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Adjuvant therapy: Extra treatment to keep cancer from returning
From MayoClinic.com
Special to CNN.com

You've already had surgery to remove your tumor. But how can you be sure that some cancer cells aren't hiding away in other parts of your body?

Your doctor might suggest adjuvant therapy as a way to target any remaining cancer cells that haven't been identified. 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. Work with your doctor to determine if adjuvant therapy is right for you.

Types of adjuvant therapy

Five main types of adjuvant therapy exist. Which adjuvant therapy is best for you is based on your type of cancer and its stage.

Chemotherapy
Chemotherapy uses chemicals 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, which makes chemotherapy useful for many types of cancer.

Chemotherapy can be used as primary or adjuvant therapy. How long you take 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 rely on hormones in your body — such as estrogen or testosterone — to fuel their growth. 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 drugs. The side effects can include hot flashes and a decreased interest in sex in both men and women. Women can also experience vaginal bleeding, and men might experience impotence.

Radiation therapy
Radiation therapy uses high-powered 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 any 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 renal cell 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
The newest form of anti-cancer therapy is called targeted therapy because these treatments tend to target specific abnormalities present within cancer cells, leaving normal, healthy cells alone. Women with breast cancer that makes too much of a protein called HER2 may choose a targeted therapy called trastuzumab (Herceptin) as adjuvant therapy. 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. Certain types of cancer — especially breast, prostate, colon and ovarian cancers — benefit greatly from adjuvant therapy. Some other types of cancer might not benefit.
  • Tumor size. A larger tumor is more likely to have spread throughout your body than a smaller tumor.
  • 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.

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? Get to know exactly what will be expected of you during treatment. 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 endure? 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.

  • Gene therapy: Cancer research topic proves challenging, but promising
  • Angiogenesis inhibitors: New cancer drugs stop tumor growth
  • Metronomic chemotherapy: Low-dose chemotherapy for advanced cancers
  • Hormone therapy: Cancer treatment for certain hormone-sensitive cancers
  • Debunking cancer myths: An interview with a Mayo Clinic specialist
  • Chemotherapy: Using chemicals to treat cancer
  • March 13, 2006

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