Adjuvant Therapy

What is Adjuvant Therapy?

Adjuvant therapy refers to additional treatments given after primary breast cancer surgery (like mastectomy or lumpectomy) to reduce the risk of the cancer returning. This therapy is a part of a comprehensive cancer treatment plan. It is typically used when there is a significant risk of recurrence based on the cancer's characteristics, such as its stage, grade, and hormone receptor status.

Who is Suitable for Adjuvant Therapy?

Patients suitable for adjuvant therapy typically include those who have undergone primary surgery for breast cancer and are assessed to be at risk of recurrence. The decision to recommend adjuvant therapy depends on several factors:

Cancer Stage and Size: Higher stages or larger tumours are more likely to be treated with adjuvant therapy.
Lymph Node Involvement: Cancer spread to lymph nodes significantly increases the risk of recurrence.
Hormone Receptor Status: The presence of hormone receptors (oestrogen and progesterone) indicates suitability for hormone therapy.
HER2 Status: Overexpression of the HER2 protein may require targeted adjuvant therapy.
Age and Overall Health: Younger age and better overall health can influence the decision to administer more aggressive adjuvant therapies due to a better capacity to handle potential side effects.

Benefits of Adjuvant Therapy

Decreased Risk of Recurrence: Adjuvant therapy helps to eliminate microscopic cancer cells that may remain after surgery but are undetectable with current testing methods.
Increased Survival Rates: Studies have shown that adjuvant therapy can improve long-term survival rates by preventing the cancer from returning.
Personalised Treatment: Adjuvant therapies can be tailored to the specific type of breast cancer, which enhances treatment efficacy and potentially reduces unnecessary treatments.

What is Breast Oncology?

Breast oncology is a specialised field of medicine that focuses on the study and treatment of breast cancer. It encompasses a broad range of disciplines, including medical, surgical, and radiation oncology, all of which are dedicated to managing breast cancer from diagnosis to treatment and follow-up care.

Types of Treatment in Breast Oncology

Adjuvant therapies for breast cancer are diverse, each targeting different aspects of cancer treatment and patient care post-surgery. These therapies are crucial in reducing the risk of cancer recurrence and addressing the physical and emotional impacts of cancer diagnosis and treatment.

Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells, typically administered through the bloodstream to impact cancer cells throughout the body. It's particularly recommended for aggressive types of breast cancer or when cancer has a higher likelihood of spreading. Chemotherapy can be tailored based on the type of cancer, its stage, and other patient factors.

Radiotherapy

Radiotherapy (or radiation therapy) involves the use of high-energy rays to target and kill cancer cells. In breast cancer, radiotherapy is generally directed at the chest wall and the surrounding areas to destroy any remaining cancer cells after surgery. It is commonly recommended when the cancer is larger when it has spread to the lymph nodes, or after a lumpectomy to help prevent local recurrence.

Hormone Therapy

Hormone therapy is used for hormone receptor-positive breast cancers, which grow in response to hormones like oestrogen and progesterone. This therapy may involve medications that block hormone receptors or drugs that lower hormone levels in the body. Common hormone therapies include tamoxifen for premenopausal women and aromatase inhibitors for postmenopausal women.

Targeted Therapy

Targeted therapies involve drugs or other substances that attack cancer cells without affecting normal cells. For breast cancer, targeted therapy often focuses on the HER2 protein, which promotes the growth of cancer cells. Medications like trastuzumab (Herceptin) target and destroy HER2-positive cancer cells.

Post-operative Exercises

Physical therapy and exercises after breast cancer surgery help in recovering range of motion, reducing pain, and minimising lymphedema (swelling due to lymph fluid buildup). These exercises are crucial for restoring physical function and improving quality of life after treatment.

Counselling

Psychological counselling and support groups play an essential role in helping patients cope with the emotional and psychological stress of a cancer diagnosis and treatment. Counseling can help address feelings of depression, anxiety, and fear, and support overall mental health.

Additional Investigations for Abnormalities

Further investigations might be needed to assess the situation if any abnormalities or unusual symptoms arise during follow-up. These can include:

Imaging Tests, such as mammograms, ultrasounds, or MRIs, are used to investigate new or unusual findings in the breast or surrounding areas.
Biopsy: If new lumps or suspicious areas are found, a biopsy may be needed to determine if cancer has returned or if a new cancer has developed.
Blood Tests: Certain blood tests can monitor for markers that might suggest a recurrence or the presence of metastasis.

Preparation Before Adjuvant Therapy

Medical Assessments: Comprehensive health evaluations, including blood tests, heart function tests (like ECG and echocardiogram if needed for chemotherapy), and scans to ensure you are fit for treatment.
Consultation with Oncologists: Detailed discussions with your cancer care team to understand the planned therapies' type, duration, and side effects.
Financial Planning: Understanding the cost of therapy and arranging finances is important, as adjuvant therapies can be expensive. It’s also important to check insurance coverage.
Nutritional Counseling: Meeting with a dietitian to ensure the body is well-nourished, which can help handle side effects better.
Psychological Preparation: Psychological counselling may be offered to help you and your family understand the emotional challenges associated with cancer treatment and to devise coping strategies.

What Happens During Adjuvant Therapy?

Adjuvant therapy involves several different types of treatments, each with specific procedures:

Chemotherapy: Administered in cycles, chemotherapy can be given intravenously in a hospital or as pills. Sessions typically last a few hours, and the cycles can range from weekly to monthly over several months.
Radiotherapy: Involves daily treatments for several weeks. Each session is quick, often just a few minutes of actual treatment time, despite possibly longer preparation times.
Hormone Therapy: Taken orally or injected, hormone therapies are often long-term, lasting several years to fully inhibit hormone-driven cancer growth.
Targeted Therapy: Similar to chemotherapy, it can be administered intravenously or orally, depending on the specific medication.

What to Expect After Adjuvant Therapy?

After completing adjuvant therapy, there are several outcomes and follow-up steps:

Monitoring Side Effects: Common side effects include fatigue, nausea, hair loss, and increased risk of infections, which must be monitored and managed.
Regular Follow-ups: These are crucial for monitoring health status, managing long-term side effects, and detecting any signs of recurrence early. Follow-ups usually include physical exams, blood tests, and periodic scans.
Lifestyle Adjustments: To support recovery and overall health, recommendations might include dietary changes, physical activity, and other lifestyle adjustments.

Adjuvant Therapy Prognosis

Generally, adjuvant therapy is designed to improve survival rates by reducing the risk of cancer recurrence. Studies have consistently shown that adjuvant therapy can significantly decrease the chance of breast cancer returning and can increase the overall survival rates, particularly in cancers that are aggressive or have higher risk factors like lymph node involvement or unfavourable hormone receptor status.

Adjuvant Therapy Risks

While adjuvant therapy plays a crucial role in treating breast cancer, it comes with potential risks and side effects, which can vary depending on the type of therapy:

Chemotherapy Risks can include nausea, fatigue, an increased risk of infections, hair loss, and more serious long-term effects like heart or nerve damage.
Radiation Therapy Risks: Potential side effects include skin irritation, fatigue, and a slightly increased risk of developing other cancers in the treated area.
Hormone Therapy Risks: Side effects may include hot flashes, mood swings, and an increased risk of blood clots and bone thinning.
Targeted Therapy Risks: Depending on the specific drug used, these can include skin rashes, diarrhoea, liver problems, and heart issues.

What if Adjuvant Therapy is Delayed?

The primary goal of adjuvant therapy is to eliminate any remaining cancer cells as soon as possible after surgery. Delaying therapy gives these cells a chance to grow and potentially metastasise, which can lead to cancer recurrence either locally or in distant organs. Delay in treatment can ultimately impact overall survival rates, particularly in aggressive types of breast cancer where the timing of therapy is crucial.