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ATT

My friend recently had a masectomy and had 5 cm tumor removed and 9 of 12 positive nodes. They're starting her on ATT chemo treatment. She's also a diabetic. Does this protocol have a high success rate and is there anything she should expect under this treatment? Thanks!
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Dear Traci: Chemotherapy is recommended as adjuvant therapy for high-risk patients following surgery.
Adjuvant treatment is treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor.   There are several acceptable alternatives for the combination of medications for adjuvant therapy depending on the preferences of the physician and patient.  One of the standard regimens for adjuvant treatment for breast cancer is a combination of Adriamycin and Cytoxan, and more recently Taxol has been added to hopefully enhance disease free survival. The combination of these three chemotherapies is prescribed in different sequences depending on your physicians or institutions particular protocol.  I think this may be the combination recommended to your friend ACT rather than ATT (these initials do not bring a particular combination immediately to mind).  You or your friend may have heard the initials incorrectly but please let us know if the treatment your friend receives is different and if you need additional information.  

The basic idea of chemotherapy is to rid the body of faster growing cancer cells. While doing this, the drug also has an effect on the faster growing normal cells in our bodies.  These include; the hair, the lining of our mouth, or the cells in the bone marrow that produce white blood cells (which help to fight infection), red blood cells (which carry oxygen through our blood), and platelets (which help to clot the blood and stop bleeding).  The chemotherapy is timed to allow the bodies normal cells time to recover between treatments.

Each chemotherapy drug has its own particular set of side effects, when combining the drugs the goal is to enhance the treatment effect and not enhance a particular side effect.  Below I have listed the common side effects of the three drugs in the ACT regimen. Some of the side effects may vary in severity depending on the dose of the medications.  Most side effects are temporary.
    
Adriamycin: decrease of white blood cells, red blood cells and platelets, hair loss, mouth sores, nail changes, discolored urine, severe sunburn with sun exposure.
Cytoxan: decrease of white blood cells, red blood cells and platelets, mouth sores, decreased appetite, taste changes, hair loss or thinning, changes in menstrual cycle, bladder irritation, nasal congestion
Taxol: decrease of white blood cells, red blood cells and platelets, allergic-like reaction, numbness and/or tingling to fingers and toes, muscle aches, bone pain, mouth sores, hair loss, diarrhea.

Some things your friend can do during treatment to help minimize side effects are: increase fluid intake especially in the 24 hours after cytoxan, good mouth care using an alcohol free mouth wash, avoid sun exposure, wearing protective clothing and sunscreen (at least SPF 15) if sun exposure is unavoidable.

The goal of treatment is to render a person disease-free after treatment so it is important to receive the full doses and to avoid postponing regularly scheduled doses for minor reasons or for less than significant toxicity.  Although the treatment side effects may be harsh, all attempts will be made to keep your friend on schedule with treatment and receiving the full doses.  The health care team will work with your friend to accomplish this task through side effect management, support, and information.  Your support of your friend through this process can be very helpful to her and your seeking information on what to expect is a step in the right direction.
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