When talking about cancer treatment, you may have heard terms like 'Adjuvant Chemotherapy' and 'Neoadjuvant Chemotherapy'. These terms may sound a bit complicated and may even scare you. But they are actually not that complicated. Today, we will talk about these two treatments in a very simple way that you can understand.
What is 'Adjuvant Chemotherapy'?
Simply put, adjuvant chemotherapy is chemotherapy given *after* your main cancer treatment (such as surgery). It is sometimes called "preventive chemotherapy."
Think about it this way. You remove some large weeds in your garden with a hoe. But there might still be small weeds and weed seeds that are invisible to the eye in the soil, right? If you leave them alone, weeds can grow back after a while.
Adjuvant chemotherapy is something like that. Let's say you have completely removed the cancer from your body through surgery. However, sometimes there may be a few very small cancer cells left somewhere in the body that are not visible to the naked eye or even detected by scans. The goal of this treatment is to find and destroy those remaining cancer cells, thereby reducing the risk of cancer coming back (recurrence) as much as possible.
So what is 'Neoadjuvant Chemotherapy'?
This is the opposite of what was said before. Neoadjuvant chemotherapy is chemotherapy given *before* the main treatment, that is, surgery.
This has several main objectives:
- Shrinking the tumor: When chemotherapy is given before surgery to shrink the tumor, it becomes much easier for the surgeon to remove it during surgery.
- Surgery to reduce the size of the tumor: Sometimes, a major surgery is required because the tumor is large. For example, in cases of breast cancer, if the entire breast is removed (mastectomy), and the tumor is shrunk by neoadjuvant therapy, it may be possible to complete the procedure with a smaller surgery that removes only the tumor (lumpectomy).
- Improving treatment outcomes: Surgical removal of the tumor can increase the success of treatment.
See this table for easy reference.
| Feature | Adjuvant Chemotherapy | Neoadjuvant Chemotherapy |
|---|---|---|
| Time to give | After the main treatment (surgery) | Before the main treatment (surgery) |
| Main objective | Destroy remaining cancer cells and prevent cancer from coming back | Shrinking the tumor to make surgery easier |
What are the common side effects of these treatments?
One of the things that many people fear when talking about chemotherapy is the side effects. Since the drugs used in both treatments (e.g. 5-FU, Taxanes, Anthracyclines) are often the same, the side effects are also very similar.
Why do these side effects occur? Simply put, chemotherapy drugs target cells that divide rapidly . Cancer cells are a type of cell that divides very quickly. But some healthy cells in our body, for example, hair follicle cells, cells that line the inside of our mouth, blood cells, and immune cells, also divide rapidly. So chemotherapy drugs can also cause some damage to these healthy cells. That's why side effects occur.
These are some of the common side effects:
- Tiredness
- Hair loss
- Mouth sores
- Nausea and vomiting
- Diarrhea or constipation
- Susceptibility to infections
- Nerve problems, such as numbness in the limbs
- Problems concentrating
The most important thing is not to be afraid of these side effects. Your medical team is there to help you manage them and minimize their impact. Also, not everyone will experience all of these side effects. Just because some people don't have side effects doesn't mean the treatment isn't working.
Questions you should definitely ask your doctor
If your doctor suggests this type of treatment, it is your right to be clear about it. Don't hold anything back. Here are some important questions you can ask.
| Ask about Adjuvant Chemotherapy (after surgery) | Ask about Neoadjuvant Chemotherapy (before surgery) |
|---|---|
| How will I be given this treatment? (Intravesically? As pills?) | What kind of medication will I be given for this treatment? |
| How long does this treatment take? | How long does this treatment take? |
| If this treatment is not taken, what is the risk of the cancer coming back? | How will this treatment affect my surgery? |
| What are the possible side effects? How long will they last? | What are the possible side effects? How long will they last? |
| How do you control those side effects? | What do you do about those side effects? |
| Are there any alternatives to this treatment? | Are there other things that can be done instead of this treatment? |
Remember, talk openly about all of this with your doctor. He or she will listen to all of your fears and doubts. It is your right, and it will give you the strength to cope well with your treatment.
Take-Home Message
- Adjuvant chemotherapy is chemotherapy given after a major treatment, such as surgery. The main goal is to destroy any remaining cancer cells and prevent the cancer from coming back.
- Neoadjuvant chemotherapy is chemotherapy given before a major treatment, such as surgery. The main goal is to shrink the tumor, making surgery easier and more successful.
- Both of these treatments can cause side effects, but there are various methods and medications to manage them and minimize their effects.
- Talk openly with your doctor to gain a clear understanding of which treatment is best for you, and what its pros and cons are.
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