"Adjuvant" cancer therapy refers to any treatment received after the initial primary cancer treatment. "Neoadjuvant therapy", on the other hand, is the supplementary cancer treatment administered before the primary treatment.
Adjuvant therapies, also known as "adjuvant treatment methods", are standard treatment approaches for certain types of cancer, including breast cancer, ovarian cancer, colorectal cancer, and lung cancer.
This term applies to a variety of specific therapies, including chemotherapy, radiotherapy, hormonal therapy, and immunotherapy.
The core objective of adjuvant cancer treatment is to reduce the risk of cancer recurrence. Although receiving adjuvant therapy does not guarantee that cancer will never return, it can indeed lower this risk.
Oncologists, as professional physicians specializing in the diagnosis and treatment of cancer, utilize various types of therapies as adjuvant treatment means. Depending on the specific condition, patients may adopt one or more adjuvant therapies as part of the overall treatment plan after the initial treatment intervention.
Adjuvant treatment generally follows the initial surgery (the primary non - adjuvant treatment). If surgery is not feasible, the initial treatment may be radiotherapy or a treatment that is regarded as adjuvant therapy in other circumstances.
The most promising adjuvant treatment plan depends on numerous factors, such as the organ affected by cancer (e.g., the breast), the extent of cancer spread, other cancer characteristics (such as the presence of specific cancer mutations), the patient's overall health status, and personal preferences.
Chemotherapy is one of the more common adjuvant therapies. Patients receive multiple doses of drugs, usually infused through an intravenous (IV) tube, to slow down or halt the growth of cancer cells.
After the initial surgery, patients may be administered one or more specific chemotherapy drugs over several months.
For example, if a patient has stage 2 or 3 colorectal cancer (colon or rectal cancer) and there are specific factors that pose a high risk of cancer, healthcare providers may recommend using chemotherapy drugs such as Adrucil (fluorouracil) after surgery.
Radiation therapy uses high - energy electromagnetic waves to treat cancer, specifically targeting areas where cancer cells may still be present. It kills or slows down the growth of cancer cells by damaging their DNA.
Radiation therapy can usually be carried out within a few weeks after the initial surgery. For instance, after breast - conserving surgery for breast cancer, radiation therapy is sometimes performed to reduce the risk of recurrence.
Both chemotherapy and radiation therapy can be used as adjuvant therapies, and this combination is called chemoradiotherapy.
Hormonal therapy, also known as endocrine therapy, is an adjuvant therapy that is only effective for cancers that respond to hormones. After the initial treatment, patients may need to receive this adjuvant therapy for several years.
Take certain types of breast cancer as an example. Estrogen can cause cancer cells with estrogen receptors (ER +) to grow more vigorously. Nolvadex (tamoxifen), as a hormonal therapy drug, can block these receptors and slow down the growth of any remaining cancer cells. Oral therapy (oral medications) is commonly used for the treatment of early - stage ER + breast cancer.
A variety of biotherapies can be used as adjuvant therapies for cancer. Biologics are drugs produced using living cells or organisms.
Adjuvant molecularly targeted therapy uses biologics that help treat certain cancers with specific acquired mutations.
For example, some breast cancer patients develop a mutation that causes the cancer to produce an excessive amount of a protein called "HER2", which promotes cancer growth. Herceptin (trastuzumab) is a molecularly targeted intravenous therapy drug that can prevent the growth of HER2 - positive cancers. Patients may need to take this drug for about a year, usually after receiving other adjuvant treatments such as chemotherapy.
Immunotherapy is a type of biologic that helps prepare the immune system to fight cancer. For example, Keytruda (pembrolizumab) is an intravenous immunotherapy drug that can bind to and activate T - cells (part of the immune system) to seek out and kill cancer cells.
Keytruda has been approved for the adjuvant treatment of some patients with stage 2 or 3 non - small - cell lung cancer. It is infused every few weeks for several months or even up to several years. In this case, it is usually used in combination with chemotherapy after surgery.
When the benefits of adjuvant therapy outweigh the risks, many cancer patients are recommended to receive it. Adjuvant therapy is most commonly used in the treatment of breast cancer, lung cancer, or colorectal cancer.
However, it is sometimes also used to treat other types of cancer, such as prostate cancer.
The specific characteristics of cancer help determine whether to adopt adjuvant therapy. For example, for most patients with stage 2 colorectal cancer, oncologists usually do not recommend adjuvant chemotherapy unless their cancer is of a high - risk type (cancer has spread to all layers of the colon wall).
In some cases, healthcare professionals strongly recommend adjuvant treatment. However, due to gaps in the scientific literature, the medical consensus may not be clear - cut. Other factors, such as the patient's age, other medical conditions, overall health status, the potential aggressiveness of the cancer, and personal preferences, all contribute to the decision - making process.
Each year, the U.S. Food and Drug Administration (FDA) approves adjuvant therapies for new indications (specific treatment methods for specific cancer types at specific stages). As a result, general recommendations may change rapidly.
Healthcare providers may also recommend off - label use of adjuvant therapies. For example, chemotherapy drugs used in slightly different situations. Off - label use of drugs refers to the use of drugs to treat diseases other than those approved by the FDA.
In addition, even if the current adjuvant treatment is not the standard treatment for a patient's specific diagnosis and situation, the patient may still be able to receive it as part of a clinical trial.
The main role of adjuvant therapy is to help reduce the risk of cancer recurrence. Even if a patient is in remission (i.e., the cancer appears to have been completely removed), there may still be cancer cells in the body that are too small to be detected. If this occurs, these cells may multiply, leading to cancer recurrence.
Adjuvant cancer treatment aims to destroy any remaining cancer cells as an additional preventive measure to reduce the risk of recurrence.
Adjuvant therapy does not focus on relieving symptoms, at least not in the short term. This is different from palliative care, which is mainly used for advanced - stage patients and helps relieve symptoms even if the cancer cannot be cured.
Certain treatment methods (such as chemotherapy) may be discussed as adjuvant therapy or palliative care depending on the treatment timing and specific purpose.
Cancer adjuvant therapies have many different potential side effects. These side effects vary depending on factors such as the type of adjuvant therapy the patient receives and the cancer stage. Therefore, patients should consult their healthcare providers about their specific situations.
Side effects and potential risks differ depending on the overall category (e.g., chemotherapy vs. immunotherapy) and the specific treatment method within that category (e.g., the type of chemotherapy drug).
The potential side effects of chemotherapy include:
Fatigue: The body feels extremely tired.
Hair Loss: Hair loss occurs.
Nausea and Vomiting: Gastrointestinal discomfort leads to vomiting.
Oral Ulcers: Ulcers appear on the oral mucosa.
Neuralgia: Nerves experience pain.
In addition, other symptoms may occur, such as difficulty concentrating, mood changes, shortness of breath, easy bruising, increased risk of infection, bladder and kidney problems, osteoporosis (thinning and weakening of the bones), and heart - related complications.
Most symptoms are most severe on the second day after treatment, but other symptoms may appear later or last longer.
Radiation can also cause symptoms such as fatigue, hair loss, skin changes, and nausea. Depending on the specific site of radiation, the following symptoms may also occur:
Headache: Head pain occurs.
Dysphagia: Difficulty swallowing food or liquids.
Edema: Local or systemic swelling of the body.
Pain at the Scar Sites of the Skin and Muscles: There is pain at the scar sites of the skin and muscles.
Sexual and Fertility Challenges: It affects sexual function and fertility.
Urological and Bladder Diseases: It triggers related diseases of the urinary system and bladder.
Other adjuvant therapies may also pose different side - effect risks. For example:
Targeted Therapy: Using targeted therapy drugs such as Herceptin (trastuzumab) for specific cancer cells may cause symptoms such as nausea, headache, fatigue, joint pain, diarrhea, or fever.
Hormone - blocking Drugs: Taking hormone - blocking drugs such as Nolvadex (tamoxifen) may cause menopausal - like symptoms, such as hot flashes, mood changes, vaginal dryness or increased discharge, and night sweats.
Immunotherapy Drugs: Using immunotherapy drugs such as Keytruda (pembrolizumab) may cause symptoms such as rashes, joint pain, low thyroid hormone levels, or an increased risk of infection.
Many side effects will gradually disappear after the completion of adjuvant therapy, but some may not. Compared with the treatment period, patients may experience the following side effects several months or years later:
Fatigue: Persistent tiredness.
Sleep Challenges: Problems with sleep.
Muscle, Bone, or Joint Pain: Pain in muscles, bones, or joints.
Symptoms of Depression: Symptoms related to depression.
Difficulty Concentrating: Difficulty in concentrating.
Peripheral Neuropathy: Numbness or tingling in the hands, arms, feet, and legs.
Changes in Hair or Nails: Changes in the state of hair or nails.
The treatment team can help patients find ways to control specific side effects. Specific strategies may include the following:
Relieving Fatigue: Prioritize rest and reduce unnecessary activities.
Coping with Nausea and Vomiting: Adopt a small - frequent - meal approach, replace solid foods with shakes, etc., and consider taking anti - emetic drugs if necessary.
Preventing Infection: Wash hands frequently and avoid contact with sick people.
Relieving Edema: Use compression garments or diuretic drugs to reduce edema (swelling).
Dealing with Oral Ulcers: Keep the mouth moist and consume soft foods.
Relieving Menopausal - like Symptoms: Try treatments such as acupuncture, antidepressants, and vaginal lubricants to relieve some menopausal - like symptoms.
Relieving Pain: Use painkillers or relaxation techniques to alleviate pain.
Given the potential side effects, treatment duration, and cost of adjuvant therapy, patients need to make a well - thought - out choice. Factors to consider include the prognostic effect, expected outcomes, and the benefits of the recommended treatment method.
If an oncologist recommends one or more adjuvant therapies as treatment options, patients should ask specific questions to understand the potential benefits of the therapy for their specific situation. Perhaps most crucially, request evidence on how the therapy may affect their prognosis (recovery).
Some adjuvant therapies, even those approved by the FDA, may not necessarily affect the prognosis of cancer, although they may slightly delay the recurrence of cancer.
Patients should raise questions and study the potential drawbacks of each potential therapy, including:
Treatment Duration: Understand how long the entire treatment process will last.
Side Effects: Be clear about the possible side effects.
Side - effect Management: Know how to deal with potential side effects if they occur.
Cost: Determine the cost of the treatment.
At the same time, ask healthcare providers about the strength and reasons for recommending the therapy, and inquire whether there are other potential adjuvant therapies.
Ultimately, all cancer treatment decisions are personalized, and the right choice for a patient may be different from that of others.
Adjuvant cancer treatment is carried out after the initial primary cancer treatment. If the primary treatment cannot completely eliminate the remaining cancer cells, adjuvant treatment helps to eliminate these residual cancer cells.
Some cancer patients are advised to receive adjuvant treatment, but this may not be suitable for everyone. Patients must carefully weigh the potential risks and benefits of all cancer treatments (including specific adjuvant treatments) with their healthcare providers.
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