Chemotherapy and Hormone Therapy

Medical oncology is the study and treatment of cancer using chemotherapy and hormone therapy. A medical oncologist is an internal medicine doctor with special training in cancer treatment. Many medical oncologists are also specialists in hematology (study of the blood).

Chemotherapy

Chemotherapy or "chemo" treats cancer using different chemicals (medications), which are also known as:

  • anti-cancer drugs
  • anti-neoplastic agents
  • chemo drugs
  • biotherapy
  • hormones
Many different drugs are used to treat breast cancer.

The most common chemotherapy drugs include:Usually given in combination, these drugs target cancer cells that are growing or dividing. They can also affect normal, healthy cells.

How they work
Chemo drugs work actively against rapidly dividing cells in the body, such as:
  • Bone marrow, which produces red and white blood cells and platelets
  • Hair follicles
  • The lining of the mouth, throat, stomach, intestines and rectum
Chemotherapy drugs are not selective. They cannot tell the difference between cancer cells and healthy cells, and they may destroy both. Fortunately, normal cells recover and cancer cells die. While the normal cells are recovering, you may experience some side effects. Most of these side effects can be prevented or lessened with drugs and other treatments.

How they are given
Chemotherapy drugs are usually given intravenously (through a vein) or orally (by mouth) and travel throughout the body. They may be given before (neoadjuvant therapy) or after (adjuvant therapy) surgery to treat primary breast cancer.
  • Neoadjuvant chemotherapy: given prior to surgery to shrink large breast tumors and make surgery easier. Often used prior to a lumpectomy or when a woman would like to preserve as much of the breast as possible.


  • Adjuvant therapy: given after surgery if lymph nodes are involved, if there are other indications that the cancer is aggressive, or if the cancer has a chance to recur. It may also be used to treat breast cancer that has spread to other parts of the body (metastatic cancer). Chemo is given in cycles, which include alternating treatment periods and rest periods. This gives normal cells a chance to recover, but does not give cancer cells enough time to multiply. Each treatment may take a few hours, depending on the type of drugs used and the length of time it takes to administer each drug. Treatments may be repeated every one to four weeks, three to six months, or longer depending on your treatment plan.

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Hormone Therapy

Hormone therapy stops the effects or production of the female hormones estrogen and progesterone. Produced mainly in the ovaries, these hormones stimulate the growth of breast cancer. Medical oncologists may recommend hormone therapy to prevent breast cancer from growing, especially in postmenopausal women since their cancer cells often have receptors that attract estrogen and/or progesterone. Pre-menopausal women may also be prescribed hormone therapy following surgery, chemotherapy or radiation therapy.

Common hormone drugs used to treat breast cancer include:


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Other Treatments

Monoclonal antibodies: targeted therapies
Herceptin is an example of a monoclonal antibody used to treat breast cancer. The antibody is given to some breast cancer patients who produce an excessive amount of the HER-2/neu protein on their breast cancer cells. Herceptin works against HER-2 /neu on the surface of the breast cancer cells and prevents the breast cancer cells from growing and dividing. Herceptin can be given alone or in combination with chemotherapy. Your physician will discuss this therapy with you if you are a candidate. Many women do not benefit from this hormone based on certain test results.

Biphosphonates
These are drugs given to women whose breast cancer has spread to their bones. Pamidronate (Aredia) and Zoledronic acid (Zometa), the two most common biphosphonates, are given intravenously every three to four weeks to strengthen the bones and relieve bone pain. They also help lower blood calcium levels that sometimes increase when cancer spreads to the bones. Too much calcium (hypercalcemia) can lead to changes in mental status, nausea, vomiting, constipation, bone fractures, kidney stones, and, in severe cases, coma.
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Side Effects

Chemotherapy side effects can range from minor to life-threatening conditions depending on the chemo drug used, the dosage and a person’s overall health. Medical professionals must tell you about all the potential side effects of any treatment they prescribe before you give your consent. The majority of side effects involve damage to the bone marrow, hair follicles, and the lining of the mouth, throat, stomach, intestines and rectum. Damaged bone marrow (known as bone marrow depression or myelosuppression) reduces the production of white blood cells, platelets and red blood cells.

Different people have different reactions to the same chemotherapy. If you undergo chemotherapy, you will not know how you will react or what side effects you will experience until a few days after your first chemotherapy session. Listen to your body, pay attention to what you are feeling, and always report these symptoms to your doctor or nurse. Your initial experience will help you prepare for and cope better with future chemotherapy sessions.


Blood Cell Counts
Chemotherapy often causes your blood cell counts to drop and rise. Your doctor's office will give you routine progress reports on your blood cell counts.

White blood cells
White blood cells (WBC) are cells that defend the body against infection. If your WBC count is low (a condition known as neutropenia) due to chemotherapy, your risk of developing an infection may increase. An infection can occur anywhere in your body or be caused by organisms normally found in your body or the environment. Your doctor may delay your treatment or decrease the dose of your chemo drugs if your white blood cell count is low.

To prevent infection
  • Check your oral temperature whenever you feel you have a fever or have shaking chills.
  • Wash your hands often during the day. Be sure to wash them well before eating, after using the bathroom or picking your nose (please try to refrain from this).
  • Avoid people who have contagious illnesses, such as chicken pox or flu.
  • Do not tear or cut your nail cuticles. Use cuticle cream and push them back.
  • If you do cut or scratch your skin, clean the area at once with water and soap and call your doctor if you show any sign of infection, such as swelling, redness, tenderness and/or fever.
  • Brush your teeth with a soft toothbrush after meals or rinse your mouth after you eat.
  • Lubricate your lips frequently and use lotions/creams on your skin to prevent dryness.
  • Do not squeeze or scratch pimples or sores.
  • Clean and cook all foods well. Do not add herbs and spices after the foods have been cooked.
  • Avoid constipation. Ask your doctor for an order for stool softeners and/or laxatives if you experience problems. Avoid using enemas or suppositories unless instructed by your doctor.
  • After each bowel movement or urination, wipe yourself from front to back. If there is irritation or if hemorrhoids are a problem, ask your doctor for advice.
  • Check with your doctor first before having elective dental work or surgery.
  • Avoid cleaning pet litter boxes.
  • Avoid diaper changes of children who have had recent immunizations.
  • Always wear slippers or properly fitted shoes to protect your feet. Do not go barefoot.
  • Use gloves while gardening or washing dishes.
Platelets
Platelets are blood cells that help in clotting to prevent bleeding. If your platelet count is low, you may bleed or bruise more easily than usual.

To prevent bleeding
  • Do not give yourself an enema. Get an order for a stool softener and/or laxative if you are constipated.
  • Do not use tampons if you are still menstruating.
  • Do not take any medication, not even aspirin or aspirin-free pain relievers, without first checking with your doctor or nurse.
  • Do not have any alcoholic drinks unless your doctor says that it is all right.
  • Use cotton swabs, toothettes or a soft bristled toothbrush to clean your mouth. Do not floss.
  • Be extra careful when using knives or other sharp objects.
  • Use an electric razor when shaving.
  • Be very careful not to burn yourself, especially when ironing or cooking. Use a padded glove when you reach into the oven.
  • Avoid contact sports and other activities that might result in injury.
  • Wear heavy gloves for digging in the garden or working near plants with thorns.
  • Do not go barefoot; wear slippers or shoes at all times.
  • Do not have any elective dental work or surgeries without checking with your doctor first.

Red blood cells
Red Blood Cells carry oxygen to the tissues in your body. When the red blood cell count is low (a condition known as anemia), your body tissues do not get enough oxygen to do their work. Over time, you may become very tired physically and mentally.

To help anemia
  • Get plenty of rest; conserve your energy.
  • Try sleeping more at night and taking a short nap during the day.
  • Limit and prioritize your daily activities. Accept offers or ask family and friends to help you do your shopping, cooking or housework.
  • Try to eat a balanced diet, even when you are tired.
  • If you don't have help cooking your meals, use ready to eat foods. Double your recipes on days that you have energy to cook; place them in small containers and freeze them. You may want to contact "Meals on Wheels" about delivering food to you.
  • Drink plenty of fluids
  • Lubricate your nostrils with saline spray or gel to prevent them from drying.
  • Lubricate lips frequently to prevent dryness. Do not use your saliva to wet your lips because it will make your lips drier. Of getting out of bed quickly, sit on the side of the bed for a while before standing. If you still feel dizzy, talk to your physician or nurse about what you should do.
  • If you experience shortness of breath, breathe through your nose and exhale slowly with your lips pursed.

Nausea and Vomiting
Most of the chemo drugs used for breast cancer can cause nausea and vomiting (N&V) due to the effect of chemotherapy on the stomach. The severity of this side effect depends on the type and dose of chemo drugs used. If the chemo drugs prescribed are known to cause moderate to severe N&V, your doctor may order anti-nausea or antiemetic drugs before you start chemotherapy. You may also receive a prescription for anti-nausea medication to take for a few days whether or not you feel nauseous.

Sometimes women experience N&V even before receiving chemotherapy. This type of N&V is called "anticipatory N&V," which is usually associated with anxiety. Other types of N&V include "acute" and "delayed." Acute N&V means that the N&V occurs either during or within 24 hours of chemotherapy. This is becoming rare now because of new anti-nausea and antiemetic drugs. Delayed N&V may occur two to three days after chemotherapy and may last for a few days.

Protective and preventive measures
  • Use anti-nausea medication prior to chemo and continue through the entire anticipated duration of N&V. There are many available anti-nausea medications available over the counter or by prescription. Ask your doctor which ones would be good for you. Let your doctor know if the medications do not work for you.
  • Rinse your mouth often to remove the acidic taste.
  • Wear loose clothing.
  • Practice behavioral therapies, such as relaxation techniques and hypnosis. Breathe deeply and slowly if you start to feel nauseous.
  • Environmental changes
    • Choose a calm and reassuring area to rest, especially after meals.
    • Minimize distinctive odors or sights, including perfumes, room deodorizers and disinfectants (strong smells can trigger nausea).
  • Dietary interventions
    • Eat small frequent meals. Eat light meals before chemotherapy. Eat before you get hungry. An empty stomach will make N&V worse.
    • Suck on mints or sour candy during chemotherapy.
    • Try ginger as a tea or eating fresh, pickled or candied ginger.
    • Serve foods at room temperature or colder to minimize food odors.
    • Avoid very sweet (cakes, cookies, candies), fried, fatty or spicy foods.
    • Eat rice, bread, potatoes, hot cereals, puddings and other starchy foods.
    • Get adequate fluid intake to prevent dehydration: clear liquids or broth, unsweetened fruit juices, or light-colored sodas that have lost their fizz, such as ginger ale.
    • Sip beverages slowly between meals to avoid bloating.
    • Inhale peppermint oil, 1-2 drops, in a glass of water or on a gauze pad.
    • Avoid reclining for at least one hour after a meal.
    • If N&V occurs in the morning, eat dry foods like toast, crackers or pretzels before getting out of bed.


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    Self-Care Tips

    Before undergoing chemotherapy, your medical oncologist will explain what to expect from your treatment, including possible side effects of the chemo drugs. The following information could help prevent or lessen any side effects you may experience. It will be trial and error to see which ones work best for you, or you might find something else that can help you deal with the side effects.

    Please let your doctor or nurse know if you:

    • are allergic to any medications, either prescription or nonprescription (those you can buy over the counter)
    • are pregnant or intend to have children
    • are breast-feeding
    • are taking any other prescription or nonprescription medications
    • have any other medical problems, especially chicken pox (including recent exposure), herpes varicella zoster (shingles), infection, kidney disease, liver disease, nerve or muscle disease
    • have a history of being treated with high dose X-rays (radiation therapy) or chemotherapy
    • are taking high doses of multivitamins or anti-oxidants (such as Vitamin A, E or C) or any herbal therapies. It is very important that your doctors and health care team know what herbs you are taking before you start treatment. Use this Herbal Supplement Record form (254 PDF) to track which supplement you are taking.

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