Chemotherapy

Chemotherapy drugs are often used following surgery to kill cancer cells that may have spread outside the breast. These drugs may be administered intravenously, in pill form, or both ways. An oncologist might also recommend chemotherapy before surgery if the breast tumor is large (has a diameter greater than 5 centimeters), if the tumor is attached to the chest wall muscles, or if the patient has rapidly spreading inflammatory breast cancer. Women whose cancers respond well to chemotherapy before surgery often are able to have surgeries in which more of the breast is conserved.

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In chemotherapy, the patient receives chemicals that move through the bloodstream to all parts of the body, where they can destroy cells that have spread from the primary tumor. The course of treatment usually takes several months, with the patient receiving treatment in periodic cycles.

There are a large number of different chemotherapy drugs, and new ones are under development. These drugs attack cancer cells in a variety of different ways and interfere with various processes necessary to the cell's life. The drugs may prevent the cell's DNA from replicating, prevent the cells from dividing, or block the actions of crucial enzymes. Because they have different mechanisms of action, chemotherapy drugs are often given in combinations, or "cocktails," to subject cancer cells to several simultaneous kinds of attack.

Though chemotherapy drugs target cancer cells, they can be also toxic to normal cells. They harm cells that are rapidly dividing, damaging the cells of hair follicles, blood, the immune system, and the lining of the digestive tract, among others. Side effects vary in kind and severity from patient to patient. Depending on the chemotherapy drugs used, patients could experience hair loss, nausea, vomiting, diarrhea, mouth sores, fatigue, and a suppressed immune system. The current antinausea drugs are far more effective than a generation ago.

Most patients receive chemotherapy after they heal from breast surgery and prior to radiation. The physician chooses the chemotherapy drugs and sequence of treatment based on the details of each case. Researchers conduct many clinical trials to find drug combinations and treatment sequences that result in improved outcomes for patients who have breast cancer. You might ask your oncologist if you would be a good candidate for a clinical trial. Researchers are also examining the phenomenon known as "chemo brain"--problems with memory and concentration that may be triggered by chemotherapy and that may persist after treatment ends.