Once you’ve been diagnosed with early stage breast cancer, you and your oncologist will discuss what course of therapy is best for you.
Your oncologist will take into account the following specifics of your disease and overall health when choosing your treatment plan:
- Cancer stage: Staging is based on tumor size, whether or not cancer cells are found in your lymph nodes and whether or not the cancer has spread to distant sites including your bones, liver, or lungs. Staging is based on surgical specimen and imaging and may include CAT scans, mammograms, ultrasounds, and bone scans. Based on what’s found, your cancer will be classified from stage 1 (least advanced stage) to stage 4 (most advanced stage). Treatment for advanced breast cancer (stage 4) differs from early stage breast cancer (stages 1-3).
- Hormone-receptor status: Some cancers have estrogen receptors on the cell surface and the estrogen that’s naturally in your body and can promote cancer growth. These cancers are called hormone positive cancers and are usually less aggressive than other types of breast cancer. They tend to grow more slowly and may be treated with drugs that block the estrogen from stimulating cancer growth.
- HER2 status: About 1 out of 5 patients have cancer cells that contain too much of a protein known as HER2. These cancers are called HER2 positive and are usually more aggressive, meaning that they grow and spread fast. HER2 positive breast cancers will be treated with chemotherapy and trastuzumab (Herceptin), a drug that specifically targets the HER2 receptors.
- Age: If you’re younger than 40 when you’re diagnosed with breast cancer, your treatment plan may be more aggressive.
- Other health conditions: Some chemotherapy drugs can be toxic to your heart. If you have other medical issues, especially diabetes or high blood pressure, your oncologist may avoid these drugs.
There are many different chemotherapy drugs used to treat breast cancer that your oncologist will consider. Ask your oncologist to explain why a particular drug was selected. Although you may not have a choice in what drugs are used, it’s important to understand the plan for your health.
There are different classes of chemotherapy drugs, and you’ll most likely receive a combination of two to three drugs based on your type of cancer, your age, and other medical concerns. Using a combination of drugs is generally more effective than using a single drug.
Chemotherapy combinations are abbreviated by the first alphabets of the drug names. Some of standard chemotherapy combinations used for breast cancer are:
- AT: Adriamycin and Taxotere
- AC ± T: Adriamycin and Cytoxan, with or without Taxol or Taxotere
- CMF: Cytoxan, methotrexate, and fluorouracil
- CAF: Cytoxan, Adriamycin, and fluorouracil
- TAC: Taxotere, Adriamycin, and Cytoxan
- GET: Gemzar, Ellence, and Taxol
- TC: Taxol and Cytoxan
In some cases, special targeted medications are added to chemotherapy combinations. A common example is trastuzumab (Herceptin) for women who have positive HER2 status.
Each chemotherapy session is called a cycle. Your oncologist should explain your treatment plan including what specific drugs you’ll get, potential side effects, and how many cycles are planned.
Most chemotherapy drugs are dosed based on your height and weigh. You’ll be weighed before each cycle and your dose will be adjusted as needed. If you have liver or kidney problems, your dose may be adjusted as necessary.
Questions to Ask
Talking with your oncologist about the specific drugs, doses, and schedules will probably be overwhelming and stressful. Do your best to stay informed so you’ll know what to expect. And make a calendar of your chemotherapy dates so you can plan ahead.
It may help to ask your oncologist these questions:
- Why did you choose this combination of drug for my cancer?
- Was this combination my only option?
- How many cycles will I get and how often?
- What are the possible side effects of this combination? What can be done to make the side effects as easy to manage as possible?
Although the names of chemotherapy drugs can be confusing, knowing and understanding as much as you can about your designated drugs can leave you feeling more prepared as you begin treatment.