Which is scarier— the word "cancer" or the word "chemo?" Ask anyone who has never done chemotherapy and their answer will most likely be “chemo” because there really has never been any “feel good” chemo stories. You usually hear the worst of the worst, what doctors like to call the “Movie of the Week” type of chemo that is depicted on television.

A person who has undergone chemotherapy will answer you differently. The truth is that chemotherapy is not what it used to be. There a millions of people tolerating it better and able to go through their lives in spite of it.

 There are many drugs to counteract its side effects now, making it easier to tolerate. And there are new methods of administration that help the patient stay as whole as possible during this very difficult battle.

There still is a long way to go, but chemotherapy has definitely become both more tolerable and more effective at killing cancer cells. And that is what you must focus on: KILLING CANCER, which is the most underrated side effect of chemo – IT WORKS!

Here you will find a break down of the most popular breast cancer chemotherapies being utilized today and ways to help survive them.

THE BASICS

ABCs of CHEMO

Adriamycin,“A”, also known as Doxorubicin, belongs to the general group of medicines known as anthracyclines. It is actually a type of antibiotic, but like none you ever had before or will again. This particular drug has nicknames because of its color- Red. Some call it ‘The Red Cure’, ‘The Red Devil’, ‘Hi-test Hawaiian Punch”, etc.

Cytoxan, “C”,  is also known as Cyclophosphamide. This drug interferes with the growth of cancer cells by blocking the copying of DNA.

Epirubicin, “E” sometimes referred to as Ellence, is an anthracycline just like Adriamycin. Only this drug isn’t red, doesn’t have the cardiac side effects that Adriamycin has and it  works the exact same way.

Fluorouracil, or “5-FU”  is an antimetabolite and interferes with the growth of cancer cells by blocking necessary enzymes. Meaning, it starves the cancer cells of what they need to divide so they die.

Taxol “T” or Paclitaxel from the group of drugs called taxanes, was initially derived from the bark a yew tree. The Taxanes which are Taxol and Taxotere climb into a cancer cell and wreak havoc. Like a computer virus,  it stops the cell from being able to function normally. It can no longer divide and become two new cells. It breaks down the entire hard drive and kills the cancer cell.

Taxotere“T” or Docetaxel is the cousin of Taxol.  This is also a Taxane and it is also from the bark of a yew tree. Many people have found that if they have a hard time with Taxol, Taxotere is easier to tolerate.

Trastuzumab, HERCEPTIN, is for women who are her2nue positive. Meaning, their cancer carries the her2nue protein that promotes cancer growth. This breaks down that protein. Think of a regular cancer cell as a plain M&M. A her2nue positive cell is a peanut M&M. After the first line of chemo is used to break down the candy coating and the chocolate, a Her2Nue tumor still has the peanut inside. Herceptin goes in after your first chemo is finished and takes care of the peanut and your cancer is destroyed.

Newcomers and Advanced Disease Drugs:

These drugs are being used for advanced disease and have not been officially approved for primary disease. However, some of them work better than their older counterparts. Almost all have ongoing studies to assess if they can benefit women with primary disease as well.

DOXIL, (doxorubicin liposome) is  Adriamycin  that is encapsulated in a lipid sphere (fat bubble). It travels through the blood supply with the lipid coating on it. When it reaches its destination the coating disappears and the full effect of the drug is unleashed on the cancer cell. Because it only attacks the cancer cell and not the rest of your body, there are fewer side effects and it is very easily tolerated.

ABRAXANE (paclitaxol protein bound)  is also like Doxil. It is  pure Taxol that is suspended in albumin. It travels through the body without harming innocent bystanders. The amazing thing about Abraxane is the time it takes to get it. If you were to get Taxol the infusion lasts for close to four hours. This is because Taxol is mixed with a detergent and many people are allergic to it. So before they begin your infusion they pump you up with steroids and Benadryl. Then they start the infusion. They watch you carefully because they want to catch the allergic reaction right away. The symptoms can range from flushing of the face to difficulty in breathing. If you should have this reaction they stop the Taxol drip and give you more Benadryl. Then they start again. If you were to receive Abraxane, there would be no premedication of steroids or Benadryl, and the time it takes for the infusion is 31 minutes and you are  good to go.

Bevacizumab, AVASTIN, is the all star short stop in the lineup. It is a monoclonal antibody and an anti-angiogenesis drug which means it targets the cancer cell and only the cancer cell, gets into it, and stops it from being able to create its own blood supply that enables it to grow. It is reserved for advanced disease, but there are studies ongoing to get it approved for certain types of primary cancers.

Lapatinib, TYKERB, is the newest generation of drugs that attack Her2Nue  proteins and the Epidermal Growth Factor Receptors in breast cancer cells. It  has been shown to be superior to Herceptin, and is getting approval for wide range use. It is good news for the Her2Nue positive woman. It has the potential to be very  be good news to women who are estrogen/progesterone negative since ER/PR cancer cells have an over abundance of the Epidermal Growth Factor Receptors. Ongoing studies need to continue to see if this will benefit the 35-40% of women who are diagnosed ER/PR negative.

The platinol drugs, such as CISPLATIN, are now being tested for use as first line therapy for estrogen/progesterone negative women. It targets certain proteins that make up ER/PR Negative disease. Look for it, ask for it if you are ER/PR Negative.

Gemcitabine, GEMZAR. This is an anti-metabolite drug that is usually given in advanced disease only, or if primary chemotherapy fails.

Capecitibine, XELODA,  is another anti-metabolite that converts to the action of 5-FU once in the blood stream. It, too, has been reserved for advanced disease, but is being slowly tested in primary treatment as well.

Vinorelbine, NAVELBINE, is a plant alkaloid that comes from the periwinkle plant. Don’t let that pleasant image fool you. It is a powerful treatment for advanced disease and can be used alone or in combination. The latest use has been combining it with Herceptin.

Over the years it was found that a chemo cocktail of two or more drugs greatly improves overall survival. Here is where your oncologist will start speaking in code. The initials can be hard to follow so we have decoded everything for you. Get out your Little Orphan Annie Decoder Rings:

AC      Adriamycin and Cytoxan

CAF   Cytoxan, Adriamycin, 5-Fu (fluorouracil)

CMF   Cytoxan, Methotrexate, 5-Fu (fluorouracil)

CEF   Cytoxan, Epirubicin, 5-Fu (fluorouracil)

AC + T  Adriamycin, Cytoxan and Taxol

ATC     Adriamycin, Taxol, Cytoxan

TAC     Taxotere, Adriamycin and Cytoxan

TC        Taxotere, Cytoxan

Combinations of these treatments are calculated based on your particular cancer. Your doctor can figure out from your pathology report what best suits your needs. The educated patient is her own best healthcare advocate. You now have the tools to better understand the pathology of your cancer. With this knowledge, choosing the right chemo gets easier.

 This is a very good website to go to for more complete information, chemocare.

POTENTIAL SIDE EFFECTS

Cancer cells are rapidly dividing cells. Chemotherapy targets the rapidly dividing cells of the body, the whole body, even the healthy cells.  The healthy cells that divide rapidly are hair follicles,  the cells that line the digestive tract and blood cells. When chemo gets inside and disrupts a cell from dividing it kills off that cell’s ability to create a new, stronger set of cells. This is what happens in the hair follicles and why we lose our hair. Its machinery is broken down for a bit and needs to be repaired. So in the meantime, no more enzymes are getting to the follicle so our hair falls out. But the machinery repairs itself fast. And your hair will grow back. Your hair will grow back.

When the cells of the digestive tract are antagonized they too will revolt in the form of nausea and vomiting and maybe even diarrhea. There are medications now that are given before your infusion that make the digestive tract calm down before anything is even administered. Then there are anti-emetics (anti-vomit) given on a strict schedule to keep things calm, followed by a dosing in your IV of a steroid which acts as an anti-inflammatory to the digestive tract and further calms it down. And if you follow a schedule religiously of when to take your pills, you can actually do chemo and not feel sick At ALL. In fact, some girls get quite an appetite, which is good because an empty stomach is the worst thing that you can do to your digestive tract.

The chemo will affect your blood counts. This leads to fatigue, bruising and a lowered immunity. They have injections to boost your cell counts so that is not as big of an issue as it once was. However, you will be prone to infection and you must protect yourself at all costs. Wash your hands frequently, spray Lysol on the phone, the doorknobs, carry something like Purell in your purse, and avoid large crowds. For example, go to the movies during off-peak hours.

What Causes What...

Adriamyacin has become the standard chemo of choice. Even though there are many others to choose from. Adriamycin produces the general side effects of nausea, vomiting, mouth sores, hair loss and fatigue. ALL of these, with the exception of fatigue and hair loss, have medicines to counteract them before they begin.

There is another side effect of Adriamycin that will have to be addressed before you begin and that is it can be hard on your heart. If you have pre-existing heart trouble you should not take this drug. All women are given a test to see how well their hearts function before this drug is administered. It is called a MUGA Scan. It is a simple, painless test. An echo cardiogram may also be given.

The Ts—Taxol and Taxotere have their own set of known side effects and they are muscle aches, allergic reactions, hair loss, numbness or tingling in fingers or toes, watery eyes, and lowered blood counts. Taxol or Taxotere is given after your first course of primary chemo if necessary; remember it depends on your particular cancer. 

The side effects of Methotrexate  and 5-Fu , The M and F of CMF, are mouth sores, diarrhea, a  rash on the palms of the hands and the soles of the feet and lowered blood counts. These are temporary and go away after you are finished with the treatment.

Cytoxan, the chemo cocktail mixer, has its own set of side effects. The temporary ones are nausea, vomiting, hair loss, lowered blood counts, fatigue, fever or chills, and missed menstrual periods (amenorrhea).  All of these are combatable. There are some possible long term side effects— bladder damage, for example—that can be prevented by drinking plenty of water during your infusions. This flushes the chemical out of your bladder before it has a chance to do any harm.

Xeloda is an oral chemotherapeutic agent that was reserved for metastatic disease but is now being administered in the adjuvant setting. When taking Xeloda you must be aware of certain warning signs that have the potential to become serious. However, if you are aware of them and report them to you doctor early, you can avoid any problems.

If you should develop diarrhea or a tenderness on your hands and feet known as hand and foot syndrome, contact your doctor and your dose will be lowered so you can continue taking your medication on schedule.

 SIDE EFFECT SOLUTIONS

Mouth Sores

Mouth sores are small ulcerations on the tongue and roof of your mouth and sometimes on the inside of your cheeks. A quick first aid tip for mouth sores is to take  a q-tip and dab on some milk of magnesia as you would calamine lotion on a bug bite. This makes them dry up and  disappear.

Sometimes mouth sores are the result of thrush, a yeast infection. You will be able to tell the difference because you will have a white substance coating the inside of your mouth. Should this occur, you can get a prescription for an anti-fungal medication such as Difulcan to take orally and it works with in a day or so. There are also special mouth washes and rinses that your oncologist can prescribe to ease oral pain.

 You can often prevent mouth sores if you suck on ice during your infusions. Ask your physician about ways to prevent and treat your particular mouth sores. He may recommend switching to a mild, non alcoholic based mouth wash such as Biotene while you are in treatment.

Painful Joints

If you are having pain from one of the taxanes, Taxol, Taxotere or Abraxane,  ask your oncology team if you can to take your steroids longer until it passes. You can also try Glucosomine Powder mixed in juice 4 times a day. Vitamin supplements, L-Lysine, B6 and Niacin have been helped with joint pain as well. There are some doctors who are now giving a low dose Taxol every week instead of a large dose once every three weeks. This has made a significant improvement in the lessening of symptoms.(You should ask if this may apply to you.)

However, be advised that many oncologist do not recommend supplements during treatment because they believe that if a supplement can decrease the side effects of a chemotherapeutic drug, then it has the potential to reduce the effectiveness of the chemotherapy itself. Discuss all medications and supplements with your physician thoroughly.

Lost Periods

Glue-ey Eyes

Sometimes your eyes may produce fewer tears that would naturally keep them moist and comfortable during chemo. The result is a glue-like sensation in the eyes. Natural tear replacement drops like Gentle Tear helps to refresh and moisten your eyes. If the problem is severe, a prescription tear medication can be obtained from your cancer team.

Runny Nose and  Eyes

There is also the feeling of hay fever that can sometimes affect you during treatment. Your eyes are running and so is your nose. Speak with your doctor, sometimes a mild anti-histamine is all you need. Don’t take any medication, over the counter or not, without asking your oncologist first.

Loss of Taste/Metal Mouth

Chemotherapy can alter the taste buds. Some people feel that everything tastes like cardboard or on the other end of the spectrum, metal. Lemon wedges can wake up and refresh your mouth. Spicy foods can make a meal more interesting. Sucking hard candies during the day  can help keep the metallic taste away as well. Your mouth will get back to normal when treatment ends.

Heartburn

Some patients suffer from heartburn and keep taking over the counter medicines and never mention it to their oncology team. You should mention this to your team. Acid can build up from the chemo or the steroids causing acid reflux. A simple, daily acid reducer that your doctor prescribes can end that suffering right away.

Remember:

For a personal view of chemo, please go here