Will I Need Chemotherapy?

The Chemotherapy Consultation

How many cycles
of Chemotherapy do I need?

A question which haunts each and every patient of breast cancer - Will I really need chemotherapy? Will I lose my hair? Losing of hair and fear of chemotherapy go hand in hand. Nothing affects an identity of a woman more than losing hair. And also, patients' have heard so much about side effects of chemotherapy most of which is actually not true. When I talk to my own patients after their entire chemo is over, even they tell me, it was not all that bad at all, as compared to what people (who haven't even undergone chemo) speak without knowing about it. The role of chemotherapy is very crucial, in those where it is indicated. It attacks the cancer cells moving around in the body, and reduces the chances of cancer coming back. So please remove the bias against chemotherapy from your minds, and read on why and how it is done.

What is 'Chemotherapy' and why is it needed?
Considering the fear that one has for chemotherapy, it is very essential that a patient understands how does a cancer spread, what is chemotherapy and why it is needed. Read on by clicking here -Need for Chemotherapy - this topic will open in a new window, you can easily close that window to come back to this page to continue reading.

Who plans Chemotherapy?

Cancer treatment involves three types of doctors (in addition to many associated doctors):
Surgical Oncologist: Performs cancer surgery.
Medical Oncologist: Plans and administers chemotherapy, targeted therapy and all systemic treatments.
Radiation Oncologist: Plans Radiation Treatment.
So, Chemotherapy is planned, administered, modified and managed by a Medical Oncologist. All the above three fields of Oncology are very very vast fields by themselves, that is why they are three different specialties. Each has his own role and cannot do the role of other. For example, a Surgical Oncologist will not and should not be giving chemo. And vice versa.
So let's read on about how chemotherapy is planned and given.

How is Chemotherapy planned?

Chemotherapy planning is a challenging task. Two women of the same age, same stage of breast cancer, can get two different chemotherapy protocols depending on many other factors. Hence, this planning needs to be meticulous and reviewed regularly. Here is how a Medical Oncologist goes about:

Patient Assessment: At the first consultation, the Medical Oncologist assess the paitent in detail -
Her Age
Any associated problems like Diabetes / Hypertension / Asthma / Heart / Kidney etc.
All latest Blood Tests as also the ECG and 2D Echo profile
The Histopathology Report of the tumour, the stage of cancer, the type (based on ER PR HER2), the aggressiveness etc.
Many other points are noted. After that, the Medical Oncologist comes to a fair idea of how much will be the benefit of chemotherapy - Is it just 1 or 2 percent, or is it in the range of 4 to 6 or 8 ot 10 percent. He discusses all the pros and cons of chemo. In some patients, a 'Genetic Profiling Test' may be useful and he may recommend it. And finally, he will counsel the patient whether chemo will benefit or not. If beneficial, and patient is agreeable, he goes to next step of 'planning'

Chemotherapy Planning: Depending on the various factors above, the Medical Oncologist will select a protocol which he thinks is most suitable for patient. A protocol will contain a few drugs (maybe two, maybe three), and they may be a different times (for example, 4 cycles of two drugs first followed by 12 weekly cycles of one drug). He will plan the dose of those drugs according to the weight and height of the patient. For those who do not have a Chemoport inserted, he may counsel them about the benefits of the same and send across to the Surgical Oncologist, for the same, before starting chemo. He will fix up a date for the first chemo, usually within a few days of this consultation.

The First Chemo: For most patients of breast cancer, chemotherapy is usually a 4 to 6 hour affair (day care). At the center, the medical Oncologist will assess once more, and the associate doctors will secure needle into Chemoport and start the chemotherapy. The staff at the centre re trained to watch out for any issues developing. In the vast majority, no problem happens, and the patient goes home peacefully, with much of problems. During discharge, most Medical Oncologists prescribe some medicines to prevent side effects from developing. Patients are also counselled on what to do if certain symptoms develop, and when to report. The next visit is now around 7th or 8th day of first chemo.

The 7th Day blood tests and visit: This 7th day visit is not necessary for all, but for most, the Medical Oncologist may ask for a CBC and maybe the liver and kidney profile (as per the drug in the protocol) to check how is the body responding. Occasionally, if the tests are not in a satisfactory range, he may reduce the dose of chemo. Once this test is done, and we get a rough idea of how the body is responding, the dose of chemo is now fixed (after a change if needed), and is changed only if the patient develops certain problems. So now the next chemo will be after another 14 days (in a 21 day cycle; some patients have a 14 days cycle, some have 7 days cycle as well)

Rest of Chemotherapy cycles: Now the 7th day visit after every chemo is not needed, and the rest of chemo will go ahead as per the decided cycle days. Of course, in case of a problem, the patient can always visit the Medical Oncologist or his team

Chemotherapy Planning: Images to come soon
Chemotherapy start

How soon must Chemotherapy start?

Chemotherapy should start, ideally, by the third to fourth week, from the date of surgery, and in any case, within six weeks from the date of surgery. If the first chemo is started after six weeks, the benefit of chemo goes down, trials have shown. SO we always wish to start as early as possible.
Why the third or fourth week, you may ask? That's because chemotherapy delays wound healing. Before starting chemo, we always wish to ensure the wound is healed or has 'almost' healed. Breast cancer surgery wounds usually heal within a couple of weeks. And obviously, if there are wound problems and the wound takes some time to heal, there will be a slight delay in the starting of chemotherapy. A co ordination between the Surgical and Medical Oncologist is a must.

Our Approach at this Step

There is no active role for me as a Surgeon now, except for decision making on the chemo part, which I jointly do with my chemotherapy colleagues. But my patients become more of my friends, you see, and I always like to be around for them, in case they are facing some side effect or issue and are not able to reach out to the chemo team, sometimes. And a little positive boost to the patient always help. Knowing that 'my doctor' is just 'a call away' or just 'a message away' gives them a lot of security. It does.
So finally, the chemotherapy will get over, over a few months time and then comes the time for Radiation. The next two sections, discuss about Chemoport and about some common effects of chemotherapy.

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Journey of BC: Diagnosis

1. I feel a lump! - The first visit to doctor
2. Is it really cancer? - Confirmatory tests
3. What is the stage? - Staging and fitness tests
4. Will it be surgery first? or chemo first? - Treatment planning and sequence

Journey of BC: Surgery

5. Should I conserve or remove breast? - Choice of Surgeries for breast cancer
6. How long will be the surgery? - Admission and Surgery
7. Care after surgery - Precautions and guidelines
8. What next? - The Pathology Report

Journey of BC: Further Treatment

9. How many chemo cycles? - Chemotherapy Consultation - You are presently on this page
10. Is a PORT necessary? - ChemoPORT insertion
11. Will I be normal during chemo? - The Chemotherapy time
12. Is Radiation painful? - Radiation Therapy
13. Yes!! I did it! - Treatment is over
14. How frequently do I meet doc? - Follow up guidelines

Other Topics

Risk Factors - The Risk Factors for Breast Cancer
Symptoms of Breast Cancer - Know the Symptoms of Breast Cancer
Early Detection of Breast Cancer - The Guidelines

Neo Adjuvant Chemotherapy (NACT) - For LABC
Sentinel Node Biopsy - How is it done?
Targeted Therapy - Trastuzumab
Hormone Therapy - Who gets it?