Which Chemo Is Best For You
In cases of early stage cancer, an oncologist can make an informed decision about which drugs are best to use. Your age, the stage of the cancer, and any other health problems will all be taken into consideration before deciding on a chemo regimen.
These drugs are usually injected into a vein, either at your doctors office or at a hospital. Locations that provide chemotherapy injections are often called infusion centers.
You may need a port implanted if you have weak veins or are being given a certain type of drug. A port is a device thats surgically placed in your chest that allows for easy needle access. The port can be removed when therapy is finished.
Typically, a person is given several drugs, often called a regimen. Regimens are designed to attack the cancer at different stages of growth and in different ways. Your chemo drugs will be given on a regular schedule in doses called rounds.
According to the , the most common drugs and regimens used for breast cancer today are:
While chemotherapy treatments have greatly improved over time, there are often still noticeable side effects of treatment.
How Chemotherapy Is Used
Doctors use chemotherapy in several ways to treat to treat all stages of breast cancer. Whether or not a doctor recommends chemotherapy for you depends on the breast cancer’s characteristics, your health history, and your personal preferences.
Doctors call chemotherapy given after surgery adjuvant chemotherapy. Chemotherapy is given after surgery to destroy any cancer cells that may have been left behind or may have travelled to other places in the body. These single cells or groups of two or three cells are very small and don’t appear on imaging tests. Chemotherapy after surgery reduces the risk of the cancer coming back, called recurrence by doctors.
Doctors dont recommend chemotherapy after surgery for everyone diagnosed with early-stage breast cancer, except in the following situations:
If there are cancer cells in the lymph nodes near the affected breast, doctors may recommend chemotherapy.
If the cancer has characteristics that make it more aggressive, such as being hormone receptor-negative or HER2-positive, doctors usually recommend chemotherapy.
If youre a pre-menopausal woman, your doctor is more likely to recommend chemotherapy because breast cancer in pre-menopausal women tends to be more aggressive.
Doctors call chemotherapy given before surgery neoadjuvant chemotherapy. Chemotherapy is given before surgery to shrink large cancers, which may:
breast cancers that have spread to the lymph nodes
Treatment For Breast Cancer May Cause Side Effects
Some treatments for breast cancer may cause side effects that continue or appear months or years after treatment has ended. These are called late effects.
Late effects of radiation therapy are not common, but may include:
- Inflammation of the lung after radiation therapy to the breast, especially when chemotherapy is given at the same time.
- Arm lymphedema, especially when radiation therapy is given after lymph node dissection. For more information, see Lymphedema.
- In women younger than 45 years who receive radiation therapy to the chest wall after mastectomy, there may be a higher risk of developing breast cancer in the other breast.
Late effects of chemotherapy depend on the drugs used, but may include:
Late effects of targeted therapy with trastuzumab, lapatinib, or pertuzumab may include:
- Heart problems such as heart failure.
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Sex Contraception And Pregnancy
If you havent been through the menopause, its important to use contraception because chemotherapy drugs can harm a developing baby in the first three months of pregnancy. Its still possible to become pregnant even if your periods become irregular or stop completely.
Your specialist will usually recommend barrier methods of contraception, such as condoms. The contraceptive pill is not usually recommended because it contains hormones. Emergency contraception such as the morning after pill can still be used.
An interuterine device can be used as long as its not the type that releases hormones. If you have a coil in place that does release hormones, such as the Mirena or Jaydess, when youre diagnosed, you may be advised to have this removed.
Breast Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Breast
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes. Each lobe has many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.
Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless, watery fluid called lymph. Lymph vessels carry lymph between lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body. They filter lymph and store white blood cells that help fightinfection and disease. Groups of lymph nodes are found near the breast in theaxilla , above thecollarbone, and in the chest.
The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.
For more information about breast cancer, see:
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Treatment Modalities Of Tnbc
Patients with TNBC do not benefit from hormonal or trastuzumab-based therapy because of the loss of target receptors such as ER, PGR, and HER-2. Hence, surgery and chemotherapy, individually or in combination, appear to be the only available modalities. However, some studies have identified certain receptors as targets for new therapeutic drugs.
Treatment Of Locally Advanced Or Inflammatory Breast Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
- Targeted therapy .
- Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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How Chemotherapy Works Against Cancer
Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used for two reasons:
- Treat cancer: Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.
- Ease cancer symptoms: Chemotherapy can be used to shrink tumors that are causing pain and other problems.
Treating Stage Iii Breast Cancer
In stage III breast cancer, the tumor is large or growing into nearby tissues , or the cancer has spread to many nearby lymph nodes.
If you have inflammatory breast cancer: Stage III cancers also include some inflammatory breast cancers that have not spread beyond nearby lymph nodes. These cancers are treated slightly different from other stage III breast cancers. You can find more details in Treatment of Inflammatory Breast Cancer.
There are two main approaches to treating stage III breast cancer:
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Chemotherapy For Breast Cancer
Chemotherapy uses anti-cancer drugs that may be given intravenously or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Sometimes, if cancer spreads to the spinal fluid, which surrounds and cushions the brain and spinal cord, chemo may be given directly into in this area .
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Can Other Drugs Interfere With Hormone Therapy
Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s use of tamoxifen because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.
The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.
Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.
Other medications that inhibit CYP2D6 include the following:
- quinidine, which is used to treat abnormal heart rhythms
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What Happens During Chemotherapy For Breast Cancer
Most people receive chemotherapy for breast cancer through one of their veins . You may receive chemotherapy as one short injection or as an infusion. Infusions last longer and usually take place in a hospital or specialized infusion center.
When you get to the infusion center, your nurse administers your chemotherapy drugs and any additional medications you need. For example, you may also receive an anti-nausea medication before the chemotherapy drugs.
During the infusion:
Ovarian Ablation Or Suppression
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
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External Beam Radiation Therapy
EBRT is the most common type of radiation therapy for women with breast cancer. A machine outside the body focuses the radiation on the area affected by the cancer.
Which areas need radiation depends on whether you had a mastectomy or breast-conserving surgery and if the cancer has reached nearby lymph nodes.
- If you had a mastectomy and no lymph nodes had cancer cells, radiation will be focused on the chest wall, the mastectomy scar, and the places where any drains exited the body after surgery.
- If you had BCS, you will most likely have radiation to the entire breast . An extra boost of radiation to the area in the breast where the cancer was removed is often given if there is a high risk of the cancer coming back. The boost is often given after the treatments to the whole breast have ended. It uses the same machine, with lower amounts of radiation aimed at the tumor bed. Most women dont notice different side effects from boost radiation than from whole breast radiation.
- If cancer was found in the lymph nodes under the arm , this area may be given radiation, as well. Sometimes, the area treated might also include the nodes above the collarbone and the nodes beneath the breast bone in the center of the chest .
Patients May Want To Think About Taking Part In A Clinical Trial
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
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When To Get Help
If it takes more than 30 minutes for you to fall asleep, or if youre up for at least 30 minutes in the middle of the night tossing and turning most days of the week for at least three months, you likely have insomnia, according to Zhou. Even if a breast cancer patient does not check off these boxes, feeling dissatisfied with the quality of their sleep, or not waking up feeling refreshed, are good reasons to consult with experts to explore what might be going on.
Sometimes people who struggle with sleep are not even aware of it. Other people in their life may be aware that they are not sleeping well, but do not realize the negative impact loss of sleep has on well-being, says Walsh. She notes that if you are experiencing an increase in irritability, fatigue, a depressed mood, and anxiety during the day, it may be time to get help.
Continued sleep disruption can contribute to the development of depression, Palesh confirms. If people have depression or other psychological symptoms, I would say treat insomnia symptoms early. The general recommendation, she explains, is symptoms that last anywhere between one to six months might resolve on their own. But there is a scientific debate about this, and I tend to recommend that patients treat symptoms early on so they dont take the risk of insomnia becoming chronic later on.
Chemotherapy For Metastatic Breast Cancer
Advances in treatment are making it possible for women with metastatic breast cancer to live for many years. New drug therapies can not only slow down or stop a tumors growth but also keep symptoms at bay.
Which treatment your doctor recommends will vary based on your medical history, age, and breast cancer type, among other factors. Combinations of drugs are commonly prescribed for women with early-stage disease. Most women with advanced breast cancer generally receive only one drug at a time.
Chemotherapy drugs that MSK doctors commonly prescribe for advanced breast cancer include:
Women with advanced disease can also benefit from genomic testing. This is also called tumor sequencing or molecular profiling. It is offered to all MSK patients with metastatic breast cancer. Genomic testing involves looking at the cancer cells to see if there are any genetic mutations that could be linked to the specific type of breast cancer you have.
Our experts use a highly sophisticated testing approach developed by MSK researchers called MSK-IMPACT. The information gained from MSK-IMPACT can help us personalize your care. We can rule out drug therapies that may not work for you or sometimes recommend cutting-edge clinical trials designed to target the specific mutations in your tumor.
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External Beam Breast Cancer Radiation
External beam radiation is the most common kind of radiation treatment for breast cancer. Its a painless treatment, like getting an X-ray. A doctor will place a machine on the outside of your body and aim the radiation beams at the area of the cancer. Your doctor will figure out where to aim the rays and how much radiation to use before each treatment. They will mark the area with temporary or permanent ink.
Each treatment only lasts a few minutes. The session setup will take longer. External radiation treatment happens five days a week for about five to seven weeks. Its the longest type of radiation treatment available.
Short-term side effects of external radiation include:
- swelling and pain in the arm or chest
- weakened and fractured ribs
- future cancer in the inner lining of your blood vessels
External radiation does not leave radiation in your body. You will not be radioactive during or after treatment.
Treatment Of Breast Cancer By Stage
This information is based on AJCC Staging systems prior to 2018 which were primarily based on tumor size and lymph node status. Since the updated staging system for breast cancer now also includes estrogen receptor , progesterone receptor , and HER2 status, the stages may be higher or lower than previous staging systems. Whether or not treatment strategies will change with this new staging system are yet to be determined. You should discuss your stage and treatment options with your doctor.
The stage of your breast cancer is an important factor in making decisions about your treatment options. In general, the more the breast cancer has spread, the more treatment you will likely need. But other factors can also be important, such as:
- If the cancer cells have hormone receptors
- If the cancer cells have large amounts of the HER2 protein
- If the cancer cells have a certain gene mutation
- Your overall health and personal preferences
- If you have gone through menopause or not
- How fast the cancer is growing and if it is affecting major organs like the lungs or liver
Talk with your doctor about how these factors can affect your treatment options.
Stage 0 cancers are limited to the inside of the milk duct and are non-invasive .
Ductal carcinoma in situ is a stage 0 breast tumor.
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