For many illnesses requiring surgery, surgery is often the standalone treatment. Hernia surgery, removal of the appendix or gall bladder for infections, removal of benign tumors, surgery for injuries – in all these, once the surgery is done, no further treatment is required other than a period of recovery/rehabilitation.
In cancer treatment, things are different. Surgery alone may sometimes be insufficient to achieve a complete cure, and additional treatment is offered in such instances. In this post, we discuss the importance of integrating adjuvant treatment along with surgery for optimal outcomes when dealing with cancer.
Adjuvant treatment is the treatment given in addition to the main treatment for cancer in order to improve the chances of cure. (see this post on why adjuvant treatment is required). When the main treatment is surgery (as is the case for many cancers), adjuvant treatment could include radiotherapy, chemotherapy, hormone therapy, targeted therapy, etc.
There are many factors that go into planning the right adjuvant therapy for each patient – tumor factors (including the primary site of cancer, type of cancer, stage of cancer), and patient factors (the ability of the patient to tolerate aggressive treatment, other co-existing medical problems). For example, an elderly woman with early-stage hormone receptor-positive breast cancer may require nothing more than endocrine therapy (typically one tablet a day for five years). On the other hand, a younger woman who has been diagnosed at a more advanced stage and with a more aggressive type of breast cancer will require combined chemotherapy and targeted therapy, followed by surgery, then radiation, and finally endocrine therapy as well. For some other cancers, adjuvant treatment may not be required at all.
When adjuvant treatment is given prior to surgery, it is called neo-adjuvant treatment. For example, neo-adjuvant radiation therapy is often used in certain cases of rectal cancer – where radiotherapy is given before the main curative treatment of surgery. Sometimes neo-adjuvant therapy also helps in reducing the magnitude and the morbidity of the surgery. For example, neo-adjuvant therapy can enable the conservation of an organ during surgery (eg breast, limb, or rectum). Occasionally, neo-adjuvant treatment can even convert inoperable cancer to an operable one.
Because of rapid advances in adjuvant treatment modalities, it is critical that the surgeon who performs cancer surgery should stay abreast of the latest developments outside his field of surgery as well. To achieve the best possible outcomes for each person with cancer, the incorporation of a suitable adjuvant / neoadjuvant treatment is a key component.