Diabetes and Chemotherapy

Chemotherapy refers to the use of anti-cancer drugs to kill cancer cells. The doctor who determines which drugs and in what dosage is known as a medical oncologist. Chemotherapy is used to:

• Kill cancer cells left behind after surgery or radiation, when the cancer seems to be confined to the breast or lymph glands under the arm.
• Kill cancer cells that have spread to various parts of the body, but were not obvious at the time of initial treatment.
• Kill cancer cells if cancer recurs elsewhere in the body. When to start chemotherapy, what drugs to use, and what side effects to expect varies from woman to woman. Women should discuss this with their doctors.
• Reduce the size of a tumor before surgery, allowing the woman to have breast-conserving surgery.

Chemotherapy may be given before surgery, when the breast cancer is large or wide spread. This is called neo-adjuvant therapy.

Common Chemotherapy Drugs

The most common chemotherapy drugs used to treat breast cancer include:

• Cyclophosphamide (Cytoxan)
• Methotrexate
• 5-fluorouracil (5-FU)
• Adriamycin
• Taxol
• Taxotere

They are usually given in cycles and in combinations of two or more drugs. Popular combinations include:

• CMF - Cytoxan, Methotrexate and 5-Fluorouracil
• AC - Adriamycin and Cytoxan
• CAF (or FAC) - Cytoxan, Adriamycin, and 5-Fluorouracil

A new drug called Abraxane has been approved to reduce the side effects (see side effects below) and boost the effectiveness of traditional chemotherapy. Abraxane can be used to treat breast cancer after failure of combination chemotherapy for disease that has spread beyond the breast, or breast cancer relapses within six months of chemotherapy treatment.

Receiving Chemotherapy

Chemotherapy is given either by mouth or injected into a vein or muscle daily, weekly, or monthly. Your treatment plan is designed for your particular condition. It may vary greatly from someone else you know who had chemotherapy. For example, while some women stay in the hospital overnight to receive chemotherapy intravenously, others receive chemotherapy for an hour once a day for a week in their doctor's office. Some patients receive chemotherapy in pill form.

Sometimes, the doctor needs to surgically implant a "port-a-cath or Hickman catheter." These devices are inserted into a vein by a surgeon and have an opening to the skin, allowing chemotherapy medications to be given easily. Also, they can be used to administer fluids or take blood samples. They are implanted on an outpatient basis using local anesthesia. You must take care to keep them clean. Once chemotherapy is finished, they can be removed, usually in the doctor's office.

Chemotherapy may begin after recovery from surgery or after radiation therapy and may last six months to a year. You will be checked regularly to see how your body is responding to the treatment and what effect the treatment is having on the cancer.