Chemotherapy is the use of anti-cancer drugs, known as cytotoxic drugs, to destroy cancer cells. The drugs travel in the bloodstream to attack cancer cells throughout the body.

Chemotherapy may be used if the secondary cancer is growing quickly or has affected your liver or lungs. It may also be used after hormonal therapy if the hormonal therapy is no longer controlling the cancer, or if it's known that the cancer will not respond to hormonal therapy.

Many different chemotherapy drugs are used to treat secondary breast cancer. The drugs can either be used on their own (single agents) or together (combination chemotherapy).

Among the most commonly used chemotherapy treatments are:

• AC (doxorubicin and cyclophosphamide)
• FEC (5-Fluorouracil, epirubicin and cyclophosphamide)
• CMF (cyclophosphamide, methotrexate and 5-fluorouracil)
• Docetaxel (Taxotere®) or paclitaxel (Taxol®).

Vinorelbine (Navelbine®) or gemcitabine (Gemzar®) may also be used.

A chemotherapy tablet called capecitabine (Xeloda®) is sometimes used, usually on its own but sometimes in combination with docetaxel.

Your oncologist (cancer doctor) is the best person to decide which type of chemotherapy treatment is suitable for you, and can discuss the benefits and possible side effects with you.

Our general information on chemotherapy discusses the treatment and its side effects in detail. There are also sections on individual drugs and their side effects.

Chemotherapy is usually given as a series of treatments known as cycles. Drugs may be given weekly or every three weeks. Your complete treatment may last for several months. Although some chemotherapy drugs can be given as tablets or capsules (orally) to be taken at home, most are given by injection into a vein in the arm (intravenously). Chemotherapy into a vein is usually given in the chemotherapy department as a day case.

Chemotherapy can cause unpleasant side effects, but for women whose cancer has spread it can also make them feel better by relieving the symptoms of the cancer. The side effects can usually be well controlled with medicines. The main side effects are described below, along with information on controlling or reducing them.

Lowered resistance to infection

Chemotherapy can reduce the number of white blood cells produced by the bone marrow, making you more prone to infection. Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel ill (even with a normal temperature).

You will have a blood test before each cycle of chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if your blood count is still low. Sometimes you may be given injections of a drug called G-CSF (granulocyte-colony stimulating factor). This is a type of protein that stimulates the bone marrow to produce more white blood cells. The injections are given under the skin (subcutaneously).

Bruising or bleeding

Chemotherapy can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells)

You may become anaemic. This may make you feel tired and breathless. Let your nurse or doctor know if this is a problem.

Nausea (feeling sick) and vomiting (being sick)

Some chemotherapy drugs can make you feel sick or even be sick. This can be helped by taking anti-sickness drugs (anti-emetics) which your doctor can prescribe.

Sore mouth

Some chemotherapy drugs can make your mouth sore and may cause small ulcers. Regular mouthwashes are important and the nurses will show you how to do these properly.

Poor appetite

If you don't feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. Our section on diet and cancer has some useful tips on coping with eating problems.

Hair loss

Hair loss is a common side effect of some chemotherapy drugs. This can be very distressing for some people. However, there are many ways of covering up hair loss, including wigs, hats or scarves. You may be entitled to a free wig from the NHS. Your doctor or the nurse looking after you will be able to arrange for you to see a wig specialist. If your hair falls out, it should start to grow back within 3–6 months of the end of treatment.

Tiredness

Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.

Although they may be hard to deal with at the time, these side effects will gradually disappear once your treatment is over.

Early menopause

Some women may find that chemotherapy makes them have their menopause early. See the page 'possible effects on your sex life' for more information.