In October 2006, the day after she noticed a 2 cm lump in her right breast, 45-year-old biology teacher Radha, (name changed) met me at my clinic. I examined her and asked for a few tests, including a biopsy – the results showed that Radha had early-stage breast cancer. Surgery was scheduled the following week. The cancer was removed completely at operation, her breast was conserved with good cosmesis, and she was discharged from the hospital the day following surgery.
At the time of Radha’s next appointment a week later, the post-operative pathology results were ready. A tumor board consultation and a detailed discussion followed. She was advised to undergo eight sessions of chemotherapy (each session once in 3 weeks), followed by radiation therapy for seven weeks (5 days a week for ten minutes each day) and finally hormone therapy (one tablet a day for 5 years).
Radha’s questions at the time were:
In a previous post, we discussed why cancer can recur and the concept of micrometastases. Essentially, even when all known cancer is removed completely, it is possible that very small amounts of cancer are still present in the body and can manifest later in time as a recurrence. Based on the type and stage of cancer, the probability of recurrence can be estimated.
Treatment given in addition to the primary treatment in order to prevent a recurrence is called adjuvant treatment. Different cancers respond to different treatments, and therefore each cancer may require a different set of adjuvant treatments. For example, after surgery, a patient with colon cancer may require chemotherapy alone, whereas a patient with oral cancer may require only post-operative radiotherapy. Another patient with triple-positive breast cancer may need a combination of chemotherapy, radiotherapy, targeted therapy, as well as hormone therapy. After surgery, a patient with low-grade soft tissue sarcoma may require no further treatment at all.
The decision to recommend adjuvant treatment is based on an assessment of
These three factors vary from person to person, cancer to cancer, and stage to stage. After weighing the benefit versus risk of treatment, adjuvant treatment is offered only when the benefit far outweighs the potential side effects.
A detailed evaluation of these factors and communication with the patient is crucial to achieving the best possible outcomes in oncology.
On a happy note, it is now 15 years since Radha’s diagnosis – she retired from work last month and is planning a trip to the Himalayas later this year. Her long-drawn treatment of breast cancer is a distant memory. Over the years she has volunteered at a cancer support group and has counseled many other patients with breast cancer.