1. What is chemotherapy?
2. How chemotherapy is used?
3. Chemotherapy drugs
4. Benefits of chemotherapy
5. Chemotherapy side effects
6. How long treatment may take
7. How chemotherapy is given
8. Other issues
Chemotherapy is a treatment for breast cancer using anti-cancer (also called cytotoxic) drugs. The aim is to destroy breast cancer cells. It's known as a systemic treatment.
Cancer cells grow by dividing in a disorderly and uncontrolled way. Chemotherapy gets in the way of their ability to divide and grow. Different chemotherapy drugs work in different ways and affect the cancer cells at different phases of their growth. This is why a combination of drugs is often used.
To decide whether or not you're offered chemotherapy, various factors are taken into consideration, such as the size of your breast cancer, whether lymph nodes are affected, the grade of your cancer (defines how different you cancer cells are from normal breast cells and how quickly the cancer cells are growing) and the oestrogen receptor (ER) and HER2 receptor status. Your general health and any other medical conditions will be considered.
Some people are offered chemotherapy before surgery. This is called neo-adjuvant or primary chemotherapy. It may be used to slow the development of rapidly growing cancers or to shrink larger cancers.
Secondary, or metastatic, breast cancer is when breast cancer cells have spread from the breast to other parts of the body, such as the bones or lungs. Chemotherapy can be given to shrink or control the growth of secondary breast cancer. It can also be given to reduce some symptoms caused by the secondary breast cancer.
3. Chemotherapy drugs
Find out about the drugs used for chemotherapy.
The level of possible benefit you get will depend on several factors, including the type, grade and stage of the breast cancer and your age.
In some circumstances, the benefits of chemotherapy are clear; in others they're less certain or quite small so it can be difficult to decide whether or not to go ahead with chemotherapy. You’ll need to weigh up the likely benefits against the potential side effects.
Your decision may be influenced by factors such as any previous experience of chemotherapy, your personal priorities, your family and your work commitments. It’s important for you to discuss these issues openly with your specialist or breast care nurse, who will help and support you with your decision.
You can also talk this through with someone at Breast Cancer Care by calling 0800 800 600.
There are a number of decision-making aids using computer programmes that may help predict chemotherapy benefit. In addition, a test called Oncotype DX can sometimes help your specialist team decide if you would benefit from having chemotherapy as part of your treatment and how likely it is that your cancer will return in the future. However, it's only suitable in certain circumstances and doesn't always provide a definite answer. You can ask your specialist team whether this test would be suitable for you and if it's available.
5. Side effects
Find out about the side effects of chemotherapy.
Chemotherapy for breast cancer is usually given as a series of treatments every two to four weeks over a period of several months. This can vary, depending on the type and stage of your cancer, your general health and the combination of drugs used.
The period between each treatment gives your body time to recover from any short-term side effects.
You’ll normally be given your treatment as an outpatient so you will be able to go home the same day. You may only be there for a short time or some people may be at the hospital for most of the day. You might find it helpful to bring things to pass the time, such as books, a personal music player and snacks, and you could ask someone to come with you to keep you company.
Before each course of chemotherapy begins you will have a blood test to ensure your blood cell levels are within safe limits. Blood is often taken on the same day but can be taken earlier, for example the day before.
With some types of chemotherapy you may be given your first treatment as an inpatient and stay in hospital overnight
Chemotherapy can be given in several ways. For breast cancer the drugs are usually given:
- into a vein (intravenously)
- by mouth (orally) as a tablet or capsule.
A small plastic tube called a cannula is put into a vein (usually in the arm or hand) and the diluted drug is injected over a period of time, usually several minutes. If a large volume of fluid is needed it's given as an infusion (drip) through the cannula over several hours.
If it's difficult to find a vein, sometimes a central venous access device is used, such as a skin-tunnelled catheter. This stays in place throughout the course of the treatment.
Different types of central venous access device are described below.
A skin-tunnelled catheter (commonly called a Hickman or Groshong line) is a fine silicone tube that is put into a large vein through a small cut in your chest wall. It can stay in place for several months, which means that you don’t need to have a cannula put into the vein each time you have treatment. Blood samples can also be taken from the catheter.
The catheter can be put in under a local or general anaesthetic. A small cut is made near the collar bone though which the catheter is put into a large vein that leads to the heart. Along the outside of the catheter is a small cuff that lies just under the skin where it exits the body. After the treatment has finished the catheter will be removed under a local anaesthetic.
Peripherally inserted central catheter (PICC)
A PICC is a catheter put into a vein in your arm, at or above the bend in your elbow. It extends into the large vein leading to your heart. It is usually put in under local anaesthetic. Like a skin-tunnelled catheter it stays in place throughout the course of your treatment. It's held in place with a dressing and you'll be given instructions on how to care for and change this dressing.
An implanted port (sometimes called a Portacath) is a thin, soft, hollow tube made of plastic that can be put into a vein, usually on the chest or arm. One end of the tube goes into a large vein just above the heart and the other end connects to the port under the skin. Chemotherapy drugs can be given directly into the port by puncturing it each time with a special type of needle. It can also be used to take blood samples.
Unlike a skin-tunnelled catheter or PICC, the port is hidden and it has to be put in under general anaesthetic. When it is removed through a small cut, the wound will be stitched and covered with a dressing.
This is chemotherapy taken by mouth and it may be given as tablets or capsules. It's usually taken at home as all or part of your treatment. Your chemotherapy nurse will tell you when to take your tablets/capsules and you will be given other written instructions such as whether or not to take them with food.
You'll also be given instructions on the safe handling and storage of chemotherapy that you keep at home.
Electrochemotherapy is a new treatment and is not widely available. It's sometimes used to treat breast cancer that has spread to the skin.
Chemotherapy is injected either directly into the area of skin affected or into the bloodstream. An electric pulse is then used to help the chemotherapy reach the cancer cells. Once inside the cancer cells, the chemotherapy destroys them.
Sex, contraception and pregnancy
Chemotherapy will almost certainly affect how you feel about sex and intimacy. You may not feel like being intimate at a time when you’re dealing with treatment or you may find intimacy helps you feel more normal during an uncertain time. Everyone’s reaction will be different. Find out more about sex, intimacy and breast cancer.
If you’re pre-menopausal it’s important to use contraception, even if your periods become irregular or stop completely as it is still possible to become pregnant. Chemotherapy drugs can harm a developing foetus in the first three months of pregnancy.
Your specialist can advise you on the best form of contraception for you, but they will usually recommend barrier methods – such as condoms.
The contraceptive pill is not routinely recommended because it contains hormones. The morning after pill can still be used in emergencies.
An intrauterine device (IUD or coil) can be used as long as it’s not the type that releases hormones. It’s thought that chemotherapy drugs can’t pass into vaginal fluids or semen, but this can’t be completely ruled out as chemotherapy drugs can pass into the blood and some other body fluids.
For the first few days after chemotherapy, you may want to avoid unprotected intercourse, oral sex or any contact that involves the sharing of body fluids to ensure that your partner is not exposed to the chemotherapy drugs. Most hospital specialists will advise using barrier protection such as condoms for a few days after treatment.
Many people find that complementary therapies can help them cope with the side effects of chemotherapy, even though there may not necessarily be research evidence to support this. There are many different types including acupuncture, relaxation, visualisation, aromatherapy, reflexology, meditation and hypnotherapy.
Some therapies are available in NHS hospitals, so ask your specialist or breast care nurse for details of what is available to you. If you’re thinking of trying a complementary therapy you should go to a recognised practitioner. For more information, see our Complementary therapies booklet.
Diet and supplements
You may be able to eat normally throughout chemotherapy or your eating habits may change because of the side effects of your treatment. Some people will find they lose weight during treatment, others may gain weight.
Many people wonder if they should follow a specific diet during chemotherapy and there are many conflicting theories about diet and breast cancer, which can be confusing. It’s important to make sure you eat and drink what you feel able to, wherever possible trying to maintain a healthy, well-balanced diet. See our information on diet and breast cancer.
Check with your specialist team before booking a holiday or traveling, particularly abroad. It’s sometimes possible to plan your treatment around your trip.
If you plan to go somewhere hot, take care not to stay in the sun for long periods as your skin may be more sensitive to the sun when having chemotherapy.
It’s a good idea to avoid the sun during the hottest part of the day (11am–3pm), use a high-factor suncream and keep covered with light clothing and a hat.
Getting travel insurance while having treatment for breast cancer isn’t always straightforward. For more information, see our breast cancer and travel insurance information.
Macmillan Cancer Support has information on travel and cancer.
You should not have any live vaccines while you’re having chemotherapy as they could be harmful. Measles, rubella (German measles), polio, BCG (tuberculosis) and yellow fever are live vaccines. It’s usually safe to have these vaccinations six months after your treatment finishes. Talk to your GP or specialist before having any vaccinations.
Inactivate vaccines, such as the seasonal flu vaccine, are safe and usually recommended for people starting or on chemotherapy to reduce their risk of getting the flu.
Your immune system needs to be healthy in order to make the antibodies to the vaccine that protects you from the flu. Therefore it’s best to have the vaccination at least two weeks before your chemotherapy starts. If you’re already receiving chemotherapy then you will need to talk to your hospital specialist or breast care nurse about the best time to have your flu jab. If you have any concerns about vaccinations talk to your specialist team.