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Systemic treatment options for breast cancer

Chemotherapy, hormone therapy, immunotherapy and biological therapy are all systemic treatment options for breast cancer.

This means these are given into the bloodstream or by mouth to go throughout the body and reach cancer cells that may have spread beyond the breast.

Chemotherapy

Chemotherapy drugs are used to kill cancer cells throughout the body. They work by disrupting the mechanics of cell division.

Cancer cells are known to divide and replicate and grow much faster than normal cells and are therefore more susceptible to chemotherapy drugs.

Many different types of chemotherapy drugs are used to treat different cancers, and each drug works at a slightly different part of the cell-division process.

The treatment may include more than one drug – this is called combination therapy. A combination of drugs with different actions may work together to kill more cancer cells and reduce the chance that the cancer may become resistant to any one particular drug.

They are usually given through an intravenous drip (or, in some cases, tablets by mouth) with the aim of travelling through the bloodstream to reach more distant parts of the body.

Chemotherapy is normally given in an outpatient clinic, so patients can go home the same day.

Chemotherapy can be given in different situations which will vary according to each individual patient’s situation:

ADJUVANT CHEMOTHERAPY (Treatment after surgery)

There is the possibility that, before the time of surgery, a few cancer cells may have broken away from the main tumour and spread through the bloodstream to settle in other places such as lymph nodes, bone, liver, brain or lungs. These may start growing and cause problems sometimes many years after initial treatment.

The aims of adjuvant treatment is to kill these hidden cells and reduce the risk of future recurrence.

Not every patient needs adjuvant chemotherapy as some patients are not at high risk of this happening, and some breast cancer types do not succumb to chemotherapy as much as others.

NEO-ADJUVANT CHEMOTHERAPY (Treatment before surgery)

The main benefit of this is to shrink large cancers so that they are small enough to be removed safely or to improve cosmetic outcome.

Another advantage is that doctors can monitor how the cancer responds during chemotherapy.

ADVANCED METASTATIC CANCER

Chemotherapy can also be used as the main treatment for cancer that have already spread outside the breast and armpit (metastasised) at the time it is found, or if it spreads after the first treatments.

Possible side effects of chemotherapy

Chemotherapy drugs cannot distinguish between cancer cells and normal cells and may therefore affect some normal rapidly dividing cells in the body such as hair, skin, nails, lining of the digestive system and bone marrow (blood cell lines).

Therefore, there are various side effects associated with the therapy. Because each drug acts in a slightly different way, the side effects will also differ between drugs.

Chemocare.com has excellent information on side-effects.

Some side effects include: 

  • tiredness/fatigue (caused by low levels of red blood cells) – anaemia
  • higher risk of infection (caused by low levels of white blood cells) – neutropaenia
  • easier bruising/bleeding (caused by low platelet counts)
  • hair loss, mouth sores, skin/nail changes
  • nausea, vomiting, diarrhoea, constipation, loss of appetite
  • peripheral neuropathy
  • changes in menstrual cycle and fertility.

Please go to breastcancer.org for more information on side effects, how to manage them and when to contact your doctor.

Blood cell counts are tested routinely at intervals during chemotherapy. The regularity and type of blood test done depends on the patient, the combination of drugs used and the side effects experienced.

Thankfully, like all drugs (including Panado and Aspirin), not every side effect is experienced by every person, and some side effects are experienced to lesser degrees in some people. Many of the side effects may be unpleasant, but not harmful.

The good news is that cancer cells divide more rapidly than normal cells and therefore more likely to be killed by chemotherapy.

More good news is that normal cells are also more able to recover than cancer cells and, therefore, most side effects are not permanent and will reverse once the treatment is finished.

If you have any problems with side effects, be sure to tell your doctor or nurse because there are often ways to help.

Frequently asked questions around chemotherapy

“If I need chemo, when do I have to start?”
Within 4-6 weeks of your definitive operation. Any later than that, and research has shown you may be compromising the efficacy of the treatment.

“But I have had some post-operative complications and I am not fully healed yet. Shouldn’t I wait?”
No. Not even if you have an open wound. You need to start your chemo on time. An open wound can be kept covered and infection-free during chemo, and can be sorted out after chemotherapy. This does not impact on the cosmetic result. Skin grafts and other procedures are not recommended during chemo. Wait until afterwards.

“So just how bad am I going to feel?”
This is impossible to predict. Everybody is different. Many people can continue working during chemo, but may find they need to take a day or 2 off after chemo before going back to work.

Remember, your experience will be different from the lady sitting next to you in the chemo room, so don’t panic if you find you are having a harder time than she (or an easier time!). Tell your doctor. Often, something can be done to make the next time better. Some things you may have to endure, unfortunately.

“What about other medicines, drugs and supplements?”
It is very important to discuss any drugs you are taking or additional drugs you would like to take with your specialist. This includes vitamins or dietary supplements, vaccines or immunisations, immune boosters, alternative medicines and herbal medicines. They may interfere with the effectiveness of your chemotherapy treatment.

Cape Breast Care Clinic_Website_Services_Systemic treatment options-hormone-therapy

Endocrine/Hormone therapy

Some breast cancer cells have receptors which allow oestrogen and progesterone hormones to attach to them and stimulate them to divide and grow.

These cancers are then described as being oestrogen- and/or progesterone-positive. Endocrine (hormonal) therapy may then be advised as part of the cancer treatment.

Examples of endocrine treatment include Tamoxifen or Aromatase inhibitors. These are given in the form of a tablet each day for 5 to 20 years. They prevent oestrogen having a stimulating effect on the cancer cells.

Other types of endocrine therapies are also available, some of which are injectables, such as Faslodex.

Find more information on hormone therapy from breastcancer.org.

Side effects of endocrine treatment

Side effects from endocrine treatment are very manageable:

TAMOXIFEN:  most side effects do not occur immediately but rather some time after treatment has been started. Being an “anti-hormone” some of these side effects may include:  hot flushes, vaginal discharge or dry vagina, weight gain, mood changes and decreased libido (sex drive).

Other important side effects of tamoxifen include: increased risk of blood clots particularly  deep venous thrombosis  (DVT) and  thickening of the lining of the uterus  which may lead to an increased incidence of edometrial cancer (women on tamoxifen should therefore have a yearly gynaecological check-up and ultrasound scan of the uterus).

AROMATASE INHIBITORS:  the “hormonal” side effects are similar to Tamoxifen:  hot flushes, vaginal discharge or dry vagina, weight gain, mood changes and decreased libido (sex drive).

In addition, some patients may experience  muscle or joint aches

Osteoporosis and osteopaenia (thinning of the bones)  may occur and it is therefore important for patients to take supplementary calcium and Vitamin D and have a baseline Bone Mineral Density Scan done when starting the treatment and yearly while taking it.

Read breastcancer.org’s resources on hormonal treatment side effects.

More info

For information on TARGETED systemic breast-cancer treatment options, read  here.

Find out more about local breast cancer treatments (chemotherapy, hormone therapy, immunotherapy and biological therapy)  here.

For  useful information from reputable websites, please refer to our support list here.

For a list of trusted treatment associates, please click  here.

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