Breast Unit
Chemotherapy
Chemotherapy
Some of our breast cancer patients are recommended to have chemotherapy as part of their breast cancer treatment. Chemotherapy is a treatment using anti-cancer (cytotoxic) drugs. Chemotherapy may be given before surgery (this is neo-adjuvant chemotherapy) or after surgery (adjuvant chemotherapy).
The aim of chemotherapy is to destroy any cancer cells that may have spread from the breast to other parts of your body. Standard scans and tests may not be able to detect very small numbers of cells that may have broken off from the original breast cancer. Given before breast surgery, neoadjuvant chemotherapy may also reduce the size of a breast tumour allowing for breast conservation surgery in some cases.
The decision about which treatment to offer a patient, is made by our multidisciplinary team. The decision to have chemotherapy is made by each individual patient and their oncologist in an oncology clinic appointment. This appointment is usually within 6 weeks following surgery. During this appointment the risk, benefits and consequences of chemotherapy are discussed.
Types of Chemotherapy
There are many different types of chemotherapy and the drugs can be used in different combinations. Chemotherapy drugs will usually be given intravenously into a vein for primary breast cancer. The chemotherapy is likely to start within a few weeks of the Oncology appointment.
Some patients who require chemotherapy may want to discuss fertility issues following breast cancer treatment. An opportunity to discuss this with your oncologist and gynaecologist will be offered. Occasionally this may entail referral for egg harvest.
Adjuvant chemotherapy
For those patients having chemotherapy after their surgery, the treatment is usually given as an outpatient approximately 6 weeks after your operation. The oncologist will go through the details at the outpatient appointment, including the duration and frequency of treatment.
After the oncology outpatient appointment, the chemotherapy team will make contact regarding the appointment times and the length of time the chemotherapy may take. Chemotherapy for breast cancer is usually given once every three weeks for six treatments (called "cycles").
Neo-adjuvant chemotherapy
When chemotherapy is given before surgery, the response to treatment is assessed with a mammogram and ultrasound after the 2nd cycle of chemotherapy. If the tumour is not responding or getting smaller then either the type of chemotherapy is changed or surgery occurs sooner.
Surgery usually occurs approximately four weeks after the final cycle of chemotherapy. Patients are seen in the surgical clinic again (Breast Unit) after the 5th cycle of chemotherapy to discuss and plan surgery.
Side effects
Chemotherapy drugs may cause side effects and many people worry about this part of their treatment. Some of the most common side effects are nausea and vomiting, hair loss or thinning, sore mouth, mouth ulcers, tiredness and a reduced ability to make new blood cells, meaning there will be a greater risk of infection. These side effects will vary according to the drugs given and the specialist oncology team will prescribe drugs to help you cope with them.
The oncology team will go through the treatment and potential side effects in detail and provide information on the specific chemotherapy prescribed. It is important to contact the Chemotherapy Unit promptly if side effects occur and emergency contact telephone numbers will be provided.
At the Royal United Hospital we offer a wig service if your chemotherapy will cause hair loss, please ask your oncologist or breast care nurse for further information.
Herceptin® (Trastuzumab)
This drug works by blocking specific ways that breast cancer cells divide and grow. A minority of breast cancers have a higher than normal level (over expression) of HER2, a protein that stimulates them to grow, and will benefit from having Trastuzumab. Tests to measure HER2 levels are performed on breast tissue removed by biopsy or during surgery.
Trastuzumab is usually given following surgery and chemotherapy, but may also be given at the same time as chemotherapy. Trastuzumab is usually given for a 1 year. This will be discussed, where appropriate, with the oncologist in clinic. If the tumour was found to be HER2 negative, then Trastuzumab will not be of benefit and so will not be recommended.