Oncological pathologies occupy one of the first places in the number of deaths worldwide. Unfortunately, the incidence of cancer is not decreasing, but only increasing. Scientists are trying to find ways to treat cancer pathologies that would completely cope with the disease. To date, 3 methods of combating cancer are being performed: surgery, chemo- and radiation therapy. All of them are aimed at removing the tumor itself and reducing the risk of relapse. To stop the growth of atypical cells, adjuvant and neoadjuvant chemotherapy is performed. These methods are used both as a complex treatment, and independently (with some oncological pathologies).
Adjuvant chemotherapy - what does it mean?
Chemotherapy is a medical treatment. For its implementation, cytostatic agents aimed at the death of tumor cells are used. Patients often wonder: adjuvant chemotherapy - what is it? This term implies the conduct of drug treatment courses after surgery. Based on this, adjuvant chemotherapy is a measure necessary to avoid the further development of cancer. This type of treatment is used in almost all tumors. It is used for cancer of the lungs, breast, stomach, intestines and other organs. Chemotherapy is carried out before and after surgery. For some types of cancer (Hodgkin's disease, a tumor of the red border of the lips, skin), it is the only treatment method.
Types of chemotherapy drugs
All chemotherapeutic drugs are cytotoxic drugs. Their action is aimed at the inevitable death of the tumor cell. This is done in various ways. In most cases, drugs disrupt cell DNA synthesis. As a result, it loses its ability to divide. Violation of the synthesis or function of DNA is carried out by embedding in a chain, breaking bonds between nucleotides.
Chemotherapeutic drugs have a different structure. Some of them are created on a plant basis (the medicine "Vincristine"), others are classified as alkylating agents (solution or tablets "Cyclophosphamide"). Chemotherapeutic groups also include special antibiotics, anthracyclines and platinum preparations. Representatives of these groups are medicines “Rubomycin”, “Adriamycin”. Adjuvant chemotherapy is administered via intravenous drip. Ointment and tablet forms are considered less effective, therefore they are used extremely rarely. In some cases, medications are administered intraperitoneally, that is, into the abdominal cavity. Sometimes intra-arterial access is used for injection.
Why is chemotherapy given?
Like all other treatments, adjuvant chemotherapy has certain indications. Before starting treatment with cytostatic agents, it is necessary to conduct a complete examination of the patient. After that, the doctor assesses all the risks and decides on chemotherapy. The following indications for the treatment of cytostatics are distinguished:
- Tumors of the hematopoietic system (leukemia). With this type of cancer, chemotherapy is the only method of combating atypical cells.
- A muscle tissue tumor is rhabdomyosarcoma.
- Chorioncarcinoma.
- Tumors of Wilms and Burkitt.
- Malignant neoplasms of the mammary gland, uterus and appendages, digestive tract, genitourinary system, lungs, etc. In these cases, adjuvant chemotherapy is an additional treatment method. It is performed after removal of the tumor.
- With inoperable cancer. In some cases, treatment with cytostatic agents can reduce the size of the tumor. This is necessary for surgical treatment (for example, ovarian cancer). Also, this method can be used in order to reduce the scale of surgery (for breast cancer). In these cases, neoadjuvant chemotherapy is used.
- Palliative care. With advanced forms of cancer, chemotherapy is used to alleviate the patient's condition. Most often it is used in children. It is also used as palliative care for cancer of the intestine, brain or neck.
The procedure for chemotherapy
As you know, chemotherapy is not always easily tolerated by patients. In most cases, patients experience a lot of adverse reactions that occur due to the introduction of cytostatic agents. Some patients refuse treatment.
Adjuvant chemotherapy courses. The duration of treatment is from 3 to 6 months (sometimes more). The course selection is determined by the doctor, taking into account the patient's condition. Most often, about 6-7 courses of chemotherapy are carried out in six months. It is believed that the more often the patient receives treatment, the more effective the result. For example, a course of chemotherapy can last 3 days every 2-4 weeks. At the time of treatment, it is necessary to carefully monitor the patient's condition. Also, the blood count is checked in the interval between courses.
Contraindications to chemotherapy treatment
Despite the effectiveness of treatment with cytostatic agents, they are not always prescribed. Every doctor knows that adjuvant chemotherapy affects not only the tumor process, but also on healthy cells. In particular, this applies to white blood cells. Some drugs have a harmful effect on the cardiovascular system and lungs. Severe kidney and liver diseases are considered contraindications for chemotherapy. This is due to the fact that the risk of developing failure of these organs is too great. Also, chemotherapy should not be prescribed to patients who have a history of calculous cholecystitis (gallstones). Contraindications for cytostatic therapy are changes in the general blood test. Special parameters have been established at which treatment is not possible. These include: platelet count less than 100 * 10⁹, a decrease in hematocrit and hemoglobin. Also, chemotherapy should not be performed for patients with severe asthenisation syndrome. Acceptable for treatment is a body weight of 40 kg or more.
Side effects of chemotherapy drugs
The severity of the chemotherapeutic treatment lies in its side effects. In addition to the external manifestations of the adverse effects of drugs, there are changes in the analyzes. The main side effect is the inhibition of the hematopoietic system. This mainly concerns the white blood cell. As a result of the detrimental effect on white blood cells, the body's immune system suffers. This is manifested by general weakness, the attachment of various infections. Another side effect is the neurotoxic effects of drugs. Some patients have a depressed state, tearfulness, sleep disturbance. Patients also report nausea, vomiting, and diarrhea. Side effect of cytostatic agents affects the appearance of patients. On examination, alopecia (hair loss) and pallor of the skin are noted.
Gastric Cancer: Chemotherapy
Oncological processes in the stomach are often observed. Usually they develop on the basis of polyposis or peptic ulcer. The main manifestations of stomach cancer are pain in the epigastric region, aversion to meat food, belching. In the initial stages of the oncological process, surgical treatment is necessary. It consists in resecting the organ and creating an anastomosis between the esophagus and intestines. Adjuvant chemotherapy for gastric cancer is performed in the absence of contraindications. It allows you to extend the period of remission, and also slows down the metastasis of the tumor. Unfortunately, cytotoxic drugs are not effective in all forms of stomach cancer. Its positive effect in adenocarcinoma has been proven. It is also carried out as a measure of palliative treatment.
Adjuvant therapy for breast cancer
Adjuvant chemotherapy for breast cancer is necessary for any histological forms of the oncological process. It is performed after surgical treatment, regardless of the amount of surgery (mastectomy or sectoral breast resection). This is necessary to avoid the metastasis of atypical cells in the lymph nodes and distant organs. In rare cases, chemotherapy is not a mandatory treatment for breast cancer. For example, if the size of the tumor is less than 1 cm and does not extend to the lymph nodes. Also, with caution, it should be used in young patients. During premenopause, treatment with cytotoxic drugs is performed for all patients, with the exception of those who have contraindications.
Is adjuvant chemotherapy given for borderline cystadenoma?
Many women are familiar with a diagnosis such as an ovarian cyst (cystadenoma). In most cases, the formation is benign and rarely goes into the cancer process. Nevertheless, there are some varieties of cystadenomas that are prone to malignancy. These include serous and papillary borderline tumors. Symptoms of these formations can be pain in the lower abdomen, menstrual irregularities. They are found with ultrasound of the pelvic organs. An accurate diagnosis can only be made with a biopsy of cystadenoma. In borderline formations, surgical treatment is necessary, the volume of which depends on the age of the patient. Adjuvant chemotherapy is carried out in rare cases when the risk of high metastasis of the tumor. It is also indicated for relapse of the oncological process on another ovary.
Chemotherapy for lung cancer
The most common cancer is lung cancer. It takes millions of lives around the world. Adjuvant chemotherapy for lung cancer is almost always indicated. It is necessary not only after surgical treatment, but also as an independent method for diffuse small cell tumors. Various drugs are used. Among them are medicines “Cisplastin”, “Vinorelbine”, “Gemcitabine” and others. The main indication for chemotherapy is peripheral and central lung cancer with involvement of the chest lymph nodes. Treatment with cytotoxic drugs is not carried out only in case of patient failure, the presence of decompensated diseases, senile age and at the 4th stage of the oncological process.
The relationship of chemotherapy with the development of metastases
One of the main goals of treatment is to remove metastases during adjuvant chemotherapy. It is believed that due to the action of cytostatic drugs, the risk of relapse of the tumor process is significantly reduced. Thanks to chemotherapy in the postoperative period with cancer of the breast, lung, uterus and appendages, complete removal of metastases in the regional lymph nodes occurs. The risk of their appearance in distant organs is also reduced. Based on this, drug treatment of cancer helps to slow down the cancer process, and in some cases, a complete cure.
Testimonials from experts and patients about adjuvant chemotherapy
According to oncologists, chemotherapy is an aggressive method of exposure to the body. It not only suppresses the patient’s immunity, but is also difficult for patients to tolerate. Nevertheless, today treatment with cytotoxic drugs has more advantages than disadvantages. It is noted that with a combined approach to the fight against oncology, the chances of survival increase.