Breast Cancer
Side Effects
Because breast cancer treatment is likely to damage healthy cells and tissues, unwanted side effects are common. Specific breast cancer side effects depend mainly on the type and extent of the treatment. Side effects of breast cancer may not be the same for each woman, or even for women having the same treatments. And a woman's breast cancer side effects may change from one treatment session to the next. The health care provider will explain the possible side effects of breast cancer treatment and how to manage them.
Breast Cancer Surgery Side Effects
Surgery for breast cancer causes short-term pain and tenderness in the area of the operation, so women may need to talk with their doctor about which method of pain control would be appropriate. Any kind of breast cancer surgery also carries a risk of infection, poor wound healing, bleeding, or a reaction to the anesthesia used in surgery. Women who experience any of these problems should tell their doctor or nurse right away.
Removal of a breast can cause a woman's weight to shift and be out of balance--especially if she has large breasts. This imbalance can cause discomfort in a woman's neck and back. Also, the skin in the breast area may be tight, and the muscles of the arm and shoulder may feel stiff. After a mastectomy, some women have some permanent loss of strength in these muscles, but for most women, reduced strength and limited movement are temporary. The doctor, nurse, or physical therapist can recommend exercises to help a woman regain movement and strength in her arm and shoulder.
Because nerves may be injured or cut during surgery, a woman may have numbness and tingling in the chest, underarm, shoulder, and arm. These feelings usually go away within a few weeks or months, but some women may have permanent numbness.
Removing the lymph nodes under the arm slows the flow of lymph. In some women, this fluid builds up in the arm and hand and causes swelling (lymphedema). Women need to protect the arm and hand on the treated side from injury, even long after surgery. They should ask the doctor how to handle any cuts, scratches, insect bites, or other injuries that may occur. Also, they should contact the doctor if an infection develops in the arm or hand.
Breast Cancer Radiation Treatment Side Effects
The radiation oncologist will explain the possible side effects of breast cancer radiation therapy --including uncommon side effects that may involve the heart, lungs, and ribs. One of the common side effects of breast cancer radiation treatment is fatigue, especially in the later weeks of treatment and for sometime afterward. Resting is important, but doctors usually advise their patients to try to stay reasonably active, matching their activities to their energy level. It is also common for the skin in the treated area to become red, dry, tender, and itchy. Toward the end of treatment, the skin may become moist and "weepy." Exposing this area to air as much as possible will help the skin heal. Because bras and some types of clothing may rub the skin and cause irritation, patients may want to wear loose-fitting cotton clothes. Good skin care is important at this time, and patients should check with their doctor before using any deodorants, lotions, or creams on the treated area. These effects of radiation therapy on the skin are temporary, and the area gradually heals once treatment is over. However, there may be a permanent change in the color of the skin.
For most women, the breast will look and feel about the same after radiation therapy. Occasionally, the treated breast may be firmer. Also, it may be larger (due to fluid buildup) or smaller (because of tissue changes) than it was before. For some women, the breast skin is more sensitive after radiation treatment; for others, it is less sensitive.
Chemotherapy Side Effects for Breast Cancer
The side effects of chemotherapy depend mainly on the drugs the patient receives. As with other types of breast cancer treatment, side effects vary from person to person. In general, anticancer drugs affect rapidly dividing cells. These include blood cells, which fight infection, cause the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, bruise or bleed easily, and may have less energy during treatment and for some time afterward. Cells in hair follicles and cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients may lose their hair and may have other side effects, such as loss of appetite, nausea, vomiting, diarrhea, or mouth sores. Many of these chemotherapy side effects can now be controlled, thanks to improvements in antiemetics (drugs that reduce or prevent vomiting) and other medications. Side effects generally are short-term problems. They gradually go away during the recovery part of the chemotherapy cycle or after the treatment is over.
With modern chemotherapy, long-term side effects are quite rare, but there have been cases in which the heart is weakened, and second cancers such as leukemia (cancer of the blood cells) have occurred. Also, some anticancer drugs can damage the ovaries. If the ovaries fail to produce hormones, the woman may have symptoms of menopause, such as hot flashes and vaginal dryness. Her periods may become irregular or may stop, and she may not be able to become pregnant. However, some women may still be able to get pregnant during treatment. Because the effects of chemotherapy on an unborn child are not known, it is important for a woman to talk to her doctor about birth control before treatment begins. After treatment, some women regain their ability to become pregnant, but in women over the age of 35 or 40, infertility is likely to be permanent.
Side Effects of Breast Cancer Hormonal Therapy
Hormonal therapy can cause a number of side effects. They depend largely on the specific drug or type of breast cancer treatment, and they vary from patient to patient. Tamoxifen is the most common hormonal treatment. This drug blocks the body's use of estrogen but does not stop estrogen production. Tamoxifen may cause hot flashes, vaginal discharge or irritation, and irregular periods. Any unusual bleeding while taking Tamoxifen should be reported to the doctor. Younger women taking tamoxifen may become pregnant more easily and should discuss birth control methods with their doctor.
Serious side effects of tamoxifen are rare, but this drug can cause blood clots in the veins, especially in the legs. In a very small number of women, tamoxifen has caused cancer of the lining of the uterus. The doctor may do a pelvic exam, as well as biopsies or other tests of the lining of the uterus, to monitor for this condition. (This does not apply to women who have had a hysterectomy, surgery to remove the uterus.) Young women whose ovaries are removed to deprive the cancer cells of estrogen experience menopause immediately. The side effects they have are likely to be more severe than the effects of natural menopause.
Biological Therapy Side Effects for Breast Cancer
Herceptin is the biological therapy used to treat some women with breast cancer that has spread. Side effects that most commonly occur during the first treatment with Herceptin are fever and chills. Other possible side effects include pain, weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, and rashes. These side effects generally become less severe after the first treatment.
Herceptin also may cause heart damage, which may lead to heart failure. It can also affect the lungs, causing breathing problems that require immediate medical attention. Before a woman receives Herceptin, the health care provider checks the woman for heart and lung problems. During treatment, the health care provider watches for signs of heart and lung problems.