Adjuvant Treatment

Adjuvant therapy is a term used to describe additional treatments that can be used after surgery to further improve treatment of the cancer. These include:

Radiotherapy to the breast / chest wall or armpit

Drug therapy - Drugs can circulate around the body to reach cancer cells. There are three groups of drugs

1. Chemotherapy drugs - these are cell poisons.

2. Hormonal therapy - these drugs block the stimulating effect of oestrogen on cancer cells in various ways.

3. Biological agents - These are newer drugs such as Herceptin that are designed to interfere with cancer growth at specific sites.

If you have a "well behaved cancer" with a good prognosis then adjuvant treatment will add very little benefit whereas if the cancer is a fast growing aggressive type then it will be much more important.

Adjuvant therapy is in effect like an insurance policy. We pay a little more up front in the form of extra treatment in the hope of avoiding bigger problems with recurrence or spread of the cancer in a few years time. It is important to try to understand the real benefit to you of these extra treatments. Sometimes it may only be one or two percent. Lets imagine for example that we estimate that 70 out of 100 patients with your type of cancer will be alive and well at five years with no extra treatment. If the oncologist says that chemotherapy offers a 2% survival benefit then 72 patients out of 100 all given chemotherapy will be alive at 5 years. This very modest difference has to be balanced against the side effects, inconvenience and sometimes the cost of the proposed treatment. Each person is different. Some will want to feel that they took every possible option available - others may want to only accept a treatment if it significantly improves their outlook. Dr Carole Hungerfood uses an expressive quote in her book. She says that we should avoid "disease substitution" which means that there is nothing to be gained if a medication causes as many or more side effects and risks than the condition it is intended to treat.

It can be confusing trying to understand how these different options fit together and exactly what they do. I find that this is one of the most difficult concepts for people to grasp. I am often asked for example, why someone needs chemotherapy if they are having radiotherapy.

It is useful to go back to the diagram of the three different areas that need to be kept in mind when planning treatment.
Referring to the chart you will see that radiotherapy is a local treatment that will only deal with cells within the breast, whereas chemotherapy drugs circulate in the body and can reach cells at distant locations.

 
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