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Chemotherapy is a treatment method that uses medication to destroy cancer cellsCell:
The basic structural and functional unit of all organisms.

Chemotherapy is a systemic treatmentSystemic treatment:
A treatment method that is applied to and takes effect in the entire body. Chemotherapy, hormone therapy and HER-2 targeted therapy are systemic treatments for breast cancer.
that is taken by mouth or given into a vein and takes effect on the whole body. It is usually given after surgery. The goal of chemotherapy after surgery is to destroy any remaining cancer cells at the tumourTumour:
An abnormal mass of tissue that occurs when cells divide more than they should or do not die when they should. Tumours may be benign (not cancer) or malignant (cancer). A tumour is also called a neoplasm.
location, and cancer cells that may have spread from the breast to other parts of the body. Chemotherapy helps reduce the risk of recurrenceRecurrence:
Cancer that returns after treatment.
(the cancer coming back).

For very large breast cancer tumours, chemotherapy may be given before surgery. The goal of chemotherapy before surgery is to shrink the tumour so that it is easier to operate on (known as “neoadjuvantNeoadjuvant:
Treatment that is given before the primary treatment, such as chemotherapy that is given before surgery to shrink tumour size.

Your medical oncologistOncologist:
A doctor or surgeon who specializes in treating cancer. A medical oncologist specializes in drug therapy (chemotherapy) for cancer. A radiation oncologist specializes in treating cancer with radiation.
will be involved in planning your chemotherapy treatment. Because chemotherapy drugs work on cancer in different ways, early stageStage:
A way of classifying breast cancer that describes how far a cancer has spread. It identifies whether breast cancer is at an early, locally advanced or metastatic stage. The stage of breast cancer can sometimes be represented as a number (e.g. between 0 and 4).
breast cancer is usually treated with more than one type of chemotherapy drug at a time. Chemotherapy is also used in metastaticMetastatic (metastases):
The spread of cancer from its original (primary) location to another part of the body. A tumour that is formed by cancer cells that have spread to another part of the body is called a “metastatic tumour” or a “metastasis.”
breast cancer, with the goal of treating the symptoms of the cancer by slowing its growth or shrinking it. In this case, a single chemotherapy drug is usually used.

The drugs used, the dose, and the schedule and length of treatment will be informed by a number of factors, including the goal of the treatment, the stage of the cancer, and other methods of treatment that you may be receiving, such as surgery or radiationRadiation therapy:
(Sometimes called radiotherapy) A treatment method that uses a high energy beam to destroy cancer cells by damaging the DNA of cancer cells so that they can’t continue to grow.


Before your treatments begin, your doctor will run a number of blood tests to check the function of various organs, like the kidneys and liver, and make sure that you are able to undergo chemotherapy treatments.

Shortly before each treatment you may be given supportive medications to help lessen some of the short-term side effects of chemotherapy, like nausea.

There are a number of ways that chemotherapy medication can be administered, but most often it is given into a vein (intravenouslyIntravenous (I.V.):
A method of administering medication where the substance is given into a vein using a needle.
, or IV). In this procedure, a thin needle is inserted into your hand or arm and connected to a tube through which the medication flows. The medication drips slowly into the vein, and it can take several hours for your treatment to be completed. An oncology nurse will be with you while you are receiving your treatment. When the treatment is complete, the needle will be removed. If you are having your treatment as an outpatient, you will be allowed to go home then.

Chemotherapy medications can also be given into larger veins in the arm, chest or neck through special flexible tubes, called cathetersCatheter:
A flexible tube that is inserted into the body in order to remove or deliver a substance to the body, or to keep a passageway open.
, with an access point outside the body. Such catheters reduce the risk of chemotherapy spillage outside the vein and stay in your body for the duration of your chemotherapy treatment. This requires a minor outpatient surgery before your treatments begin, and another when they are all completed to remove the catheter.

Another way of taking chemotherapy medication is by mouth, in the form of pills, capsules, or liquids. If oral medication is the method that you and your health care team have chosen, you will take the medication at home.

Chemotherapy treatments are usually given in cycles. This means that treatment is given every two, three or four weeks, typically over a period of three to six months.

Side Effects

Your oncologist will discuss side effects with you in detail and prescribe medications to prevent or treat side effects.

Side effects of chemotherapy happen because the medication affects your whole body and can harm healthy cells as well as cancer cells. The dose is carefully monitored to have the most impact on the cancer while doing the least harm to healthy cells. The side effects you experience will depend on the drug combination you receive. Not everyone experiences side effects to the same extent or in the same way.

Side effects can happen during or within the hours, days and weeks after treatment. Until you know how you will react to chemotherapy, you may want to make arrangements for help getting to and from appointments and around your home.

Common short-term side effects include hair loss, fatigue, nausea, vomiting, mouth sores, muscle and joint aches, diarrhea, memory disturbances, lowered immunity/infection and menopausalMenopause:
A natural part of a woman's aging process, when the ovaries start to make less estrogen and progesterone and the menstrual periods stop. This change typically occurs between the late 40s and mid-to-late 50s.
symptoms. Your health care team will be able to treat or lessen some of these side effects, and most should go away after you have finished chemotherapy treatment.

If your oncologist has told you that your immunity may be lowered as a result of chemotherapy, it’s important to check for signs and symptoms of an infection, especially fever. If you have a fever that is 38.5°C (101.3°F) or higher, it is important that you contact your health care provider or oncologist immediately—or go directly to your local emergency department.

It’s important to know that when your hair grows back, it may not have the same texture as it did before you received chemotherapy treatment. Some chemotherapy drugs, such as docetaxel (Taxotere), carry a small risk of permanent hair loss that can affect hair on the entire body. Speak to your health care team about the side effects associated with your chemotherapy treatment and other options that may be available.

Tips for managing nausea and vomiting:

  • Take any medication prescribed for you by your doctor to help manage your side effects

  • Eat smaller meals more frequently rather than 3 large meals daily

  • Avoid foods that are greasy, spicy, or overly sweet or salty

  • Stick to eating blander foods such as rice, clear broth, crackers, pretzels, toast, boiled chicken, applesauce & bananas

  • If the smell of some foods is overpowering or unpleasant for you during  treatment, keep your meals simple, ask someone to cook foods you like, or order your favourites now and again

  • Try taking slow, deep breaths through the mouth if you feel nauseous while eating

  • Drink enough fluids. If a whole glass at a time is too much, sip small amounts throughout the day. Vomiting can quickly lead to dehydration. If you are having trouble keeping fluids down, contact your oncologist or oncology nurse

Tips for managing fatigue:

  • Exercise. As difficult as it may seem, evidence tells us that keeping active can help lessen cancer treatment-related fatigue. Do as much as you can, even if it’s only going for a short walk 

  • Plan your time. Schedule more physically and mentally intensive activities or chores for times of the day when you feel less tired

  • Listen to your body. Don’t push yourself too hard. Stop and rest when you need it

  • Ask for help. Delegating tasks to others can help you save your energy for things that are important to you, like playing with your children, or keeping up with your hobbies. Don’t try to do everything

  • Take any prescribed medications to help with anemiaAnemia:
    A condition where there is a deficiency of hemoglobin (a protein in red blood cells that carries oxygen) in the blood.
    caused by chemotherapy. Anemia can contribute to fatigue

  • Eat a healthy, well-balanced diet to help keep energy levels up

  • Try to get enough sleep during the night and take naps during the day if you need to.  If you are having trouble sleeping, talk to your health care team about options to help you sleep better 

Effects on Fertility

Chemotherapy can cause changes to your reproductive system, which may affect your fertility if you are premenopausal. The effect on fertility may be temporary or permanent, as in the case of treatment-induced premature (early) menopause. If preserving your fertility is important to you, talk to your health care team about options for drugs that are less likely to cause permanent infertilityInfertility:
The inability to produce a child. In women, this can mean an inability to conceive or carry a child to term. In men, this refers to the inability to impregnate a woman.
. You may also be able to have unfertilized eggs removed from your ovariesOvary:
A female reproductive organ in which ova or eggs are produced. The ovaries also produce the female hormones estrogen and progesterone.
and frozen to use at a later time. Your eggs can also be fertilized using your partner’s or donor sperm and the embryosEmbryo:
A fertilized egg in the early stages of development.

Drug Resistance

It is possible for cancer cells to withstand the effects of the chemotherapy drugs. This is known as drug resistance. Drug resistance can be present from the beginning, or can develop during the course of the treatment.

Drug resistance is more likely to develop when only one chemotherapy drug is used in treatment. This is another reason why a combination of chemotherapy drugs is used to treat early stage breast cancer (“multi-agent approach”). If resistance develops to one chemotherapy drug, it may become resistant to other drugs in the same drug family (groups of drugs that act the same way). When tumour cells develop resistance to more than one drug family, it is called multi-drug resistance (MDR).

Tumours which develop MDR can make it difficult to plan treatment by chemotherapy because drug options become more limited. Research is currently looking at ways to limit resistance and try to overcome MDR.

How to prepare for your chemotherapy treatment

  • Consider asking someone to drive you to and from your appointments.  Side effects like fatigue and nausea may make it hard for you to drive yourself.

  • Make arrangements to have someone help you clean, cook, care for children, and help with any other household tasks.

  • Chemotherapy treatments can take a few hours to complete. Bringing reading material, music, a laptop to play movies, and other activities that keep you busy can help pass the time.

  • If you have to or wish to work between treatments, ask your health care team when you can expect the side effects to decrease and plan any important meetings around this.

  • You may have been told by your doctor that you may lose your hair. Not everyone experiences hair loss but those who do deal with it in different ways. If you choose to wear a wig, plan to buy it before you start treatment so that it can be closely matched to your colour, texture and style. You can also take the wig to your regular hair stylist to style so that it closely matches how you normally wear it.

Ask your health care team about the benefits, limitations and possible side effects of chemotherapy to help you make an informed decision about your treatment.


Breastcancer.org. Chemotherapy. Accessed January 9, 2014

Breastcancer.org. Fatigue. Accessed January 9, 2014

Canadian Cancer Society. Chemotherapy. Accessed January 9, 2014

Canadian Cancer Society. Managing side effects: Nausea and Vomiting. Accessed January 9, 2014.

Canadian Cancer Society. Managing side effects: Fatigue. Accessed January 9, 2014.

National Cancer Institute. Managing chemotherapy side effects: nausea and vomiting. Accessed January 9, 2014.

Cancer Research UK. About fertility and chemotherapy. Accessed January 9, 2014.