One of the methods of complex therapy for malignant disease is chemotherapy. This technique is a reception of special drugs that inhibit the growth of tumors and contribute to the destruction of malignant cells. Chemotherapy of the breast can be used as the main method of treatment, or before and after surgery.
Indications for breast chemotherapy
As a rule, chemotherapy is given before or immediately after surgery.
Chemotherapy should not be used for non-invasive malignant tumors (for example, ductal carcinoma in the initial stages of development, a characteristic feature of which is the accumulation of histologically altered cells without the effect of germination in nearby tissues), in cases of the absence of metastases. In such situations, it is better to use hormonal treatment.
Often, experts prefer to use chemotherapy in the preclimacteric period in the diagnosis of invasive malignant process of the mammary gland. This is explained by the fact that in this situation the disease is characterized by a much more severe course, and chemotherapy will help to achieve the most positive result.
Treatment with chemotherapy is shown mainly in all cases where there is a spread of malignant disease in the lymphatic system. Moreover, the appointment of such treatment does not depend on the size of the primary malignant nidus or the functional ability of the appendages.
Chemotherapy is often recommended for women in the preclimacteric period with an invasive tumor, with an education size of 1 centimeter or less, with unaffected lymph nodes.
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Names of drugs for breast chemotherapy
Chemotherapy is prescribed in stages, to give the body breaks for rest and recovery. The use of certain chemotherapy drugs depends on many factors:
- stage and size of the formation, its aggressiveness, the presence of metastases in the lymph nodes;
- age and physiological features of the patient;
- period of menstrual function (reproductive, menopausal period);
- the body’s response to taking chemotherapy.
Chemotherapy drugs are divided into the following categories:
- alkylating agents violate the DNA structure of the malignant cell, which makes its further division impossible. Such agents include chlormethine, melphalan, cyclophosphamide, lomustine, busulfan, fluorobenzotep, dipin, and others;
- antimetabolites are cytostatics, inhibitory processes necessary for the development of abnormal cells. They start the death reaction of the cancer cell, which contributes to the complete gradual necrosis of the entire tumor. Preparations of this group: clofarabine, 5-fluorouracil, azacytidine, methotrexate, etc .;
- Anti-cancer antibiotics are a special group of antibiotics that are used exclusively for anticancer purposes. The most common anthracycline drugs, bleomycin, actinomycin and mitomycin;
- taxanes – antitumor drugs of plant origin, belong to the yew tree alkaloids. Among taxanes, paclitaxel and docetaxel are best known.
A course of chemotherapy can be performed using one drug, or several, combining them with each other, or prescribing them sequentially. Most often, experts use complex treatment regimens using a complex of anti-cancer drugs.
Dosage of drugs for breast chemotherapy
Most often, chemotherapy is done by intravenous drip. Dosages and dosage regimens of the drug in the body are determined individually, which largely depends on the specific diagnosis, oncological stage, the general condition of the patient, as well as his reaction to the administration of drugs.
The dosage must strictly comply with internationally accepted methods and rules.
For example, anti-cancer antibiotics are prescribed as follows:
- rubomitsin – in / in at 0.0008 g per 1 kg of patient for 5 days, after which a week-long break is taken. If there are no complications, then repeat the course from 3 to 5 days, the introduction is carried out through the day. Sometimes according to indications the dosage is increased, but not more than 0.025 g per 1 kg;
- adriamycin – administered intravenously from a proportion of 0.03 g / m², for three days in a row, followed by a break of 1 month. You can use another scheme: 0.06 g / m² once a month. The drug is administered very carefully and slowly due to the risk of necrosis at the injection site;
- Bruneomycin – is administered intravenously every 2-3 days, 0.003-0.004 g of the drug is usually used for the course of treatment.
Anti-metabolic agents are used according to the following schemes:
- methotrexate – taken orally 1-3 tablets per day, in / m or / in 0.005 g;
- fluorouracil – used in the form of droppers from a proportion of from 0.5 to 1 g per 500 ml of 5% glucose solution for 3 hours. In the form of IV injection at a dosage of 0.015 g / kg every day for 3 days, then half of the dosage every 48 hours. The course can be repeated in 1-1.5 months.
Alkylating agents are prescribed according to this scheme:
- cyclophosphamide – in the form of in / in or in / m injection at a dosage of 3 mg / kg 2% p-ra every day. For the entire course of treatment is usually used 4-14 g of the drug;
- Dipin – used in / in, and in / m, every 24 or 48 hours. A single dosage ranges from 0.005 g to 0.015 g. The average course of treatment requires the use of 0.2 g of the drug.
Treatment regimens and protocols can be coordinated by the physician also during the course of treatment, depending on the patient’s state of health, tolerance of therapy, and the effectiveness of the prescribed drug.
Chemotherapy for breast cancer
Some types of breast tumors can be cured by chemotherapy alone. But for the overwhelming number of cases, this approach is unacceptable, so chemotherapy is prescribed in order to control and inhibit tumor growth, while at the same time alleviating the symptoms. Why is chemotherapy not enough?
The fact is that often malignant cells get used to some drugs, or do not respond to them initially.
For example, imagine a situation where only 98% of malignant cells are sensitive to the prescribed drug. This means that chemotherapy will get rid of 98% of cancers. However, the remaining 2% of the surviving cells, which the drug has not affected, will continue to develop.
One of the ways to solve this issue is to use at the same time two or three different medications that can affect the cancer cell in different ways. With this approach, the chance to completely destroy the tumor is higher.
There is another option that allows you to destroy as much as possible all the cells of the tumor – an increase in the dosage of anticancer drugs. However, such a way out of the situation also has a significant disadvantage – healthy cells also suffer from high dosages, which is far from the best effect on the body.
Given the above, we can conclude that chemotherapy for breast cancer should be combined, or combined with surgical or radiotherapy. However, if chemotherapy is used in preparation for surgery, it is called neoadjuvant. If chemotherapy is used after surgery, they are talking about adjuvant chemotherapy.
Adjuvant Chemotherapy for Breast Cancer
Chemotherapy after breast surgery can be prescribed after some time, for example, in 3-4 weeks. Time after surgery is given to the body to recover and get rid of accumulated toxic substances.
Chemotherapy drugs will help destroy the remaining malignant cells, thereby preventing a possible re-development of the disease. Even if the operation was extremely successful, and the doctor removed all suspicious tissue, the cancer cells may be present in the blood and lymph circulation, where they can only be affected by chemotherapy.
Chemotherapy after removal of the mammary gland often involves the appointment of the drug anthracycline (epirubicin or doxorubicin). If the doctor allows for the likelihood of another cancer developing, add Taxotere to the treatment regimen.
Between each therapeutic course, the body should be given from one to 3 weeks to recover. After a rest, if necessary, repeat the course, taking into account the treatment regimen drawn up by the doctor. Such restorative gaps can reduce the side effects of chemotherapy, even with significant dosages of chemotherapy drugs.
Red Chemotherapy for Breast Cancer
Red chemotherapy is the philistine name for therapy using anthracycline drugs (epirubicin, doxorubicin). Solutions of these funds are marked by a pronounced red color.
If you follow this logic, the treatment with mitoxantron should be called blue, treatment with cyclophosphamide or fluorouracil – yellow, and therapy with taxol – white chemotherapy.
The use of red chemotherapy drugs is recognized as the most toxic of all chemotherapy options for the complex use of funds. This question has not yet been fully studied, but it is noted that each “red” drug, when used independently, does not have excessive toxicity, and the combined use of “red” chemotherapeutic agents can affect a large number of adverse events.
For the reasons listed above, experts recommend chemotherapy courses alternately with “red” and, for example, “yellow” drugs, in order to increase the various effects on cancer cells and reduce the burden on the patient’s body.
Side effects of breast chemotherapy
The severity of side effects may depend on the sensitivity of the body to drugs. What are the side effects:
- loss of appetite, dyspeptic symptoms, damage to the mucous membrane of the digestive tract and liver;
- in weakening hair follicles, partial or complete baldness (hair growth is restored several months after the end of chemotherapy);
- in hyperthermia caused by intoxication;
- in the development of vascular inflammatory diseases at the injection site, as well as thrombosis, necrosis and edema of the veins;
- in dysfunction of the hematopoietic system, in particular, reducing the number of platelets and leukocytes.
During the period of chemotherapy, the patient may feel tired, so doctors strongly advise you to rest a lot and temporarily switch to a benign lifestyle. If during therapy you have to go to work, then you should spend the planned short breaks to recuperate.
Most chemotherapeutic agents leave the body through the urinary tract. For this reason, the kidneys are under a lot of stress. In order to reduce the load on them, as well as remove accumulated toxic substances from the body, you should drink plenty of clean water, at least two liters.
In order to reduce the severity of side effects, you must follow a few rules:
- you should go for the chemotherapy procedure after having a little snack. Overeating and starving is bad;
- try not to eat heavy fatty foods;
- if nausea periodically occurs, do not start a hunger strike, simply reduce the amount of food eaten;
- If nausea persists, tell the doctor about it, he will prescribe you special medicines that will ease the symptom.
During chemotherapy, patients may feel a change in taste and olfactory sensations. Such symptoms should disappear on their own several months after the end of therapy.
Chemotherapy of the mammary gland can be fully effective only if the patient herself will carefully take care of her body: eat right, live active and not lose a positive attitude. Only in this case, the rehabilitation measures will bring the desired effect, and the disease will be overcome.