Adjuvant therapy: Extra treatment to keep cancer from returning
Understand your options before you decide whether adjuvant therapy is for you. Balance the side effects with the benefits of treatment when making your decision.
You've already had surgery to remove your tumor. But how can you be sure that some cancer cells haven't remained behind in other parts of your body?
Your doctor might suggest something called "adjuvant therapy" as a way to kill any remaining cancer cells that are too small to be seen by available tests. Adjuvant therapy is used after primary treatments, such as surgery or radiation, to decrease the chance that your cancer will recur. But the added benefit of adjuvant therapy doesn't come without a price - the side effects can be more than minor inconveniences.
Not everyone benefits from adjuvant therapy. Work with your doctor to determine if adjuvant therapy is right for you.
Types of adjuvant therapyThere are five main types of adjuvant therapy. Which adjuvant therapy is best for you is based on your type of cancer and its stage.
- Chemotherapy : - Chemotherapy uses drugs to kill cancer cells, either by preventing them from multiplying or by causing the cells to self-destruct. Chemotherapy can reach nearly every part of your body to kill cancer cells, no matter where they may be. Adjuvant chemotherapy isn't helpful for all cancers, so talk to your doctor about whether this treatment is right for you.
Chemotherapy can be used as primary therapy or adjuvant therapy. How long you're given chemotherapy and the side effects that result will vary based on your cancer and the drugs you take. Side effects range from very mild to more severe, including nausea, vomiting and fatigue, but many people can benefit from chemotherapy.
- Hormone therapy : - Some cancers are sensitive to hormones in your body. By reducing hormone production in your body or by blocking the cancer's ability to accept your hormones, hormone therapy can prevent your cancer from growing.
If you have breast, ovarian, uterine or prostate cancer, your doctor might have a lab analyze your cancer to see if it's hormone sensitive. If it is, you might benefit from hormone therapy.
Hormone therapy can be used in conjunction with surgery, radiation or chemotherapy. The side effects depend on the type of hormone therapy, but can include hot flashes, a decreased interest in sex, changes to your bones and possibly an increased risk of heart problems. Women can also experience vaginal bleeding, and men might experience impotence.
- Radiation therapy : - Radiation therapy uses high-powered X-rays to kill cancer cells. Doctors recommend it as a primary treatment or as an adjuvant therapy.
Radiation therapy is given internally or externally, and it usually focuses on one area of your body. In rare circumstances, you might receive radiation therapy over your entire body. Side effects can include fatigue as well as sunburn-like burns to the skin where the radiation was focused.
- Immunotherapy : - Immunotherapy attempts to influence your body's own immune system to fight off remaining cancer cells. Immunotherapy can either stimulate your body's own defenses or supplement them, for example, putting antibodies or immune cells from another person into your body.
Immunotherapy is still considered experimental. However, doctors are using it in difficult-to-treat cancers that don't respond to usual treatments, including melanoma, lymphoma and kidney cancers. Side effects can range from flu-like symptoms to water retention and weight gain. Some immunotherapy agents have serious side effects that can cause breathing difficulties and heart failure.
- Targeted therapy : - Targeted therapy aims to alter specific abnormalities present within cancer cells. For example, women with a type of breast cancer that makes too much of a protein called HER2 may choose a targeted therapy drug that blocks the action of that specific protein. These medications target the specific protein, slowing the cancer's growth. More targeted therapies are under development and may one day be available for use as adjuvant therapy.
How effective is adjuvant therapy ?
Because none of these treatments is completely harmless, it's important to determine the risks of adjuvant therapy versus the benefits.
The following factors can help you and your doctor determine whether adjuvant therapy is appropriate for you and, if so, which type: -
- Type of cancer : - Treating certain types of cancer - especially breast, prostate, colon and ovarian cancers - with adjuvant therapy can be very beneficial. For other types of cancer, there might not be a benefit.
- Stage of cancer : - A cancer's stage refers to the extent of the cancer. If the cancer is at a very early stage - before it has had time to spread - then the chance of cancer recurring after surgery may be very small. Adjuvant therapy may offer little benefit in this case. If cancer is at a later stage - if it is a large tumor or if the cancer has spread to nearby lymph nodes - then the chance that cancer will reappear sometime in the future is much greater. Adjuvant therapy may be more beneficial in this case.
Number of lymph nodes involved. The larger the number of lymph nodes involved, the greater the chance that cancer cells will be left behind after local therapy, such as surgery.
- Hormone receptivity : - Hormone therapy won't be effective if your tumor is not hormonally sensitive.
Other cancer-specific changes. Certain cancers may have specific changes within their cells that indicate they are particularly sensitive to adjuvant therapy. Your doctor may request special testing of your cancer cells to determine if adjuvant therapy would be beneficial.
Receiving adjuvant therapy doesn't guarantee your cancer won't recur. It can, however, help reduce the risk that your cancer will come back.
Is adjuvant therapy for you ?
As you're deciding whether adjuvant therapy is right for you, you might want to discuss the following issues with your doctor: What procedures are you considering? Find out exactly what will be expected of you during adjuvant therapy. Will you have to see your doctor for injections or will you take pills at home?
What are the side effects? What side effects are you willing to live with? Which ones will be too much for you to tolerate? Do you plan to work or stay active during treatment? Could side effects interfere with your plans?
What are the chances you'll stay cancer-free? Understand how likely it is that your cancer will return if you decide against further therapy and how much improvement you might experience if you do undergo additional therapy. Your doctor can estimate how well your treatment will work based on comparisons with data accumulated from studies of other people with your same type of cancer, at the same stage and given the same treatment. Remember that this is only a prediction.
Together you and your doctor can weigh these factors and decide whether the benefits of adjuvant therapy outweigh the risks for you.
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