Breast Cancer Survivors

Chemo Secrets From a Breast Cancer Survivor

Undergoing chemotherapy can be one of the most terrifying things that you go through in your life. One of the most frightening things about chemotherapy is the lack of real information that most people have about it, and the unknown makes it so much more frightening as a result. This eBook, written by a young cancer survivor gives you the real story about what chemo is all about. The most valuable information you can get about chemotherapy is from someone that has already experienced it. This PDF eBook allows you to download and read it as soon as your order it. You can begin your journey of reassurance as soon as you want! Because that's what this is about: chemo does not have to be a terrifying unknown! Other people have gone through it before, and want to help you through it as well! This eBook is the guide through chemo that many people wish they could have had, and now you can have it yourself! More here...

Chemo Secrets From a Breast Cancer Survivor Summary


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2132 Classification of the drugs used for chemotherapy

The agents used in cancer chemotherapy are divided into four groups. Since cancer during pregnancy is fortunately rare, and antineoplastic therapy is usually conducted as combination chemotherapy following established standard protocols, it is difficult to determine the teratogenic potential of individual cytostatic drugs in the human. Apparently, antimetabolites possess the strongest teratogenic potential after transrctinoic acids such as tretinoin (see Chapter 2.17).

Fetal Risk Summary

Allopurinol, a xanthine oxidase inhibitor, is used for the treatment of primary or secondary hyperuricemias, such as those occurring in gout or during cancer chemotherapy. Because these conditions are relatively rare in women of childbearing age, there are few reports describing the use of allopurinol during pregnancy. No adverse fetal outcomes attributable to allopurinol have been reported in humans. The manufacturer is aware of two unpublished reports of women receiving the drug during pregnancy who gave birth to normal infants (1). In a 1972 study, allopurinol produced cleft palate and skeletal defects in mice (2). However, in studies involving other animal species, no fetal harm was observed (1,3).

248 Dopamine antagonists

Ondansetron is a selective serotonin-(5-HT3)-antagonist, used for treating chemotherapy-induced nausea and vomiting. Ondansetron Corticosteroids have been proposed to modify the chemoreceptor trigger zone in the brain, and are used to control nausea and cme-sis associated with chemotherapy (Italian Group for Antiemetic Research 2000, Safari 1998).

Breast Feeding Summary

Okun DB, Groncy PK, Sieger L, Tanaka KR. Acute leukemia in pregnancy transient neonatal myelosuppression after combination chemotherapy in the mother. Med Pediatr Oncol 1979 7 315-9. 10. Blatt J, Mulvihill JJ, Ziegler JL, Young RC, Poplack DG. Pregnancy outcome following cancer chemotherapy. Am J Med 1980 69 828-32. 13. Green DM, Zevon MA, Lowrie G, Seigelstein N, Hall B. Congenital anomalies in children of patients who received chemotherapy for cancer in childhood and adolescence. N Engl J Med 1991 325 141-6.

2138 Cytotoxic anthracydine antibiotics

Re-examination of 13 children of this group when aged between 6 months and 9 years demonstrated that their development was normal. Zuazu (1991) describes two other pregnancies exposed during the first trimester one ended in a spontaneous miscarriage 20 days after the end of multi-agent chemotherapy, and the other proceeded to delivery of a healthy premature baby in week 34. Artlich (1994) describes a patient who underwent treatment with daunorubicin and cytarabine at the time of conception, and received cytarabine and thioguanine 5 weeks later. The child had craniosynostosis and radial aplasia. When administered during the second third trimester, daunorubicin may occasionally elicit myelo-suppression. A case report (Nakajima 2004) showed again that cytotoxic therapy (doxorubicin and ifosfamide) during the second third trimester may lead to healthy but growth-restricted children. This applies also to a study of 57 pregnant breast cancer patients who were treated...

2139 Other cytotoxic antibiotics

During the second third trimester were apparently healthy (Han 2005) or with minor problems (Molegi 2007). Normal growth and development was found in a group of 22 children who were prena-tally exposed to bleomycin. In 11 of them, maternal chemotherapy for cancer had begun in the first trimester (Aviles 1991).

21310 Folate antagonistic antimetabolites

Chemotherapy for cancer using MTX Ten articles describe pregnant women who had received methotrexate as part of cancer therapy during the first trimester. It is notewor thy that 16 healthy children were bom in this high-risk group (Zemlickis 1992, Aviles 1991, Feliu 1988, Dara 1981, Pizzuto 1980) 1 child had inguinal hernia (Giannakopoulou 2000), there was 1 spontaneous miscarriage (Giacalone 1999), and 1 stillbirth without malformations (Peres 2001). Only 1 child had characteristic malformations (Bawlc 1998) this child's mother had been treated for breast cancer with a weekly dose of 80 mg MTX from weeks 8-29. Moreover, she had received irradiation treatment from weeks 16-25, with the fetal dose estimated at 14 rad. The dose ranges of M IX administered in combination chemotherapy, attempted abortions, and for rheumatic indications ( low-dose treatment) overlap. Therefore, the conclusion is inadmissible that Lhcrc arc safe and risky indications for MTX. However, since there has been...

21312 Pyrimidinederived antimetabolites pyrimidine antagonists

Of cytosine, from which it differs by its sugar component, arabinose. There have been 11 published reports on pregnancies following cytarabine exposure in the first trimester. Six children were healthy (Aviles 1991, 1990), and one spontaneous miscarriage occurred 20 days after the end of cytotoxic therapy (Zuazu 1991). There were two induced abortions, one of which was induced after 20 weeks with an apparently normally developed fetus (Zemlickis 1992, Lilleyman 1977). Three children had limb anomalies one of them also had bilateral microtia and atresia of the exterior auditory canal (Wagner 1980). The mother had received cytarabine three times in connection with maintenance therapy for acute lymphatic leukemia at the time of conception, in week 6 7, and in week 10. This is the only case report of a mono-drug therapy all the other cases received multi-agent chemotherapy. The second anomalous child had radial aplasia on both sides and four fingers on each hand, with a hypoplastic thumb,...

21314 Platin compounds

At present, there is only one case report on multiple chemotherapy using cisplatin, cyclophosphamide, and doxorubicin in the first There are about 28 publications about treatment during the second and third trimesters, administered as mono-drug Lherapy as well as multi-agent chemotherapy. Han (2005) reports two cases with apparently normal outcome after therapy with cisplatin, etoposide, and bleomycin. Ferrandina (2005) describes a healthy male premature baby after prenatal exposure to six cycles of cisplatin. Tomlinson (1997) reports a normal pregnancy using cisplatin and cyclophosphamide, and gives a summary on nine further cases, including a premature birth with neutropenia and reversible hair loss from day 10 onwards which had been exposed to cisplatin, bleomycin, and etoposide until 6 days prior to birth. At the age of 1 year, the child was apparently normal except for a moderate sensineural hearing loss bilaterally (Raffles 1989 see also case description in section 2.13.4). One...

21316 Enzymes and antibodies exerting antineoplastic effects

Trastuzumab is a monoclonal antibody which blocks the human epidermal growth factor 2 protein and has an estimated half-life of 12 days. Waterstone (2006) reported on an uneventful prcgnancy and the delivery of a healthy girl whose mother conceived 3 days after her second cyclc of trastuzumab. There is one case report of inadvertent exposure of a 28-year-old with breast cancer who was given the drug every 3 weeks until week 20 of her pregnancy. When, in week 23, the pregnancy was noticed, a lack of amniotic fluid prevailed with a healthy female fetus. Gradually, Lhe amount of amniotic fluid recovered. In week 37, a healthy girl was delivered whose kidney function was normal at the age of 6 months and who showed no sign of pulmonary hypoplasia (Watson 2005). There is another report regarding the development of an oligohydramnios after trastuzumab therapy. Fanale (2005) described a case where therapy with trastuzumab and vinorelbine was started after week 27 because of metastatic breast...

21317 Antineoplastic drugs with endocrine effects

The hormone antagonist tamoxifen is used for the treatment of breast cancer. Its effect on the endometrium might indirectly pose a risk to prenatal development. In 37 pregnancies collated by the manufacturer, 19 newborn babies were healthy and 2 children had craniofacial deformities. Two other case reports describe a child with anomalies resembling Goldenhar syndrome (Cullins 1994), and a newborn girl with indifferent genital development (Tewari 1997). An adenoma of the vagina was diagnosed in a girl aged 2 years whose mother had taken tamoxifen until the fourth month of pregnancy. There are also reports of apparently normal pregnancies (Andreadis 2004, Isaacs 2001, Lai 1994). Nine pregnancies following induction of ovulation with tamoxifen resulted in newborn babies that had no malformations (Ruiz-Velasco 1979). There is, however, insufficient data for a discriminative risk evaluation. Andreadis CH. Charalampidou M, Diamantopoulos N et al. Combined chemotherapy and radiotherapy...

2151 Hypothalamic releasing hormones

Releasing hormones are responsible for regulating the synthesis and secretion of FSH and LH. Many synthetic human GnRH agonists are marketed, including buserelin, gonadorelin, goserelin, leuprore-lirt, nafarelin, and triptorelin. Cetrorelix and ganirelix are inhibitors of GnRH. In women, GnRH agonists have been used to treat estrogen-dependent breast cancer, endometriosis, hirsutism, and polycystic ovarian syndrome, but the widespread use of protocols using GnRH agonists antagonists in assisted reproductive technologies has led to an increasing number of pregnant women being exposed to these types of drugs. Most of the data concerning the safety of the GnRH analogs have not demonstrated serious side effects, such as increase in the incidence of miscarriage, birth defects, or fetal growth restriction, in human pregnancies exposed to GnRH (Tarlatzis 2004,

21817 Biphosphonates and other osteoporosis drugs

In one study, there was no major congenital anomaly among 24 pregnancies with pre-pregnancy or early pregnancy exposure to alendronate (Ornoy 2006). Another case report describes a healthy newborn, with normal bone structure and uneventful development until the age of 1 year, who was exposed to 10 mg per day throughout pregnancy (Rutgers Aferhagc 2003). Another report was on a woman receiving zoledronic acid during the second and third trimesters, after chemotherapy for breast cancer during the first trimester. The child was born at 35 weeks' gestation, and was followed until the age of 1 year, during which time development was normal (Andreadis 2004).

31 The advantages of breastfeeding versus the risks of maternal medication

There are many advantages to breastfeeding for the mother herself The process facilitates the rapid recovery postpartum, with a reduccd loss of blood and the prompt involution of the uterus to its pre-pregnant state (Labbok 2001). Further breastfeeding prevents post-partal depression (Groer 2005), and reduces the long-term risk of obesity and osteoporosis for the nursing mother. Studies of specific diseases show that there is a reduced risk of breast cancer and ovarian cancer for women who breastfeed (Lawrence 2005, Collaborative Group 2002). Finally, the special relationship between mother and

Explanation Of Condition134

Breast cancer is most commonly associated with postmenopausal women but is increasingly affecting women of child-bearing age. The classic presentation is with a painless, slow growing and palpable mass. Other symptoms include nipple discharge and breast skin changes. Breast cancer once diagnosed is attributed a 'stage' in order to guide treatment decisions. Stage 0 - non-invasive breast cancer with no invasion of surrounding tissue Stage I - invasive breast cancer in which the tumour measures

Preconception Issues And Care

Women with a previous history of breast cancer who are contemplating pregnancy should seek advice from their obstetrician, breast surgeon and oncologist. In general, a delay of two years post cancer treatment is recommended to allow for early recurrences to be detected5. Younger women (

Nonpregnancy Treatment And Care

Most malignant melanomas are treated entirely with surgical removal. Early stage disease is treated with wide local excision with margins of normal tissue of 1-3 cm4. More advanced disease is difficult to treat and some treatments are intended to be palliative rather than curative. Possible treatments include lymph node dissection, chemotherapy, radiotherapy and interferon therapy6.

184 Gestational Trophoblastic Disease 221

A rare situation occasionally arises with a twin pregnancy where one is viable and the other is molar. In this situation, pregnancy can be allowed to continue if the mother wishes as there is no increased risk of developing persistent trophoblastic disease, and the outcome after chemotherapy, if required, is unaffected. These pregnancies are high risk, with increased rates of early miscarriage, second trimester loss and pre-eclampsia. The chance of a successful pregnancy with a live baby is 40 13. If a woman conceives within 12 months of chemotherapy, joint assessment involving obstetrician, oncologist and fetal medicine specialist is required to ascertain the risk of teratogenicity

Patient Organisations

Breast Cancer Care Breast Cancer Care (2005) Factsheet Breast cancer during pregnancy. Grosser, L. (2004) Breast cancer during pregnancy. British Journal of Midwifery, 12(5) 299-304. RCOG (2004) Guideline No. 12 Pregnancy and Breast Cancer. January. London Royal College of Obstetricians and Gynaecologists.

Collection and Storage of Eggs

There is a risk with some cancers, such as breast cancer, that the hormones used in ovarian stimulation may also stimulate the cancer to grow. It therefore may not be advisable to have ovarian stimulation. Your doctors will be able to discuss this with you. It may be possible to collect one or two eggs without ovarian stimulation, although this reduces the chances of a successful pregnancy.

2254 Infection Control

Parasitic infections such as malaria, hookworm, whipworm, and schistosomiasis can cause or exacerbate anemia, especially when the infection is moderate to heavy, and when women are coinfected with multiple parasites 64 . Helminthes attach to the intestines and or bladder and feed on blood, causing regular host blood loss due to blood loss at the site of helminth attachment, and the blood consumed by the parasite. Parasitic infections can lead to, among other symptoms, anorexia, malabsorption of nutrients, nutrient loss through fecal or urinary blood loss, nausea, diarrhea, and vomiting, which can result in depletion of iron stores and iron-deficiency anemia 65, 66 . Efforts to control and prevent parasitic infections such as the use of bed nets, routine deworming using chemother-apeutic agents, malaria prevention and control, and improved sanitation can help combat anemia (Table 22.6). Specific to pregnant women, it is likely safe to provide deworming therapy after the first trimester...

Treatment Of Miscarriage A historical perspective

To prevent miscarriage and other pregnancy problems such as toxaemia, premature delivery and intrauterine fetal death, about six million pregnant women were exposed to diethylstil-boestrol (DES) from 1940 until 1971. Fortunately, some of the users were included in controlled studies that showed that DES was of no value to prevent miscarriage, or in preventing any of the other conditions for which it was given. On the contrary, DES carried an increased risk of the patients' developing breast cancer, and for the offspring a higher risk of genitourinary malformations, psychiatric disorders and vaginal or cervical clear cell adeno-

2133 Vinca alkaloids and structural analogs

Three children aged 2 and 3 years whose mothers were treated for breast cancer with vinorelbine plus 5-fluorouracil during the second and third trimesters developed normally (Cuvier 1997). Another pregnancy with vinorelbine and trastuzumab (see section 2.13.16) in the third trimester was complicated by an oligohydramnios, which was thought more likely to be a side effect of trastuzumab (Fanale 2005). Transient pancytopenia was reported in some children following exposure during the second third trimester (Hsu 1995, Murray 1994). One case report describes a premature baby that developed cerebral atrophy with enlargement of the cerebral ventricles its mother had been treated for an ovarian tumor and received 100mg m2 etoposide for 5 days in week 26 27 in combination with bleomycin and cisplatin (Flit 1999). Another premature baby (gestational age 27 weeks) whose mother had received multi-agent chemotherapy with etoposide, bleomycin, and cisplatin in week 26, developed severe leukopenia...

Congenital Heart Disease

About 3 percent of cases are associated with a disease the mother had during pregnancy, including diabetes, lupus, rubella (German measles), or phenylketonuria (PKU), a disorder involving the enzyme that processes the amino acid phenylalanine. Certain drugs taken during pregnancy, such as lithium, ethanol (alcohol), warfarin (a blood thinner), thalidomide, antimetabo-lites (such as some cancer chemotherapy drugs), and anticonvulsant (seizure) medications are also associated with an increased incidence of congenital heart defects.

Interassay Variation

Nicked Hcg

Heterophilic antibodies are human antibodies against other antibodies (human or animal) that can link a capture and tracer antibody in the absence of specific analyte and give a false-positive hCG result (30-33). Because antibodies are large glycoproteins and generally do not cross the glomerular basement membrane and enter urine, this is only a problem in serum, not urine, assays (30-33). The USA hCG Reference Service is a reference facility consulting with physicians in cases of conflicting or nonrepresentative hCG test results. In the last 5 yr, the USA hCG Reference Service has identified 54 cases of women who were erroneously treated for gestational trophoblastic disease, choriocarcinoma, or ectopic pregnancy because of false-positive hCG results (4,22,32-38). In the first few months of operation, the USA hCG Reference Service investigated three unusual cases (22). In all three cases, the women had an incidental pregnancy test that was positive. The positive hCG persisted with...

A future scenario

Upon her weekly log in to her personal health record (PHR) she notices that the 'health maintenance' label, in the lower corner of the screen, is flashing. BA clicks on it and sees a message that 2 years have passed since her last mammogram and the system recommends her to get a mammogram. BA thinks she has recently had one and is not sure she needs it. She clicks on the message and it changes to a view of all of her mammograms over the past 5 years. It appears the system is correct she does indeed need a mammogram. By clicking on the message for the new mammogram she is able to send an electronic message to the radiology department at her local hospital and confirm an appointment for her mammo-gram next week. Using her PHRs built-in Google search engine, with its pre-defined medical search algorithm, BA 'Googles' pre-appraised high quality information regarding new methods of diagnosing breast cancer. She is particularly impressed with a short video that...


Contagious Periods Someone infected with tuberculosis is very contagious to others because tuberculosis is spread through the air, by coughing or sneezing. TB bacteria can remain airborne for a period of time, long enough for an uninfected person to breathe them in. Anyone with active TB should not be around anyone with immune system problems such as someone with HIV or someone who is receiving chemotherapy.

Case Study 162

A woman in her mid-20s had just given birth for the first time. She had recently married and had never lived away from her parents before. The pregnancy had been perfect in every way, giving her wonderful energy and a feeling of absolute joy she had never experienced before. However, 3 weeks after the birth she started to worry about the health of the baby. She was reassured that everything was perfect, but she found it impossible not to imagine something was wrong. A week after this she started to imagine she had breast cancer and stopped breastfeeding and also started to reject the child, passing all mothering responsibilities to her husband. As soon as she was given a clear bill of health for breast cancer, she convinced herself she had ovarian cancer. She was not depressed but rather obsessed, spending most of the day reading medical journals and researching everything she could on cancer. She was diagnosed as having a causative factor in the Earth Element (Stomach and Spleen) and...


Williams SF and Schilsky RL 2000 Neoplastic disorders - breast cancer in Barron WM and Lindheimer MD (Eds) Medical Disorders During Pregnancy, 3rd Ed. London Mosby Elsevier 400-401 5. Burstein H and Winer E 2000 Primary care for survivors of breast cancer. New England Journal of Medicine, 343 1086-1094 7. RCOG 2004 Guideline No.12 - Pregnancy and Breast Cancer. London Royal College of Obstetricians and Gynaecologists 9. Guinee VF, Olsson H, Moller T, et al. 1994 Effect of pregnancy on prognosis for young women with breast cancer. The Lancet, 343(8913) 1587-1589 10. Petrek JA, Dukoff R and Rogatko A 1991 Prognosis of pregnancy-associated breast cancer. Cancer, 67(4) 869-872 13. National Cancer Institute cancertopics pdq accessed 15-06-2007 14. Barthelmes L, Davidson LA, Gaffney C, et al. 2005 Pregnancy and breast cancer. British Medical Journal, 330 1375-1378

Antineoplastic Drugs

Antineoplastic agents may have adverse effects on both male and female fertility (117). In men, oligospermia and azoospermia have been noted in cancer patients treated with a variety of agents. These changes are often reversible with cessation of therapy. Freckman and colleagues (118) discovered a loss of ovarian primordial follicles along with amenorrhea in women treated with chlorambucil for breast cancer. The alkylating agents and vinca alkaloids were the types of agents associated with the greatest effect on fertility (117).

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