Neoadjuvant chemotherapy is a form of chemotherapy aimed at reducing the cancer tissue's size before surgery by administering specific medication, radiation, or hormones. While earlier it was only used for advanced-stage breast cancer, today it is used for various other types of cancer such as colon, lung, bladder, and prostate cancer. It provides ease in further treatment and removes any cancerous tissue that may have gone undetected on imaging.
Alternate Name -
Route of Administration (Body Location)
- oral, intravenously, or via an injection
Procedure - During neoadjuvant chemotherapy, anti-cancer medication is administered via the abovementioned routes. This occurs in cycles lasting up to 3-6 months with rest periods in between. The oncologist decides the mode of drug delivery and duration of the procedure based on the location and severity of the cancer. This could occur in the doctor's office or even at the patient's home. This process is done before moving on to the next major step in treatment, such as surgery to remove the cancerous tissue from one's body.
Some commonly used medication includes - anthracyclines, 5-fluorouracil, taxanes, cyclophosphamides, and carboplatin.
With this treatment, the size of the cancer is aimed to be reduced, but it is believed to give cosmetically better results post-surgery. Other advantages include:
- Making inoperable tumors operable.
- Reducing the need for mastectomies in case of breast cancer, and ultimately.
- Making surgical removal of cancer more manageable.
This differs from adjuvant chemotherapy as the latter is done after the primary treatment modality to destroy the remaining cancer cells.
- There is no need to be admitted to the hospital for this procedure.
- The doctor conducts a full body assessment, with the following tests are performed.
- Tumor evaluation is done by taking a biopsy or histopathological methods to confirm the cancer type and diagnosis.
- Imaging - This includes using ultrasounds and magnetic resonance imaging (MRI) to defect the extent of spread and stage of cancer.
- Lymph node evaluation - to check for local and distant metastasis or spread of cancer.
- There are no dietary limitations in this procedure except that the patient is regularly asked to maintain a healthy balanced diet.
Procedure Type -
There is regular follow-up during the cycles of therapy. After that, you are expected to meet the doctor to check for regression or progression of the disease and decide the next step in treatment which is usually surgery.
After the treatment, a thorough clinical examination and imaging are conducted to check for the above. Quite commonly, a PET scan is used to assess the outcome of neoadjuvant therapy.
Finally, the doctor must decide the need for adjuvant therapy based on pathological studies in case of remnants of cancer.
The patient must stick to the recommended follow-up routine to keep the disease in check and follow any doctor's advice.
A significant risk in this procedure comes because of delaying the surgical removal of cancer as it may grow or spread during this period. This is quite a rare occurrence. Additionally, the following side effects have been reported
- Hair loss
- Vomiting and Nausea
- Sore mouth
- Increased risk of infection
- Decreased cognitive function
All of these are temporary and go away once the therapy is completed. There are, however, the following serious complications that may occur in the long run -
- Heart Disease
- A type of blood cancer - leukemia
Surgery is generally planned 3-4 weeks post neoadjuvant chemotherapy to allow for immune and general recovery. Since, after this procedure, the body's immune system becomes weak, one should avoid people with infections and colds. It is also essential to maintain a steady diet and ingest plenty of fluids to allow the drugs to spread through your body. There is no need to worry if the side effects are not improving, but you must inform the doctor as they may prescribe you a particular medication to deal with them. Recovery may seem like a long and tedious road, but there is always light at the end of the tunnel!
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