preserve your fertility with your breast cancer specialist before starting treatment, especially chemotherapy treatment.

For more information see the Breast cancer in young women page.

Things you can do now

For more information about chemotherapy treatment for early breast cancer visit BCNA’s My Journey.
Join our Online Network if you think talking to others online and sharing experiences will help.
Download Cancer Council's  Understanding chemotherapy booklet.
The Westmead Breast Cancer Institute's section on Chemotherapy for breast cancer contains extensive information, including side effects and some frequently asked questions. 
Visit Cancer Australia’s website for information about chemotherapy for breast cancer.
The eviQ Cancer Treatments Online website contains a fact sheet on chemotherapy and its side effects.