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1. What is chemo?
In chemotherapy, agents are used to prevent the growth of cancer cells. Because cancer cells divide quickly and uncontrollably. "The drugs interrupt this process, which leads to cell death," says Elena Kralidis, oncologist, of Breast Cancer Center of Aarau Cantonal Hospital. There are a few dozen cytostatic drugs, as they are called in technical language, that interfere with the differentiation mechanisms of the division phases of the cancer cell.
2. What is the purpose of chemotherapy?
Chemotherapy usually starts after surgery or radiation therapy. The experts then speak of "adjuvant" chemotherapy. The goal: to destroy all the remaining tumor cells in the body and thus prevent a relapse. Sometimes chemotherapy is done before surgery to reduce the size of the tumor. If breast cancer is already formed of offspring, chemotherapy is also possible. "Then it is Cancer curb and control, "says oncologist Elena Kralidis. Chemotherapy is almost always supplemented by other treatments such as hormonal or radiotherapeutic treatments.
3. How does chemotherapy work for breast cancer?
It usually takes place in several cycles. In between, there are breaks of one to four weeks. Meanwhile, healthy cells can recover. If chemotherapy is poorly tolerated, breaks may be prolonged.
What is breast cancer? A tumor is formed when the cells divide uncontrollably. Illustration: Getty Images
4. Is chemotherapy still given by infusion?
Some drugs are given in tablet form, but most are given by infusion into a vein. As a rule, no hospitalization is necessary for chemotherapy.
5. When is chemotherapy needed for breast cancer?
This is decided on a case by case basis. First, it all depends on the risk of cancer recurrence. In order to assess the risk of relapse, it is important to know if and how many lymph nodes are affected, what is the size of the tumor and how fast it grows. "The higher the risk of relapse, the sooner we recommend chemotherapy," said Stefan Aebi, head of the tumor center at the Lucerne Cantonal Hospital. On the other hand, the question arises whether chemotherapy has any effect. Because there are different types of breast cancer and all do not respond to chemotherapy.
For many patients, the above criteria can be used to determine whether chemotherapy is meaningful or not. However, there are borderline cases where the decision is difficult. "For example, in women who have a small but aggressive tumor, without involvement of lymph nodes," says oncologist Stefan Aebi. These patients have the opportunity to do a so-called gene expression test. During this process, the genetic material of the tumor cells is examined to determine the degree of activity of genes that influence cancer growth. "In simple terms, it's about the likelihood of a relapse," says Stefan Aebi.
6. What is the reliability of genetic testing to help with or against chemotherapy?
Additional long-term studies are needed to further investigate the utility of these tests. However, for many pathologists and oncologists, including Stefan Aebi and Elena Kralidis, it is already clear that such tests can facilitate decision-making in some cases. "They are only used when the cancer is hormone sensitive, after menopause and when no more than three lymph nodes are affected," says Stefan Aebi. There are currently four well-established tests in Switzerland that are paid for by health insurance. "You can choose one or the other test with good reason," says Stefan Aebi. It is important that the responsible physician is familiar with these tests. "If the patient turns to a certified breast center, this criterion must be met."
7. Who decides if chemotherapy will be performed?
In the best case, the doctor and the patient decide together. "Some women with breast cancer are however more afraid of chemotherapy than before the disease and categorically refuse treatment," said Stefan Aebi. "In such cases, we must accept the patient's decision." The opposite case of a person wanting chemotherapy for fear of a relapse, although doctors have advised against it, is extremely rare. "Here it is clearly stated that a doctor is obliged to refrain from unnecessary treatments."
8. Why is chemotherapy sometimes abandoned?
"The use of chemotherapy has decreased because other treatments, such as hormone therapy, have improved," says Stefan Aebi of the Lucerne Cantonal Hospital. In addition, it has been shown that chemotherapy does not benefit all patients. "We now know more about the types of tumors that chemotherapy makes no sense."
9. Are there alternatives to chemotherapy?
It varies from one case to the other. Sometimes hormone therapy is enough. However, it is by no means appropriate for all types of breast cancer and all patients. Other treatments, such as radiation therapy or immunotherapy, do not usually replace chemotherapy but are an important adjunct.
10. Why are there sometimes massive side effects?
Funds are not just about uncontrolled growth of cancer cells. "Even healthy cells in the body that divide quickly are affected," says Elena Kralidis. These include the cells of the hair root, mucus and blood. As a result, it can cause side effects such as hair loss, diarrhea or anemia. But as the body's cells have the ability to recover, unwanted side effects usually disappear after treatment.
11. What are the most important side effects and how can they be mitigated?
hair loss
This is one of the worst side effects for many patients and weighs down the psyche. "Hair loss is not common to all," says Elena Kralidis. "It depends on the medicine and the dose." Hair loss usually starts two to three weeks after chemotherapy. The hair is often pushed back a few months after the last treatment and many patients no longer need headgear.
Treat hair loss: be it a rag, a wig or a bald head – it is essential that the affected people choose who they feel comfortable with. Photo: iStock
In order to limit hair loss, the cooling of the scalp is proven. The patient is placed on a cold hood. As a result, the cytostatic agents act less strongly on the roots of the hair, because a cold scalp is less well supplied with blood. A study from the University of California at San Francisco concludes that the method is quite effective. The proportion of women needing a wig was around around thanks to the cooling method
50 percent back. The fear that cancer cells will survive in the scalp resulting in cutaneous metastases has been refuted. Nevertheless, the method is used reluctantly in many clinics. "A chemotherapy session lasts several hours and many patients find that it is very uncomfortable to put on the hood for so long," Elena Kralidis said. "Some even have migraines."
Severely afflicted patients often use a wig. Generally, disability insurance or AVS contributes to costs. Some women tie a scarf or wear a hat. The cantonal counseling centers of the League Against Cancer inform about possibilities and transmit addresses.
nausea
Another feared side effect is nausea with vomiting. The occurrence of this side effect depends on the drug administered and its dose. Some women generally have more nausea and vomiting than others. Nowadays, there are effective drugs that can also be taken as a preventive measure. "Because of the chemotherapy, almost no one ever vomits again," says Elena Kralidis. "It is possible, however, that a slight nausea persists."
tired
Chemotherapy, cancer and mental stress can consume forces. There are no drugs for fatigue. Nevertheless, something can be done about it: "It is important to provide relaxation to recharge your batteries," says oncologist Elena Kralidis. She recommends that he move regularly. "Whether it's jogging, yoga or walking, everyone must discover for themselves what activity is beneficial to him." During chemotherapy, most patients are on sick leave. For professionals, the question arises whether a return with a reduced workload is possible. Cantonal cancer leaks inform cancer and work rights.
12. What can people do to relieve side effects?
In addition to relaxation and exercise, awareness-based procedures have proven useful, focusing attention on the present moment. At the Institute of Complementary and Integrative Medicine of the University of Zurich, patients with cancer can take a course that sometimes focuses on mindfulness. Some patients are assisted by a psycho-oncological consultation.
13. What about complementary medicine therapies?
It is estimated that half of those affected by cancer also use complementary therapies in addition to conventional medicine. These can help mitigate the side effects of the treatments and the burden of the disease. Many patients appreciate being able to act against the disease themselves. This promotes well-being and quality of life. More detailed information can be found on the Krebsliga website.
14. What are the possible late effects of chemotherapy in breast cancer?
Few patients have chronic fatigue called fatigue syndrome. Another possible late consequence is a nerve injury. "They are manifested by emotional problems in the hands and feet," explains Elena Kralidis. In addition, some cytostatics can, in rare cases, damage the heart muscle and thus cause a reduction in cardiac output. Rarely, chemotherapy triggers another cancer years later, such as leukemia.
15. Why do some breast tumors continue to develop despite chemotherapy?
All types of cancer do not respond as well to chemotherapy. In addition, tumor cells sometimes become insensitive to drugs. This can not be expected at the beginning of chemotherapy. "Even after successful treatment, a relapse can not be ruled out," says Elena Kralidis. In very rare cases, the cancer reappears even after twenty years. However, generally, the longer the elapsed time, the lower the risk of relapse.
(Swiss family)
Created: 18.10.2018, 15:15
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