Adjuvant Therapy Modern cancer management is characterized by multi-modality treatment. Breast cancer management is no exception. Treatment can include all or a combination of surgery, radiotherapy, chemotherapy, and endocrine therapy. Adjuvant therapy is additional therapy or treatment, used after primary treatments such as surgery or radiation, to decrease the chance that your cancer will recur. Surgery The treatment of early breast cancer will usually start with surgery. The need and extent of treatment after surgery depends on the type of breast cancer and its staging. Both surgery and radiotherapy are given to eradicate disease in the breast (if preserved) and chest wall (if mastectomy had been done). Chemotherapy and endocrine therapy are given to control disease in the rest of the body like the lungs, brain, liver and bone sites where cancer can spread. Treatment given after surgery is termed adjuvant therapy. Radiotherapy In radiotherapy, high energy rays are given to kill cancer cells. It is commonly used in two situations. It is mandatory if the breast with breast cancer had been preserved. The other situation is when a mastectomy is done for a more advanced cancer. For example if the cancer is large or many armpit nodes had been involved, radiotherapy may be given after the mastectomy. It is given daily over a period of 6 weeks. The side effects are minimal, usually including a ‘sun tan’ over the irradiated area and some tiredness. Chemotherapy Chemotherapy is the use of medicine known as cytotoxics. Examples are Adriamycin, cyclophosphamide and the Taxanes. These drugs are usually injected through a vein three weekly in what is call a cycle. They do cause tiredness, nausea, hair loss and numbness of the toes and feet. However there are now medications that will lessen the nausea and boost blood cell counts, making chemotherapy safer and more comfortable. Endocrine Therapy Growth of breast cancer cells is very often driven by the presence of estrogen (female hormone). Doctors have successfully taken advantage of this fact to effectively control breast cancer, using an approach termed endocrine therapy. This is done using two inhibitors. The first is Tamoxifen. This drug blocks the estrogen receptors on the surface of breast cancer cells, so that estrogen cannot latch onto the receptors to promote the growth of cancer cells. Aromatase inhibitors are a family of drugs that virtually cut off the production of estrogen by the body. It is a new class of drugs that have been proven to be very effective in breast cancer treatment. However they can only be used in patients who have stopped menstruation. Quite often endocrine therapy is used in conjunction with chemotherapy.