Adjuvant Chemotherapy for breast cancer is the one that is given after the surgery. It could be recommended for the following reasons-

• The lymph nodes under the arm had breast cancer cells
• Large primary cancer in the breast
• Grade 3 breast cancer cells
• Cancer cells tested negative for hormone receptors and hence would not respond to hormone therapy

Doctors recommend chemotherapy after surgery when there is a chance that cancer cells could split from the tumor in the breast and spread to another part of the body. Adjuvant chemotherapy kills these cells thus reducing the risk of recurrence.

Adjuvant therapy is recommended even when there is no evidence of cancer cells found after the surgery because some cells are left behind and extremely small to be detected. Adjuvant therapy after breast-conserving surgery or mastectomy reduces the risk of breast cancer recurrence.

Systemic adjuvant chemotherapy treatment for breast cancer is used to destroy the microscopic deposits of cancer cells that could have metastasized. Hence, it is recommended for most patients based on risk assessment.

There are three different types of adjuvant therapies for breast cancer- Endocrine therapy, Chemotherapy and Trastuzumab. Apart from these, some other method are also used to cure breast cancer. We have discussed these method below.

Chemotherapy

Chemotherapy destroys the remaining cancer cells increasing the chances of cure even after surgery. This is given in cycles of 3-4 weeks. There is a break in between each cycle. The duration of the cycle varies from 3-6 months. The break in between cycles allows the body to recover from the side effects. This treatment is a combination of two or more drugs.

Side effects that occur are mostly temporary. They are chemotherapy induced nausea and vomiting,  mouth sores, lowering of the blood counts and hair loss.

Long-term side effects are premature menopause, damage to the heart and risk of leukemia.

Trastuzumab

Trastuzumab is drug that targets a protein called HER2. This protein is found in high levels in some breast cancers. This could be recommended in addition to chemotherapy especially if the breast cancer is HER2-positive.

Trastuzumab is administered intravenously once a week or in every three weeks. This is continued for one year. A common side effect of trastuzumab durg is fever or chills. Heart failure could also occur rarely in some women. However, this heart damage is not permanent.

Endocrine Therapy

Hormones are secreted by the endocrine glands to control the growth and activity of normal cells. In breast cancer, both the female hormones estrogen and progesteron tend to promote the growth of certain breast cancer cells. Depending on the particular hormone used, adjuvant endocrine therapy works by blocking the production of these hormones. Hence, they prevent the hormones like estrogen from reaching its target receptors on cancer cells.

Other Methods of Breast Cancer Treatment

Anti-estrogens – tamoxifen

This is the oldest and most common anti-estrogen drug that prevents the hormone from attaching to the breast cancer cells thus inhibiting their growth. Tamoxifen reduces the risk of recurrence by about 30%. It is taken in a pill form, once daily for about five years. Some of the common side effects of this drug are hot flushes and weight gain. However, tamoxifen sometimes leads to thrombosis or endometrial cancer.

Aromatase inhibitors – anastrozole, exemestane and letrozole

This is the next generation of endocrine therapy. These drugs block estrogen produced by the adrenal glands above the kidneys. They inhibit the activity of the enzyme aromatase that converts androgen hormones into estrogen. These drugs are used in post-menopausal women in whom the only source of estrogen production is the adrenal gland. Side effects are menopausal symptoms like hot flushes, vaginal dryness,  fatigue, nausea, headache, muscle pain and diarrhea.

Adjuvant chemotherapy for breast cancer has shown very good results in reducing the number of deaths and risk of relapse in women with operable breast cancer. The therapy with anthracycline drugs has been more beneficial than the conventional CMF chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil) . Research is still going on in developing new drugs to increase the chances of complete cure of breast cancer.