1. How is chemotherapy given?
can be given in several ways. For breast cancer, the drugs are most commonly given:
- Into a vein (intravenously)
- By mouth as tablets or capsules (orally)
2. Intravenous chemotherapy
Chemotherapy side effects
Learn about the possible side effects of chemotherapy for breast cancer, and how they can be managed or controlled.
How intravenous chemotherapy is given depends on factors such as how easy it is for your chemotherapy team to find suitable veins, and your preferences.
Cannula
The most common way of giving chemotherapy involves inserting a small needle and a plastic tube called a cannula into a vein. It’s usually inserted in the back of your hand or lower arm. The needle is removed and the cannula is left in place. The cannula will be removed before you go home.
The chemotherapy drugs are slowly injected into the vein. If a large volume of fluid is used it will be given as an through the cannula over a fixed period of time.
Risk of lymphoedema
Lymphoedema is swelling caused by a build-up of fluid in the body’s tissues. It usually affects the arm, but it may also affect the hand and fingers. Lymphoedema can also affect the breast, chest, and occasionally the shoulder or the area on the back behind the armpit.
Some people develop lymphoedema after surgery or radiotherapy to treat breast cancer.
There’s no consistent evidence that giving intravenous medicines in your “at risk” arm (the arm the side of your operations) will increase your risk of lymphoedema.
While many treatment teams will give chemotherapy into a vein in the arm on the opposite side, practice can vary between hospitals. Some teams may give chemotherapy in the arm on the same side as your surgery, or alternate the arm used each cycle. This is also usually the case if you’ve had surgery on both sides.
If you have lymphoedema
If you have lymphoedema, the cannula will be placed in the arm on the opposite side to where you had surgery. If you have lymphoedema on both sides, your treatment team will talk to you about how your chemotherapy will be given.
Other ways of giving intravenous chemotherapy
Sometimes a central venous access device (a device inserted through a vein that fluids and medication can be given through) is used to give chemotherapy. This stays in place throughout the course of your treatment.
There are different types of intravenous access devices.
Skin-tunnelled catheter (Hickman or Groshong line)
A skin-tunnelled catheter is a fine silicone tube that’s inserted into a vein through a small cut in the chest. It’s also called a Hickman or Groshong line.
The catheter is usually put in under a local anaesthetic, but a general anaesthetic (medicine to make you sleep) can be used if necessary.
It can stay in place for several months. Your treatment team can also take blood samples from it.
Your chemotherapy nurse will explain how to take care of your catheter.
The catheter will be removed using a local anaesthetic.
Peripherally inserted central catheter (PICC)
A PICC is inserted into a vein in your arm, at or above the bend in your elbow, and into the large vein leading to your heart. It is usually put in under a local anaesthetic.
It can stay in place throughout your treatment. Your treatment team can also take blood samples from it.
The PICC line will be covered by a clear dressing. You’ll be given instructions on how to look after it and change the dressing.
Implanted port
An implanted port is a small disc connected to a thin tube (catheter). It’s put under the skin, usually in your chest or arm. The other end of the tube goes into a large vein just above your heart. The port is hidden but can be felt under the skin.
It’s usually put in using a local anaesthetic. You may be given medication to help you relax.
Chemotherapy drugs are given directly into the port. The area over the port may be numbed with an anaesthetic cream before a special needle is pushed into the port to give the chemotherapy.
Your treatment team can also take blood samples from it.
The implanted port can stay in place throughout your treatment.
The port can be removed under a local or general anaesthetic. When it needs to be removed, a small cut is made over the site of the port. The port is removed and the catheter is taken out of the vein. The wound is stitched and covered with a dressing.
You’ll be given instructions on caring for your dressing and what to do if you feel sore or bruised after the port is removed.
Blood clots
If you have a Hickman, Groshong or PICC line, it’s possible for a blood clot to form in your vein at the end of the line.
Blood clot symptoms
Contact your treatment team or go to your local A&E department straight away if you have any of the following symptoms:
- Pain in your arm or leg
- Redness/discolouration of the skin of the arm or leg
- Heat and swelling of the arm or leg
- Swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck
- Shortness of breath that comes on suddenly
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Some symptoms may look different on different skin tones.
Find out more about blood clots.
If a blood clot forms, you’ll be given medication to dissolve it. Your line may need to be removed.
These lines can also get blocked or infected. You’ll be given information about what to look out for.
3. Oral chemotherapy
Oral chemotherapy is taken by mouth, either as tablets or capsules. You usually take it at home.
The hospital pharmacist or your chemotherapy nurse will give you instructions on how to handle and store oral chemotherapy. They’ll also tell you when and how to take it, for example if it should be taken with food.
The drugs you’re given by the hospital make up a complete cycle of treatment, so it’s important to take them exactly as they’ve been prescribed.
Always read the labels on the boxes before you leave the hospital. If the instructions are unclear, ask your treatment team or pharmacist before taking any of the drugs.
If you cannot take your chemotherapy for any reason, or if you are sick after taking your tablets, do not take an extra dose. Contact your treatment team immediately for advice.
Just like intravenous chemotherapy, oral chemotherapy can cause side effects. You’ll also need regular blood tests.
4. Electrochemotherapy
Electrochemotherapy, sometimes called ECT, is a treatment for secondary breast cancer that has spread to the skin (skin metastases).
It combines a low dose of a chemotherapy drug with electrical impulses. The electrical impulses are given using an electrode directly to the areas being treated. This allows the chemotherapy to work in the treatment areas only, with little or no effect in other areas.
If this is a suitable option for you, your treatment team can refer you to the nearest available hospital for treatment.
Find out more about skin metastases.
5. Further support
You can find people going through treatment at the same time as you on the chemotherapy monthly threads on our online forum.
You can also speak to our specialist nurses on our free helpline – see below.
