Chemotherapy is used to treat many types of cancer. Adjuvant chemotherapy is when you get chemo after the primary treatment, usually surgery.

In this article, we’ll take a closer look at both adjuvant and neoadjuvant chemotherapy, when they’re typically used, and why your doctor might recommend one over the other.

Adjuvant therapy is any type of therapy that follows the primary treatment. So, adjuvant chemotherapy takes place after you’ve had first-line treatment, such as surgery to remove a cancerous tumor.

The main goal of adjuvant chemotherapy is to lower the chance that the cancer will return, and to improve the outcome of first-line treatment.

Sometimes cancer cells can be left behind after surgery. It’s also possible that cancer cells may be circulating in your bloodstream or lymphatic system.

The traveling cancer cells don’t show up on imaging tests. Without treatment, they can find their way to distant organs to form new tumors.

Chemotherapy is a systemic treatment. Chemo drugs attack rapidly dividing cells, such as cancer cells, throughout your body.

It’s also important to know that chemo drugs can destroy healthy cells too because traditional chemotherapy does not specifically only target cancer cells.

But the chemotherapy treatment may help lower the risk that the cancer cells will spread to distant organs. Your doctor will work with you to monitor your treatment experience.

Your doctor may recommend adjuvant chemotherapy if:

  • you have a particular type of cancer or carry certain biomarkers that are known to respond well to chemotherapy drugs
  • you carry specific genetic mutations that carry a high risk of cancer recurrence
  • during surgery, cancer cells were found in your lymph nodes
  • your cancer is not positive for hormone receptors, making hormone therapy ineffective
  • you have a later stage cancer

Adjuvant therapies are frequently used to treat the following cancers:

Even so, there are individual factors that guide the decision to use adjuvant chemotherapy.

For example, a 2017 research review noted that adjuvant chemo is standard care and beneficial for people with stage 3 colon adenocarcinoma.

But not all people with stage 2 colon cancer get the same benefit. In stage 2 colon cancer, the use of adjuvant chemo may depend on certain biomarkers.

All these factors must be considered when deciding if adjuvant chemo is likely to be beneficial.

Neoadjuvant chemotherapy means that chemo takes place before the main treatment. The goal is to improve the likelihood that the main treatment, usually surgery or radiation therapy, will be successful.

As with adjuvant chemotherapy, there are many factors involved in choosing the timing of neoadjuvant chemo.

Your doctor might recommend neoadjuvant chemotherapy in the following situations:

  • The primary tumor is large or pressing on vital organs, which can make surgery complicated and risky. Chemo may be able to shrink the tumor first so it’s less risky to remove.
  • There’s a chance that cancer cells have broken away from the primary tumor. Any complications from surgery can delay the start of adjuvant chemo. Starting with chemo can prevent tumors from developing in distant organs.
  • Doing chemo first can help doctors see how effective it is. That can be factored into a long-term treatment plan.
  • In breast cancer, shrinking the tumor before surgery may allow for breast conserving surgery over a mastectomy.

Your doctor will likely use imaging tests to monitor tumor shrinkage with neoadjuvant chemo. In some cases, there may be a pathologic complete response. This means that no cancer is found in tissue that’s removed during surgery.

Your response to neoadjuvant therapy can help guide decisions about adjuvant therapy.

A 2015 research review showed that in some types of cancer, neoadjuvant therapy is linked to favorable survival.

No matter when you get it, there are many potential side effects to chemotherapy. These side effects can vary quite a bit from one chemo drug to another.

Chemo drugs work by attacking fast-growing cells, like cancer cells. But some healthy cells are fast-growing, too. These healthy cells can get damaged in the process. This can cause side effects such as:

  • nausea, vomiting
  • fatigue
  • hair loss
  • bruising and bleeding easily
  • mouth sores, dry mouth
  • infection
  • anemia
  • loss of appetite
  • weight loss
  • diarrhea, constipation
  • urine and bladder conditions
  • numbness, tingling, nerve pain
  • changes to skin and nails
  • mood changes
  • changes in sexual desire and function
  • loss of concentration and focus, commonly referred to as “chemo brain

Everyone reacts differently to chemo. You typically won’t have all these side effects.

Some chemo drugs can cause long-term side effects such as:

Your oncology team will give you self-care tips to help you deal with many of these side effects. They can even help prevent some, such as nausea, by giving you medication along with your treatment.

You may be tempted to dismiss some side effects, but it’s important to mention them. Many are treatable. And some could indicate a serious condition that needs to be addressed.

Is chemotherapy a necessary part of your treatment plan? Should you have it before or after primary treatment? These are decisions you’ll discuss with your oncologist soon after the diagnosis. Here are some questions you might want to ask:

Questions to ask

  • Why are you recommending adjuvant or neoadjuvant chemo? What’s the goal?
  • What can I expect if I have chemo?
  • Are there any alternatives?
  • What are the potential side effects and complications?
  • How many treatments will I need?
  • Where will treatments take place and how long will they last?
  • Will my health insurance cover it? What if I don’t have health insurance?
  • How will we know it’s working?
  • If it’s not working, what’s next?
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In addition to chemotherapy, adjuvant treatments can include:

Adjuvant chemotherapy is chemo that you get after your primary treatment, such as surgery or radiation. Neoadjuvant chemotherapy is when you get chemo before your primary treatment.

Whether you get chemo before or after first-line treatment depends on many factors, including the cancer type, biomarkers, and size and location of tumors.

The goal of adjuvant chemotherapy is to help lower the risk that cancer will spread or come back again.