Cold cap, FEC-T and effective chemo treatment

So I started my 1st chemo treatment last week.  Just before my 1st treatment I felt like I had a head cold and mentioned it to the nurse.  I was diagnosed with triple negative breast cancer in Malaysia, had a lumsectomy where they found it had spread to 3 nodes.  They did a masectomy and were happy they had removed it but it was pretty aggressive.  So at my nurse appointment the nurse said if I continue to feel like I did they might need to do a scan as sometimes with breast cancer it can spread to the brain!  Not the right thing to say as I am now a little worried.  Given that I am having chemo I am kinda okay as surely the chemo goes everywhere and it should get anything if it spreads…but then I decided to use the cold cap.  So my question is, does the cold cap stop the chemo from treating the brain effectivley?  Am I being completely stupid with this?


Hi Minipixie
I have no medical knowledge but common sense would suggest that those cells that are protected from chemo by the cap, would also not be effectively treated by the chemo. This could be an oversimplification but I’d rather be bald for a while than let stray cancer cells lurk untreated.
Jacq x

Hello Minipixie1


Sending you a virtual hug and good wishes.


Well you  have enough to think about getting through your treatments without the additional worries.  We have so much to take into account and then we decide to torture ourselves with all worse case scenarios.  From what you  have stated, it would seem the nurse jumped the gun/maybe could have checked things out more with you. 


 It is common to be checked for cancer spread prior to treatment commencing.  Did you have a scan prior to your treatment to check whether the cancer had spread, apart from in lymph nodes?  From what I know, it would be extremely rare for breast cancer to spread first to the brain.


You say you have a “head cold”  - what do you mean by that? My definition of a head cold is a common cold with symptoms more centred around the head and facial region, runny nose, sore throat etc.   But then this may not be what you mean. If it’s a cold then I would expect it to clear up at least within 10 days/a couple of weeks.  Maybe it is a sign of the effect of the chemo hitting your immune system.  The symptoms of cancer spreading to the brain are different to having a cold as far as I know,  eg.Headaches that get worse or keep coming back, Seizures ,Problems walking, speaking, seeing, or thinking, Changes in behavior or personality, Nausea and vomiting and others.


 I am picking up that you seem to be saying not that you are worried about using the cold cap and this causing risks of cancer spreading to the brain but  that you are concerned  that you have spread to the brain already and that if you continue with the cold cap you are worried that that it will reduce the effectiveness of chemo? 


Maybe I have picked this up wrong but whichever is the case  then I really would advise that you  discuss it with the team/Oncologist undertaking your treatment and they can check for spread/reassure you/advise you accordingly.


There are no guarantees that chemo will always work and  prevent recurrence, and some chemo, like taxotere, can have a rare side effect of leaving people bald or with thin patchy hair which can be obviously extremely distressing.  In the end there are risks with any choice we make, we just need to be informed and to weigh up the pros and cons based on what is important to us.


Regarding use of cold cap  generally with treatment.  I am no medic either. When I researched the pros and cons for myself, I think they have been in use for over 20  years or something like that.  If use was linked to brain cancer spread then I think it would be very well documented by now.  I think I did come across one case where they thougt it may have occurred but this was not totally clear.  I think that the concern was more about cancer spread initially to the scalp.  However, the scalp and head will surely still get a dose of chemo even with the cold cap.  It may not get the initial strongest hit but the cold cap is only on your head for a couple of hours whilst the chemo drugs keep travelling and working in your body surely for some time.


On the Macmillan site, they list the following circumstances in which cold capping is not deemed suitable:

Scalp cooling is not suitable if:


  • You have a blood (haematological) cancer, such as myeloma, leukaemia or lymphoma. This is because there is a risk of cancer cells surviving in the blood vessels of the scalp. This means that the cancer may come back.
  • You have already had your first course of chemotherapy without scalp cooling.
  • You need very high doses of chemotherapy. Scalp cooling is less likely to work with high-dose chemotherapy.
  • You are having continuous chemotherapy through a pump for several days.
  • Your liver is not working as well as it should be. The chemotherapy drugs may stay in the body for longer than usual. It may not be possible to keep the scalp cold for long enough.
  • You have severe migraines

Take care Minipixie and hope you let us know how you get on x

Hi guys thanks for your response, I’m really not worried about losing my hair, I was doing it more for my daughter who seems hung up on that one aspect, she will be fine if I lose my hair, just like she was eventually fine with my scars and no boob! But I was more worried that by doing the cold cap I was limiting chemo from getting everywhere and killing all cancer cells. No I didn’t have a scan. Will definitely ask at my next appointment before my next chemo. Thank you all