FEC chemotherapy is generally used in treating breast cancer. It is a combination of three chemotherapy drugs- 5Fluorouracil (5FU), Epirubicin and Cyclophosphamide given once every three weeks intravenously in an outpatient setting.

It is essential to have a blood test before each regimen to check the blood counts.

FEC drugs are put into the bloodstream intravenously with the help of a thin, short tube called canola that is put into the arm vein each time in the beginning of the treatment. The drugs could also be inserted through a central line, portacath or PICC line that are long plastic tubes inserted into a large vein in the chest. Once this tube is placed in the chest, it remains there until the entire treatment is over.

This treatment is done in cycles of 3-4 weeks each. Like this, 6-8 cycles are done with a break in between each cycle.

Cyclophosphamide could be taken either as an injection or as a tablet. In case of injections, all the three drugs are injected on the first day of each of the three-four weeks cycle. In case of cyclophosphamide as tablets, they are taken every day for the first 2 weeks followed by injections of epirubicin and 5FU on the first day of each of the 4-week cycle.

Side effects of FEC Chemotherapy

• Increased susceptibility to infections due to decreased immunity that happens due to a drop in the number of white blood cells

• Headaches, muscle pain, cough, sore throat, pain while passing urine and chills
• Fatigue and breathlessness due to reduction the red blood cells that causes anemia
• Bruising, nosebleeds and bleeding gums due to a drop in platelets
• Hair loss and body hair loss in 2 to 5 weeks after the treatment starts
• Loss of appetite
• Diarrhea
• Loss of taste or a metallic taste in the mouth
• Feeling of being sick
• Mouth ulcers
• Irritated eyes, watery eyes or a blurred vision
• Irregular menstruation
• Loss of fertility
• FEC has a harmful effect on a developing baby. Hence, this a woman should not conceive during this treatment.
• Dark red or pink urine for a day or two due to the color of epirubicin which is quite normal

Most of these side effects are temporary. They go away once the treatment is over. If not, they can be controlled with medication. Except, in case of infertility or conception, the patient needs to discuss it with the doctor beforehand.

Occasional Side Effects of FEC Chemotherapy

• Skin changes - Skin could darken or the patient could have an itchy rash. Skin becomes sensitive to sunlight. There are brown marks following the vein where 5FU is injected.

• Nail changes - Nails become uneven, dark or brittle.
• Changes in liver function could be diagnosed by blood tests
• Inflammation around the drip site - There could be redness, swelling or leaking at the drip site. It is essential to let the doctor know this immediately.

Rare but Serious Side Effects of FEC Chemotherapy

• There is a risk of second cancer some years after FEC treatment

• Confusion or unsteadiness due to imbalance in the brain
• Burning, stinging or pain while passing urine (cystitis) or blood in the urine. It is essential to contact the doctor in this case.
• Heart muscle could be damaged. This is mostly temporary. However, it could be permanent in some cases. Regular heart tests are essential in this case.
• Changes in lung tissue could cause chronic cough or breathlessness

FEC chemotherapy is quite effective in treating breast cancer and is mostly used along with surgery. It is essential to know that you should not have immunizations with live vaccines while undergoing chemotherapy and for at least 6 months later.