Chemotherapy for Breast Cancer
What is chemotherapy?
Chemotherapy is a common cancer treatment. It’s a form of medical oncology. Chemotherapy uses drugs to destroy cancer cells or slow their growth.
You may receive only one medication as your chemotherapy treatment. More often, though, healthcare providers prescribe a combination of medicines. Your treatment will be tailored to your needs, your treatment stage and the form of cancer that’s affecting you.
Why is chemotherapy used for breast cancer?
Not everyone who has breast cancer needs chemotherapy. Depending on the cancer stage, your oncologist (cancer doctor) may recommend chemotherapy:
- Before surgery (neoadjuvant chemotherapy): You may have chemotherapy to shrink a tumor. This option could make it possible to have a less-extensive surgery. It may also allow healthcare providers to discover more about the biology of the cancer itself by how it responds to chemotherapy.
- After surgery (adjuvant chemotherapy): Sometimes, cancerous cells remain in your body but don’t show up on imaging tests. Your healthcare provider may recommend chemotherapy after surgery to kill any remaining cancer cells. This treatment can also reduce the risk of the cancer from returning (breast cancer recurrence).
- For advanced cancer: If breast cancer has spread to other parts of your body (metastasized), chemotherapy may be the main treatment.
- For IBC: Inflammatory breast cancer (IBC) doesn’t have a lump that a surgeon can remove easily. Chemotherapy often is the first treatment for IBC.
What happens before chemotherapy for breast cancer?
A few days before your chemotherapy treatment, you’ll have blood tests. The blood tests tell your oncologist and pharmacist how to tailor your treatment based on your laboratory values and body mass index (BMI).
You may receive chemotherapy through a large, sturdy tube called a central venous catheter (CVC). If your healthcare provider recommends a CVC, it will be surgically implanted before treatment. It stays in place until you finish chemotherapy. Types of CVCs include:
- Central line: Long, plastic tube inserted near your heart or in a neck vein.
- Peripherally inserted central catheter (PICC): A central line that goes in through an arm vein.
- Port-a-cath (chemo port): A small, implantable chamber where your nurse gives drug injections.
How long does chemotherapy take for breast cancer?
Typically, you receive chemotherapy in cycles. You may receive chemo every week or every two, three or even four weeks. Cycles are usually two to three treatments long. Each cycle includes a rest period to allow your body to recover. For example, you may have the same treatment every Monday for three weeks. Then you have an extra week to recover before repeating the cycle. Many people have multiple treatment cycles in a row. Treatment may last three to six months.
What happens during chemotherapy for breast cancer?
Most people receive chemotherapy for breast cancer through one of their veins (IV). You may receive chemotherapy as one short injection or as an infusion. Infusions last longer and usually take place in a hospital or specialized infusion center.
When you get to the infusion center, your nurse administers your chemotherapy drugs and any additional medications you need. For example, you may also receive an anti-nausea medication before the chemotherapy drugs.
During the infusion:
- Your nurse accesses your CVC or starts an IV.
- You may read, watch television or visit with others during your treatment. Chemotherapy infusions may last a few hours or more.
- Your nurse flushes the IV line or CVC with a saline solution and removes it.
- You wait in a recovery area for about 30 minutes to make sure you do not have a negative reaction to treatment.
What happens after chemotherapy for breast cancer?
Immediately after chemotherapy, you may feel sleepy or nauseated. Typically, the side effects of chemotherapy go away after you complete all prescribed cycles.
Risks / Benefits
What are the advantages of chemotherapy for breast cancer?
Chemotherapy can effectively shrink cancerous cells before surgery. It can also decrease your risk of breast cancer coming back after surgery.
What are the side effects of chemotherapy for breast cancer?
Chemotherapy side effects vary based on what kind of drugs you take and for how long. Common chemotherapy side effects include:
- Gastrointestinal issues, such as diarrhea or constipation.
- Hair, skin and nail changes, such as hair loss or brittle nails.
- Loss of appetite.
- Nausea and vomiting.
- Numbness or tingling.
During chemotherapy treatment, many people still work, exercise and care for their families. For others, the treatment can be exhausting and time-consuming. It may be difficult to keep up with usual activities.
Speak with your healthcare provider about the risks and benefits of chemotherapy. You may manage side effects with supportive medications, such as anti-nausea drugs. Chemotherapy side effects generally go away after you finish treatment.
Is chemotherapy the only treatment for breast cancer?
No. Occasionally, chemotherapy is the only breast cancer treatment, but most often, healthcare providers use chemotherapy with other treatments, such as:
- Lumpectomy: Removing the tumor and a small amount of surrounding breast tissue.
- Mastectomy: Removing one or both breasts.
- Hormone therapy: Taking medicines that lower estrogen or block estrogen’s effects on cancer cells.
- Targeted therapy: Taking medicines that target the changes in cancer cells to destroy them or slow their growth.
- Radiation therapy: Using high-energy X-rays to destroy cancer cells.
Is early menopause a risk of chemotherapy for breast cancer?
Yes. If you have not gone through menopause, chemotherapy may stop your ovaries from producing estrogen. You may go into early menopause. If you want to have children in the future, discuss the risks of infertility with your healthcare provider.
Some women’s ovaries begin working again after chemotherapy treatment. Women who want to bear children in the future may also choose fertility preservation before starting chemotherapy.
Are there ways to prevent hair loss with chemotherapy?
Not everyone loses hair when receiving chemotherapy, but many people do. Some people’s hair only thins. Others lose the majority or all of their hair.
Using a cold cap can reduce hair loss. Cold caps cool your scalp before, during and after chemotherapy treatment. Cooling tightens the blood vessels in your scalp, potentially reducing how much chemotherapy goes to your hair follicles.
People may choose to wear a wig as a result of hair loss. Some private insurance companies may help cover wig costs if your doctor prescribes a “cranial prosthesis” or “hair prosthesis.” Medicare Parts A and B do not cover wigs, but the costs may be tax-deductible.
Recovery and Outlook
What is the recovery time after chemotherapy for breast cancer?
When you finish chemotherapy, you may have remaining side effects of treatment. These symptoms may take months or weeks to go away. You may still experience:
- Hair changes, such as hair growing back a different color or texture.
- Nausea or vomiting for two to three weeks.
- Tiredness or fatigue for three to six months.
- Stress or “chemo brain” for six months to a year.
When to Call the Doctor
When should I see my healthcare provider?
Call your healthcare provider or seek emergency treatment if you experience:
- Fever above 100.4 degrees Fahrenheit (38 degrees Celsius).
- Chest pain or shortness of breath.
- Delirium (sudden confusion).
- Severe headache and neck stiffness.
A note from Cleveland Clinic
Chemotherapy is a common breast cancer treatment. You may have chemotherapy before or after surgery. Or you may have chemotherapy as your primary breast cancer treatment. Usually, you receive chemotherapy in two- to three-week cycles, with periods of rest between cycles. Throughout treatment, it’s normal to experience hair loss, nausea, vomiting or fatigue. These symptoms may take a few weeks or months to disappear. Your healthcare provider can talk with you about concerns and your specific treatment.
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