Chemotherapy

Therapies that circulate through your body's bloodstream to attack cancer cells wherever they may have spread are called "systemic" treatments. The mostly common systemic treatments for breast cancer are chemotherapy and hormonal therapy.

If your doctor suggests chemotherapy in addition to surgery, the reason is to increase your chances of a cure. Chemotherapy kills cancer cells that may have spread from the primary cancer and also makes it less likely that your cancer will return in the future.
 
Chemotherapy may be given by mouth or by injection into a vein or muscle. The drugs enter the bloodstream and travel throughout the body to kill cancer cells that have spread from the original site.

The reason chemotherapy works is that it kills fast-growing cells, which include cancer cells, but also other fast-growing cells such as hair follicles. That is one reason for many of the typical side effects of chemotherapy treatment such as hair loss.

• Chemotherapy given before breast surgery is called neoadjuvant therapy.
• Chemotherapy given after surgery is called "adjuvant" treatment.
• Dose-Density Chemotherapy
• Side Effects of Chemotherapy
• Hormone Therapy

Chemotherapy before surgery
This approach is commonly used to treat women with larger, more advanced breast cancers.

One advantage of having chemotherapy before surgery is that you will be able to see whether the treatment is effective in shrinking your tumor. Shrinking the tumor makes it easier to remove. Your doctor may recommend that you have chemotherapy before your cancer surgery, rather than after. This is called "neoadjuvant" therapy.

Neoadjuvant chemotherapy is the standard treatment for women who have tumors that are too large to remove surgically with a cosmetically acceptable outcome. It is also the standard treatment for women with inflammatory breast cancer.

Successful neoadjuvant chemotherapy will shrink your tumor before surgery, making it easier to remove. This treatment will also decrease your chances of a recurrence. For a small number of women, having neoadjuvant chemotherapy may allow them to have breast-conserving surgery, such as a lumpectomy, rather than a mastectomy.

Chemotherapy after surgery
Adjuvant chemotherapy has been proven to improve the cure rate and overall survival rate for breast cancer patients.

Opting for adjuvant chemotherapy after surgery may reduce your risk of a recurrence of breast cancer by as much as 40 percent.

Doctors and researchers at SCCA are studying new ways of delivering these powerful drugs to make them as effective as possible, and also to reduce the side effects of chemotherapy treatment.

New Ways of Giving Chemotherapy: Dose Density
Doctors and researchers at Seattle Cancer Care Alliance are working to find new and more effective chemotherapy drugs and combinations of drugs. In addition, they are studying the way in which the drugs are given, to find more effective treatments for breast cancer.

One change in the way chemotherapy is given, which is being studied by SCCA oncologists, is related to dose density. Rresearchers are looking at the frequency of chemotherapy treatments, as well as the size of the dose, to find the most effective combination for killing cancer cells.

They have found that some chemotherapy drugs, which normally are given to breast cancer patients once every three weeks, are more effective if they are given more often in smaller doses. In addition, side effects such as nausea, vomiting, mouth sores, and fatigue are less troubling with the smaller dose.

A clinical trial of the drugs Adriamycin and Cytoxan, in which the Adriamycin is given weekly and the Cytoxan given daily, is on-going at SCCA. This clinical trial is not randomized, although SCCA researchers will soon be participating in a randomized clinical trial to test these changes in the way the drugs are given.

Side Effects of Chemotherapy
The side effects of chemotherapy vary according to the drugs that are used. The most common side effects include nausea, vomiting, hair loss, and fatigue. Other possible side effects include mouth sores, and an increased chance of bleeding, infection, or anemia. Patients tolerate chemotherapy much better than in the past, however, because of new drugs that help control side effects.