Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The goal of chemotherapy is the maximum damage to cancer cells while doing so that the minimal damage to normal tissue. Women with chemotherapy for breast cancer:

before surgery to reduce cancer. This is known as neo-adjuvant chemotherapy.
After the operation, as the doctors that there is a risk of recurrence of cancer. This is known as adjuvant chemotherapy.
When chemotherapy is used?
There are several situations in which chemotherapy may be recommended.

Adjuvant chemotherapy: Systemic therapy administered to patients with no evidence of tumor after surgery is called adjuvant therapy. Although surgery is used to display all cancers that can be removed, adjuvant therapy are used to destroy any cancer cells left behind can not be seen. Adjuvant therapy after breast-conserving surgery or mastectomy reduces the risk of breast cancer return. Both chemotherapy and hormonal therapy can be used as adjuvant treatment.
Neoadjuvant chemotherapy, chemotherapy given before surgery is called neoadjuvant therapy. Often the same therapy neoadjuvant chemotherapy used as adjuvant therapy used (it is only granted for the operation rather than later). In terms of survival, there is no difference between giving chemotherapy before or after surgery. The great advantage of neoadjuvant chemotherapy is that it is possible to reduce the large tumors are therefore small enough to be removed by lumpectomy instead of mastectomy. Another possible benefit of neoadjuvant chemotherapy is that physicians can see how the cancer responds to chemotherapy. If the tumor does not shrink, the doctor may try different chemotherapeutic drugs.
Chemotherapy for advanced breast cancer: Chemotherapy can also be used as a treatment of choice for women who have breast cancer and outside the armpit area distributed at the time of diagnosis is made, or if it spreads after treatments Home. The duration of treatment depends on whether the tumor is shrinking, as it shrinks, and how a woman tolerates the treatment.
As You like It Chemotherapy drugs are usually given to you as an outpatient, either by injection into a vein (intravenously) or in the form of tablets. Chemotherapy into a vein, as one session of treatment, usually within a few hours. This is followed by a rest period of several weeks, allowing the body to recover from any adverse treatment. A complete cycle of chemotherapy is likely to take 4-6 months.

Drug Used
There are many different chemotherapy drugs used to treat breast cancer, and are often used in combination (called chemotherapy).

The chemotherapy drugs most common are:

cyclophosphamide
epirubicin
fluorouracil (5FU) (5FU)
methotrexate
Paclitaxel (Taxol) (Taxol)
doxorubicin (adriamycin ®) (Adriamycin ®)
docetaxel (Taxotere ®). (Taxotere ®).
Other drugs may also be used.
Commonly used chemotherapy combinations are:

FEC – 5FU, epirubicin and cyclophosphamide
AC – doxorubicin (adriamycin ®) and cyclophosphamide
CMF – cyclophosphamide, methotrexate and 5FU
E-CMF – epirubicin and CMF
FEC-T – FEC plus docetaxel (Taxotere ®).
It is able to offer a wide range of chemotherapy treatments, such as the different combinations have different effects.

The search is always conducted to improve the effectiveness of chemotherapy and reduce side effects and you may be asked to participate in research studies | Compare different forms of chemotherapy.

Benefits of chemotherapy

Cancer in women is unlikely to return, chemotherapy alone may reduce the risk of cancer returning (recurrence) with a small amount. In women where the chances that the cancer came back later, chemotherapy can significantly reduce the risk of relapse. Your doctor can let you know how chemotherapy is likely to make a difference in your case. They can also tell the possible side effects.

Side Effects
Chemotherapy drugs can cause unpleasant side effects, but these can usually well control with medication. Side effects occur depends on the drugs that you provided.

Everyone is different and responds to treatment with chemotherapy in a different way. Some people have very few side effects, while others will be many. Almost all the side effects are only short term and will gradually disappear after treatment is stopped.

Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase during treatment.

Common side effects
nausea and vomiting. Drugs such as ondansetron (Zofran) and aprepitant (EMEND) can help relieve these side effects.
diarrhea
Temporary hair loss
Weight Loss
fatigue
depression
Serious short-and long-term complications can also occur and may vary depending on the specific drugs. These may include:

anemia. The anemia induced by chemotherapy is usually treated with erythropoietin stimulating agents, which epoietin Alfa (Epogen, Procrit) and darberpetin alfa (Aranesp) includes. ESAs should not be used unless the patient’s hemoglobin drops below 10 g / dl. These drugs can cause serious health risks if used for a hemoglobin level of 12 g / dl or more. Physicians must follow strict guidelines when administering the dose of these drugs. Patients should discuss the risks and benefits of ESAs with their oncologists.
increased risk of infection, with severe reduction in white blood cells (neutropenia). The addition of a drug called granulocyte colony-stimulating factor (filgrastim and lenograstim) may help reduce the risk of serious infections.
damage to liver and kidneys.
Abnormal blood clotting (thrombocytopenia).
allergic reaction, particularly platinum-based drugs.
menstrual abnormalities and infertility. Early menopause occurs in approximately 30% of women receiving chemotherapy, especially in the more than 40. A drug is a hormone gonadotropin-releasing hormone analogue that puts women in pre puberty temporary state during chemotherapy may preserve fertility in some women. Women may also consider the cryopreservation of embryos – the collection of eggs, followed by in vitro fertilization and cryopreservation of embryos for later use. American Society of Clinical Oncology suggests that women undergoing treatment for cancer see a specialist in reproductive health to discuss all available options for preservation of fertility.
sexual dysfunction.
In rare cases, secondary cancers such as leukemia.
quarter to one third of women report problems in concentration, motor function and memory, which may in the long term.
heart problems. Trastuzumab (Herceptin) may increase the risk of heart failure, particularly in women with pre-existing risk factors. Cumulative doses of anthracyclines (doxorubicin, epirubicin) can also damage heart muscles over time and increase the risk of heart failure.
Taxanes could lead to a decrease in white blood cells and possible problems in the heart and central nervous system. Allergic reactions may occur more often than TAXOTERE Taxol. Taking a steroid before taxane administration can help prevent such reactions. Therapy with taxanes may also cause severe joint and muscle pain in some patients, relievable with corticosteroids.

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Surgery
Most patients with breast cancer surgery to remove breast cancer. Some lymph nodes under the arm are usually outside and looked under a microscope to see if they contain cancer cells.

Breast-sparing surgery, surgery to remove the tumor, but not the breast itself, includes the following:

Lumpectomy: surgery to remove a tumor (solution) and a small amount of surrounding healthy tissue.
Partial mastectomy: surgery for the breast cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
Patients treated with breast-conserving surgery may also be a number of lymph nodes under the arm are removed for biopsy. This procedure is called lymph node dissection. It can be done at the same time, such as breast-conserving surgery or after. Node dissection is performed through a separate incision.

Other forms of intervention are as follows:

Total mastectomy: surgery to remove the whole breast that has cancer. This procedure is called a simple mastectomy. Some lymph nodes under the arm can be removed for biopsy at the same time as the breast or after surgery. This is done through a separate incision.
Modified radical mastectomy: surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining of the chest muscles and sometimes part of the muscles of the chest wall.
Radical mastectomy: surgery to remove the breast, chest wall muscles under the breast is, and all lymph nodes under the arm. This procedure is called a Halsted radical mastectomy.
Even if your doctor of all cancers that can be seen when the delete operation, some patients may be given radiation therapy, chemotherapy or hormonal therapy after surgery are cancer cells left to kill. Treatment given after surgery to reduce the risk that the cancer will return is called adjuvant therapy.

If a patient has a mastectomy to breast reconstruction (surgery to reconstruct the shape of the breast after a mastectomy) may be considered. Breast reconstruction can be done at the time of mastectomy or at a later date. Breast reconstruction can be made of its own (no breast patient), tissue or by using implants filled with saline or silicone gel. Before the decision to implant is made, patients can call the Food and Drug Administration (FDA), Center for Devices and Radiological Health 1-888-info-FDA (1-888-463-6332) or visit the FDA website for more information about breast implants.

Radiotherapy
Radiotherapy is a treatment for cancer that uses high-energy X-rays or other radiation to kill cancer cells or to continue to grow. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of tumor.

Chemotherapy
Chemotherapy is a treatment for cancer drugs that block the growth of tumor cells used either to kill cells or prevent them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs in the blood and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ or a body cavity such as the abdomen, it acts primarily to cancer cells in those areas (regional chemotherapy).The way the chemotherapy is given depends on the type and stage of tumor.

Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the blood. Some hormones can cause certain cancers to grow. If the tests show that cancer cells have places where hormones can attach (receptors), drugs, surgery or radiation is used for the production of hormones to reduce or stop the work. The hormone estrogen, which some breast cancers grow mainly by the ovaries. Treatment to stop making estrogen the ovaries is called ovarian ablation.

Hormone therapy with tamoxifen is often administered to patients with early stage breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells throughout the body and can increase the risk of developing cancer of the endometrium. Tamoxifen women have a pelvic examination every year for signs of cancer. Any vaginal bleeding other than menstrual bleeding, must be reported to a doctor as soon as possible.

Hormonal treatment with an aromatize inhibitor is given to some postmenopausal women with hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogen to grow. Aromatize inhibitors reduce estrogen in the body by blocking the enzyme aromatize from turning androgen into estrogen.

For the treatment of early breast cancer, certain aromatize inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 or more years of tamoxifen. For the treatment of metastatic breast cancer, aromatize inhibitors have been tested in clinical trials to compare the hormonal therapy with tamoxifen.

Targeted Therapy
Targeted therapy is a form of therapy that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinas inhibitors are two types of targeted therapies studied in the treatment of breast cancer.

Monoclonal antibody therapy is a cancer treatment that uses antibodies in the laboratory from a single type of immune cells. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill tumor cells, their growth, or keep them spread block. Monoclonal antibodies are given by infusion. They may only be used for or drugs, toxins, or radioactive material directly to tumor cells. Monoclonal antibodies can be used in combination with chemotherapy as adjuvant therapy.

Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of growth factor protein HER2, which sends growth signals to cells of breast cancer. Approximately one quarter of patients with breast cancer have tumors that can be treated with trastuzumab in combination with chemotherapy.

Tyrosine kinas inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinas inhibitors can be used in combination with other anticancer drugs as adjuvant therapy.

Lapatinib is a tyrosine kinas inhibitor that blocks the effects of the HER2 protein and other proteins in cancer cells. Can be used to treat patients with HER2 positive breast cancer that has progressed following treatment with trastuzumab

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Chemotherapy usually contains a combination of drugs is often more effective than a single drug given alone. There are many combinations of drugs used to treat breast cancer. Ask your doctor for specific information and side effects can you expect from your chemotherapy drugs.

Because chemotherapy for breast cancer
Drugs for breast cancer chemotherapy intravenously (directly into a vein) or orally (by mouth). Once the drugs enter the bloodstream, they travel to all parts of the body to which cancer cells can spread outside the breast to achieve – so the chemotherapy is considered a “systemic” form of treatment for breast cancer.

Chemotherapy is administered in cycles of treatment, followed by a recovery period. The entire chemotherapy treatment takes several months to a year, depending on the type of certain drugs.

When you are given chemotherapy for breast cancer?

When breast cancer is confined to the breast or lymph nodes, chemotherapy may be given after a lumpectomy or mastectomy. This is known as adjuvant therapy and may help reduce the risk of recurrence of breast cancer.

Chemotherapy can be administered as a treatment of choice for women that the cancer has spread to other parts of the body beyond the breast and lymph nodes. This spread is called metastatic breast cancer and is available in a small number of women at diagnosis, or if the cancer comes back sometime after the initial treatment of localized (non-metastatic) breast cancer.

Chemotherapy can also be administered before surgery to shrink a tumor.

Work during chemotherapy for breast cancer
Most people are able to continue working while receiving chemotherapy for breast cancer. You can schedule your treatment during the day or just before the weekend, so they do not interfere with your work program. You can adjust the schedule while undergoing chemotherapy, especially if you have side effects.

If you receive adjuvant chemotherapy (after surgery for removal of all cancers known), it is possible for the doctor to directly determine whether the treatment works because there is no tumor left to evaluate. However, adjuvant chemotherapy has proved useful in studies where some women received chemotherapy, while others do not.

After the completion of adjuvant therapy, the doctor to evaluate your progress through regular physical examinations, routine mammograms, and appropriate tests as a new problem arises. If you are treated with chemotherapy for metastatic disease, progress is monitored by blood tests, scans and / or x-rays.

Possible Side effects of chemotherapy drugs
Specific side effects of chemotherapy occur depends on the type and amount of medication you receive and how long will take them. The most common side effects are temporary:

nausea and vomiting.
Loss of appetite.
Hair loss.
Mouth ulcers.
Changes in the menstrual cycle.
High risk of infection (due to decreased white blood cells).
Bruising or bleeding.
Fatigue.
Ask your health care provider about specific side effects can you expect from your specific chemotherapeutic drugs. Also discuss with your provider side effects that are worrying you or you can not manage.

Treatment of breast cancer with chemotherapy
Chemotherapy refers to the use of anti-cancer drugs to destroy cancer cells. The doctor determines that the drug and what is known as an oncologist. Chemotherapy can be used for three main purposes:

Adjuvant therapy: the goal is to help prevent or delay the cancer returns after the first surgery and radiotherapy. Even if the cancer appears to be confined to the breast and lymph nodes under the arm, there is a chance that all cells can spread to other areas that can not be seen. Chemotherapy is given to try to kill the cells.
Neo-adjuvant. Sometimes breast cancer is so great that shrinks for the first time with chemotherapy may make it easier to do an operation.
Treatment of metastatic disease. If the cancer shows in some parts of the body that the breast and lymph nodes under the arm, it is called metastatic disease. Chemotherapy is one of the main ways that cancer cells have spread to other parts of the dead body, and to help them live longer with good quality of life. Where to begin chemotherapy, what drugs to use and what to expect side effects vary from woman to woman. Women should discuss this with their doctors.
Common chemotherapy drugs for breast cancer
Some of the most common chemotherapy drugs used to treat breast cancer are:

Anthracyclines: this class of drugs includes doxorubicin (adriamycin), epirubicin (ellence) and liposomal doxorubicin (Doxil)
Taxane: This class of drugs includes docetaxel (Taxotere), paclitaxel (Taxol), and protein-bound paclitaxel (Abraxane)
cyclophosphamide (Cytoxan)
Capecitabine (Xeloda) and 5 fluorouracil (5 FU)
vinorelbine (navelbine)
Gemcitabine (Gemzar)
trastuzumab (Herceptin): This drug is for use in women who have breast cancer HER-2 gene
Chemotherapy drugs are usually given weekly 2.4 cycles. In neo-adjuvant and adjuvant settings are usually in combinations of two or more drugs. Monotherapy (one drug at a time) can be a good choice for the treatment of breast cancer has already spread to other areas.

Chemotherapy for breast cancer

for breast cancer, chemotherapy is given either by mouth or injected into a vein daily, weekly or every 2-4 weeks. The treatment plan was designed for your specific condition. It can vary from someone else you know who had chemotherapy. For example, while some women in the hospital overnight to receive chemotherapy intravenously, others receive chemotherapy to once a day for a week in the office of their physician. Some patients receive chemotherapy in pill form.

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After the woman has undergone treatment for the elimination of breast cancer, you need to make stricter controls over the first five years. After they shall continue to be controlled like any healthy woman.

The controls are:

During the first two years, physical examinations will be conducted every three months and annual mammography.

Over the next three years, the physical examinations conducted every six months and annual mammography will also.

These controls will not require any other evidence provided that the woman is asymptomatic and her doctor so it sees fit.

Other tests are not uncommon blood tests, chest radiography and serial bone X-rays. You can perform some other evidence relating to any symptoms that the patient present.

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The surgical procedure was always done by a surgeon / gynecologist expert in breast cancer, allows local control of the disease and carry out an accurate diagnosis because it can determine the characteristics of the tumor and the number of nodes affected by malignant cells .

Radiotherapy is the use of high-energy rays such as X rays, to destroy or decrease the number of cancer cells. Local treatment is given after conservative surgery (when used after mastectomy is because it believes that there is a risk that the tumor is played). It develops over about 20-30 days (the oncologist and the radiologist felt it appropriate), and the patient goes to an outpatient clinic or room where radiation therapy is performed, does not have to be hospitalized for it.

As such, the treatment lasts a few minutes. It is not painful but it is something like an X-ray radiation only is greater and is concentrated in the affected area. What is achieved with radiotherapy is to reduce the size of the tumor, then surgery to remove or, upon completion of the operation, clear the area of malignant cells.

Side effects of this treatment include fatigue, or fatigue, swelling and heaviness in the breast, redness and dry skin (like after a sunburn), which usually disappear after six or 12 months. The action of the apparatus is usually very focused so that its effects are usually short and usually well tolerated by patients. A good combination of rest, physical activity and delicate garments can reduce this discomfort. (* See it in pictures)

Chemotherapy involves the administration of drugs that kill cancer cells and avoid the appearance of tumor in other parts of the body. There are several routes of administration, but the most common are the oral and intravenous.

No hospitalization is necessary for this treatment, can be done on an outpatient basis. This will depend on the state of the patient and duration of treatment, one track can last between four and eight months. The chemotherapy can be done as an adjuvant, ie, added to surgery or as sole treatment for cases of recurrence, and surgery is not a solution.

Neoadjuvant chemotherapy is one that is performed before surgery and only in some cases. Your objectivism is to reduce the size of the tumor and to perform an operation that will help to preserve the breast in women for whom the first option was a mastectomy.

Women with a recent diagnosis should know that there is an alternative to mastectomy (radical surgery) and should start talking to your doctor about the possibility of receiving quimioterapita first.

Adjuvant chemotherapy was performed after surgery to kill any cancer cells remaining in microscopic quantities and prevent their growth.

Only 10% of all patients who receive no postoperative treatment and which are those with no affected lymph nodes and the tumor is less than 1cm., And / or hormone receptor positive.

These drugs are given by way of cycles, with a recovery period between each.

The total duration of treatment varies depending on the patient required chemotherapy but ranges from three to six months.

Side effects of chemotherapy:
Because they are very strong drugs, have few side effects in some cases, very unpleasant. It must be said that are given, along with them, other drugs that reduce some of these effects. The most common are:

- Nausea and vomiting (Read more).
- Loss of appetite.
- Loss of hair.
- Mouth sores.
- Fatigue.
- High risk of infection by the decrease in white blood cells.
- Changes in the menstrual cycle.
- Hematomas.

Chemotherapy as treatment for relapse (when the cancer recurs in the other breast or other organ) is administered in the manner described above, except that the dose must be appropriate to stage of cancer.

Alongside chemotherapy, hormonal therapy will be provided that the present tumor hormone receptors.

Hormone therapy involves the administration of drugs that block the action of hormones that stimulate the growth of cancer cells.

They are given to those patients who are hormone receptor positive, this comes to be 60-70% of patients diagnosed with breast cancer.

Years ago after ovariectomy was performed to prevent the action of hormones but, at present, this technique is not used and instead used hormone therapy.

Recently, new drugs are being used for this therapy, which are:
- Drug antiestrogens or estrogen receptor modulators.
- Luteinizing hormone agonists at the level of the pituitary gland, which is responsible for estrogen production in premenopausal women.
- Drugs of aromatase, an enzyme that produces estrogen in women whose ovaries no longer produce them, ie, in menopausal women.
- Drug type of progesterone.

Side effects of these drugs are similar to symptoms that occur at menopause, ie hot flashes, nervousness, and so on. In some postmenopausal women have seen other risks such as increased thrombophlebitis, etc..

These drugs have several routes of administration that will be chosen according to a decision by the physician and patient. These routes are oral, subcutaneous and intramuscular (via injection).

The surgery will be done after obtaining the biopsy result. With it, is to achieve total tumor removal. Depending on this, the surgery will be more or less complicated.

The breast-conserving surgery is to remove the tumor trying to preserve as much breast tissue intact. Depending on the size of the tumor have the following types of surgery:

Lumpectomy: removal of the tumor with a rim of normal tissue.

Partial mastectomy or wide excision: Removal of the tumor along with a larger amount of normal tissue.

Quadrantectomy: removal of one quarter of the breast. These types of surgery will be performed in cases where the tumor is small, about 15% of cases, the amount of tissue that is removed is so small that it does not show much difference between the operated breast and non has been. Survival rates among women who have been implanted with conservative surgery and it was removed the entire breast to a are identical. These are the options of surgery:

Simple mastectomy: it removes the entire breast tissue but leaves the underlying muscle intact and enough skin to cover the wound. The breast is reconstructed more easily if the pectoral muscles and other tissues that are below it are unaffected. This technique is used when the cancer is invasive and has spread within the breast ducts.

Modified radical mastectomy removes the entire breast, axillary nodes some of the same arm of the breast and a small section of pectoralis ..

Radical mastectomy removes the tumor and the breast, underlying pectoral muscles and axillary nodes.

Sentinel lymph node biopsy: During surgery, inject a dye or a radioactive substance into the tumor site. The substance is transported by the lymph and if captured by the first node, which is one that can contain as many cancer cells, more nodes are removed. If it contains no malignant cells are not removed others. Chances of survival are greater if not affected axillary nodes. This biopsy is not performed if the tumor is very localized and very small, but if not, is done to try to prevent problems that may occur to remove lymph nodes.

Lymphedema: is a complication that occurs in one or two women out of 10 audited. This complication is swelling, stiffness or pain and loss of mobility in the arm after lymph node removal. The woman, once operated, you should avoid gaining any weight with that arm and perform strenuous exercise. The treatment for this problem is through massage or compression bandages. It is making a new technique, which is under study, which involves liposuction to remove fat that is stored in the arm.

Breast reconstruction: in general, to reconstruct a breast, a woman has to pass twice by surgery, a mastectomy and one for the implantation of the prosthesis. Generally not usually done at a time because it would need to be a long time under anesthesia and prefer to do this in two different interventions. There is no inconvenience for the patient to intervene when she sees fit. The implant is usually silicone or saline. Not all women who have undergone a radical mastectomy, wants to perform implant. Spending again for an operating room to undergo surgery with anesthesia and subsequent recovery, some choose to make the artificial limbs.

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