Chemotherapy and Systemic Therapy

To reach cancer cells that may have spread beyond the breast and nearby tissues, physicians employ systemic therapy, given orally or by injection. Examples of systemic treatments include chemotherapy and hormonal therapy.

Systemic therapy given to patients after surgery is called adjuvant therapy. The goal of adjuvant therapy is to kill hidden cells. Even in the early stages of the disease cancer cells can break away from the primary breast tumor and spread through the bloodstream. These cells cause no detectable symptoms; they don't show up on an x-ray and can't be felt during a physical examination. But they can establish new tumors in other organs or the bones.

Sometimes oncologists give patients neoadjuvant therapy — that is, systemic therapy before surgery. In women diagnosed with metastatic breast cancer, systemic therapy rather than surgery serves as the main treatment.

Chemotherapy

Patients take chemotherapy, a treatment of anti-cancer drugs intravenously (injected into a vein) or orally. Either way, the drugs travel in the bloodstream and move throughout the entire body. Doctors who prescribe these drugs (medical oncologists) generally use a combination of medicines, proven more effective then a single drug. The most frequently used combinations are:

• cyclophosphamide, methotrexate, and fluorouracil (CMF);
• cyclophosphamide, doxorubicin (Adriamycin), and fluorouracil (CAF);
• doxorubicin (Adriamycin) and cyclophosphamide (AC) with or without paclitaxel (Taxol)

Doctors give chemotherapy in cycles, with each period of treatment followed by a recovery period. The total course of chemotherapy lasts 3 to 6 months depending on the regimens used. The side effects of chemotherapy depend on the type of drugs used, the amount taken, and the length of treatment.

Patients can experience permanent complications from anti-cancer drugs and/or premature menopause and infertility. The older a women is when she receives chemotherapy, the more likely she will stop menstruating or lose her ability to become pregnant.

Doxorubicin may cause heart damage, but doctors limit the dose and perform periodic tests to check heart function in order to prevent this side effect.

Temporary side effects of these drugs might include loss of appetite, nausea and vomiting, mouth sores, hair loss, and changes in the menstrual cycle. Because chemotherapy can damage the blood-producing cells of the bone marrow, a drop in white blood cells can raise a patient's risk of infection; a shortage of blood platelets can cause bleeding or bruising after minor cuts or injuries; and a decline in red blood cells can lead to fatigue.

But patients can fend off these side effects. For example, several drugs can prevent or reduce nausea and vomiting. A new group of drugs called growth factors can help bone marrow recover after chemotherapy and can treat problems resulting from low blood counts. Talk with your doctor about the treatment that is right for you.