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Dr West

FAQ: What is Adjuvant Therapy, and How Can It Help Patients with an Early Stage Cancer?

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When patients are found to have a cancer that is at an earlier stage that may be able to be cured with a “local therapy” such as surgery or radiation, we know that these cancers can recur months or years later, .This is presumably because of micrometastatic deposits traveling n the bloodstream, which cause distant recurrences, or in the region of the primary tumor, causing regional recurrences.

For many cancers, there is also a proven value in giving additional therapy to address the possibility of any invisible disease beyond what was seen on scans and by the surgeon.  This is often systemic therapy such as chemotherapy or targeted therapy, and it may also include radiation given along with or instead of systemic therapy.

When given before the potentially curative local therapy, this is called neoadjuvant (or sometimes pre-operative or induction) therapy. .When given following the local therapy, it is called adjuvant therapy, coming from the meaning of  the word adjuvant as “helper”. While there are certain advantages to a neoadjuvant approach, giving the additional treatment later has a couple of its own key advantages.

First, while we know that it can be challenging to give multiple different types of anti-cancer therapy and that patients sometimes can’t get through all of it, giving the curative therapy first ensures that the patient gets through “dinner before dessert” — with the adjuvant therapy providing a role as a bonus as tolerated.

Second, when patients have undergone surgery first, it is possible for a pathologist to learn a wide range of important details that can help us tailor the best adjuvant therapy for that patient’s cancer. For instance, pre-operative scans may sometimes be inaccurate, suggesting possible cancer involvement in areas that have infection or inflammation, or the imaging may underestimate the extent of disease found in normal-sized lymph nodes when the pathologist looks under a microscope.  Another common scenario is finding a molecular or hormonal target that is associated with a particularly effective post-operative treatment. Radiation may also be indicated if there is microscopic involvement of cancer at or near the surgical margin of where the cancer was resected. All of these are examples of using the information from the surgery to more precisely tailor an optimal treatment plan for the patient.

Depending on the cancer and the patient’s circumstances, post-operative treatment may include conventional chemotherapy, a targeted therapy, hormone therapy, radiation, or some combination of these strategies.  Immunotherapies are also being actively studied as an adjuvant therapy approach for the future.  For many cancers, one or more of these approaches can lead to a significant increase in the chance of patients with an early stage cancer being cured after their local therapy.


7 Responses to FAQ: What is Adjuvant Therapy, and How Can It Help Patients with an Early Stage Cancer?

  • cards7up says:

    If going in for surgery dx stage IA and chemo first then during surgery, 9 n1 lymph nodes found with extra capsular extension and 1 station 5 n2 lymph node found cancerous upgraded to stage III. Would radiation be typical to the mediastinum? Thank you
    Take care, Judy

  • Dr West
    Dr West says:

    There’s no absolute rule, but it’s common to favor radiation if there are one or more N2 nodes involved. This can be done concurrent with chemotherapy but is probably most commonly done sequentially, after chemotherapy.

    Good luck.

    -Dr. West

  • pamela42 says:

    Hi Dr. West. I was diagnosed with 1B cervical cancer 18 months ago. My first cone biopsy didn’t have clear margins, so I ended up having a radical hysterectomy, keeping my ovaries (41 at the time). No cancer was found, no node involvement, and I was declared cancer free with follow up of visits every 3 months, and scans every 6. So far so good. Something has always bugged me though. The initial biopsy showed vascular invasion. When I saw this post it got me thinking again about whether any other follow up treatment should have been considered. Due back in for scans in a month and wondering if it’s worth bringing up?

  • Dr West
    Dr West says:

    The idea of adjuvant chemotherapy is that it’s given within a few weeks after surgery. Beyond that, the opportunity to treat possible micrometastatic disease is not likely as good. The longer out from surgery you go, the less likely it is for the cancer to come back. There really wouldn’t be a value in considering adjuvant therapy many months, let alone more than a year, out from surgery. Instead, it’s already likely that the cancer won’t return — so congratulations for having too good a prognosis to really be a candidate for adjuvant therapy.

    Good luck.

    -Dr. West

  • pamela42 says:

    Thanks Dr. West. Appreciate the advice!

  • loriann58 says:

    Hello Dr West, 58 yr old female, diagnosed SCLC almost 5 months ago. I have had 2 scans [CT] since my biopsy of my R10 and 11 lymph nodes, and am stable. My onc is advising eptos/carboplatin/rad …..I cant wrap my head around this at all. I dont feel good about this without some extensive work up. I was considering doing just radiation maybe to the affected areas, lymph nodes and 12mm nodule in lower R lobe, and no chemo, or just chemo? and no radiation? This is such a hard place to be!!! I am really afraid of chemo, if it wasnt 60 yrs old i might feel different, but its old, and doesnt work on my issue, and that is a fact Im aware of. Thanks in advance for any insight you may have, best wishes for you, Lori Ann

  • Dr West
    Dr West says:

    I wouldn’t presume to tell you what to do, but the combination of chemotherapy and radiation is very standard and considered optimal for patients with limited stage SCLC. Please see this summary for a discussion of what is recognized as standard of care around the world in this setting:

    http://cancergrace.org/lung/2010/08/07/treatment-of-small-cell-lung-cancer/

    It is unusual to see no progression of SCLC over many months, and there is always room to individualize based on the characteristics of the patient. However, your age is on the young side for SCLC, and nothing about it would lead us to be less inclined to treat it as aggressively as would otherwise be indicated.

    Good luck.

    -Dr. West

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