When a doctor tells you or someone you know has cancer, the next thing that comes to mind is probably surgery to remove the tumor. That's normal. But did you know that sometimes, before this surgery, there is a special treatment that can be given to shrink the tumor, control it, and make the surgery easier and more successful? That's what we call Neoadjuvant Therapy in medicine. Today, we'll talk about this, very simply, in a way that you can understand.
Simply put, what is Neoadjuvant Therapy?
Imagine you're going to run a big marathon. How much easier would it be if you warmed up a little and did some small exercises (warm-up) before you started running, rather than just running straight away? That's how it is with this.
Neoadjuvant therapy is a type of treatment that is given to shrink a tumor before surgery to remove it. Your oncologist may also call it ``perioperative therapy'' or ``induction therapy.'' The main goal of this treatment is to shrink a large tumor so that it can be easily removed by surgery. Surprisingly, sometimes this treatment can completely eliminate the tumor, making surgery unnecessary.
What are the types of this treatment?
There are several main types of treatment used as neoadjuvant therapy. Your doctor will determine the most suitable treatment for you based on factors such as the type and stage of your cancer.
| Treatment method | What happens to it? |
|---|---|
| Chemotherapy | This is done to destroy cancer cells before they divide and the tumor grows. |
| Hormone Therapy | Some types of cancer (e.g. breast, prostate cancer) are stimulated by hormones. This treatment works by blocking the supply of those hormones and stopping the cancer from growing. |
| Immunotherapy | This stimulates our own body's immune system and makes it fight cancer cells. |
| Radiation Therapy | This uses radiation, such as high-energy X-rays, to destroy cancer cells. |
Sometimes, your medical team may give you more than one of these treatments. For example, giving chemotherapy and radiation therapy together is called ``neoadjuvant chemoradiation.''
This treatment period can last from a few weeks, a few months, or even a year. In most cases, surgery is performed within a month of completing this treatment.
What types of cancer is this treatment used for?
This treatment method is currently being successfully used for more than ten types of cancer. These are some of the most common cancers.
Breast Cancer
This method is very important in breast cancer, especially:
- If the tumor is a little big.
- In rapidly spreading types like `inflammatory breast cancer`.
- For some specific types of breast cancer, such as `HER2-positive` and `triple-negative`.
This treatment may allow for a smaller surgery (lumpectomy) to remove only the tumor, rather than a major surgery (mastectomy) that removes the entire breast.
Colon Cancer
If colon cancer has spread (metastasized) to other areas, such as the liver, chemotherapy may be given before surgery.
Lung Cancer
Chemotherapy or chemoradiation is most commonly used for advanced non-small cell lung cancer.
Prostate Cancer
Some types of this cancer in men are driven by the hormone testosterone. So hormone therapy reduces the activity of that hormone and controls the tumor.
Rectal Cancer
It is common to give radiation therapy and chemotherapy together for rectal cancer that has spread. Sometimes, chemotherapy is given first, followed by chemoradiation, in a method called ``total neoadjuvant therapy''.
What are the benefits of Neoadjuvant Therapy?
There are several benefits that a patient receives from this treatment method.
Simply put, this is done to weaken the enemy (cancer) as much as possible before the big battle called surgery.
| Advantage | Explanation |
|---|---|
| Cancerous tumors shrink | Large tumors can be made smaller and more easily removed by the surgeon, which reduces the risk of injury to the body during surgery. |
| Making surgery easier | Because the tumor is small, the incision during surgery is smaller. Therefore, the healing time is shorter and the pain is less. |
| Measuring the success of treatment | Doctors can see how the cancer responds to treatment before surgery, which can help them make the best decisions about post-surgery treatment. |
| Preventing the spread of cancer | Sometimes, cells that break away from a cancer tumor and travel throughout the body in small, undetectable forms called ``micrometastases.'' These treatments can also destroy those cells that are hidden in the body. |
| Reducing the risk of cancer recurrence | Research has found that this treatment reduces the risk of recurrence of some types of cancer. |
Let's also be aware of side effects.
Like any cancer treatment, these treatments can cause side effects. But what they are depends on the type of treatment you are receiving. Some of the most common side effects include:
- Fatigue
- Nausea and vomiting
- Appetite
- Diarrhea
- Loss of taste in the mouth
But don't worry. Your doctor will educate you about the possible side effects and the medications you can take to manage them before you start treatment. Your medical team will also help you manage these symptoms to a great extent through palliative care.
When do you need to see the doctor?
While you are receiving this treatment, your medical team will be monitoring you closely. However, if you experience any problems, don't delay in reporting them.
If any of the following occur, call your doctor immediately:
- If the side effects are worse than expected: For example, if you can't control the nausea even after taking medication, and you feel uncomfortable all day.
- If you notice new changes in your body: If you develop any new symptoms that suggest the cancer is getting worse.
What is the difference between Neoadjuvant and Adjuvant Therapy?
These two words can be a little confusing, but the difference is very simple.
- Neoadjuvant Therapy: Treatment given before surgery (like a warm-up before a marathon).
- Adjuvant Therapy: Treatment given after surgery. This is done to kill any cancer cells that may be left in the body after surgery and prevent the cancer from coming back. (Like a cool-down after a marathon).
Neoadjuvant therapy is not a treatment option for every cancer patient. However, depending on your situation, it may be a good option for you. So, talk openly about this with your doctor. Ask all your questions and get a good understanding of your treatment journey.
Take-Home Message
- Neoadjuvant therapy is a treatment given before surgery to shrink or destroy a cancer tumor.
- This makes the surgery easier, safer, and more successful. Sometimes, surgery may not be necessary.
- Various types of treatments such as chemotherapy, radiation therapy, and hormone therapy are used under this.
- This treatment also allows doctors to identify the most effective treatment for a particular cancer.
- Your medical team will help you manage side effects during treatment, so don't be afraid to talk to them about any concerns.
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