Adjuvant and Neoadjuvant Chemotherapy

Medically Reviewed by Brunilda Nazario, MD on March 29, 2024
Written by Stephanie Watson
6 min read

Adjuvant chemotherapy – also called preventive chemotherapy – is a cancer treatment you get after surgery, radiation, or other main treatments to destroy any leftover cancer cells. The goal is to prevent your cancer from coming back. 

Even if surgery removed your cancer, sometimes a few stray cancer cells stay in your body. Those cells can multiply and spread. Chemotherapy is medicine that kills cancer cells anywhere in your body. Adjuvant chemotherapy lowers the risk that the cancer will return, which your doctor calls a recurrence.

Neoadjuvant chemotherapy is medicine that treats your cancer before it has a chance to grow, or shrinks the tumor before surgery so it's easier to remove. Unlike adjuvant chemotherapy, which you get after another treatment, neoadjuvant chemo comes before surgery or another treatment so that surgery isn't so extensive. 

The adjuvant chemotherapy drugs you get depend on your type of cancer. Examples of these medicines include:

  • 5-fluorouracil (5-FU) stops cancer cells from fixing their own DNA.
  • Anthracyclines such as doxorubicin (Adriamycin) and epirubicin (Ellence) damage the DNA in cancer cells.
  • Carboplatin (Paraplatin) has the metal platinum in it, which slows or stops cancer cells from dividing.
  • Cyclophosphamide (Cytoxan) slows the growth of cancer cells.
  • Taxanes like docetaxel (Taxotere) and paclitaxel (Taxol) stop cancer cells from dividing.

You get adjuvant chemotherapy after a main cancer treatment like surgery or radiation. The goal is to make your treatment work better and help you live longer. Usually, you'll get chemo as an infusion into a vein. Sometimes, chemotherapy comes as pills you take by mouth.

Your doctor might recommend adjuvant chemotherapy if:

  • You have an early-stage cancer that could come back.
  • You have a late-stage cancer, and surgery or radiation can't remove the whole tumor.
  • The cancer has spread into your lymph nodes.

These are some questions to ask your doctor if they recommend adjuvant chemotherapy for you:

  • How will I get adjuvant chemotherapy?
  • How long will I need to take it?
  • What are the chances that my cancer will come back if I don't have this treatment?
  • What are the possible side effects? How long will they last? 
  • How will you manage any side effects I have?
  • What are the alternatives to adjuvant chemotherapy?

Doctors use adjuvant chemotherapy to treat:

Breast cancer. You might get chemotherapy after surgery to lower the chance that your cancer will come back.

Colorectal cancer. Doctors give chemotherapy after surgery to remove part or all of the colon. Adjuvant chemotherapy kills any cells that are left behind after surgery, or that spread from the colon or rectum to other parts of your body. Chemotherapy also helps radiation treatment work better.

Lung cancer. Adjuvant chemotherapy is a treatment for some people with non-small-cell lung cancer (NSCLC). It helps to improve survival after surgery removes the cancer.

This treatment can't prevent your cancer from coming back, but it can lower the odds of a recurrence. Adjuvant chemotherapy works better against some cancers than others. How well it works depends on things like:

Your type of cancer. Adjuvant chemo works better for breast, colon, and NSCLC (non-small-cell lung cancer) than for other cancers.

Your cancer stage. This treatment may be more helpful if your cancer has spread than if it's early-stage.

How likely the cancer is to return. Some cancer cells have gene changes that make them more likely to return. Adjuvant therapy can be more helpful in those cases.

How many lymph nodes have cancer in them. Once cancer is in your lymph nodes, it can more easily travel to other parts of your body. Adjuvant chemotherapy kills cancer cells in your lymph nodes after you have surgery.

Chemotherapy targets quickly dividing cells. Cancer cells divide quickly, but so do healthy cells like hair and immune cells. When chemo damages healthy cells, it can cause side effects.

Each type of chemotherapy has its own possible long- and short-term risks. Some common chemotherapy side effects are:

  • Tiredness
  • Hair loss
  • Mouth sores
  • Nausea and vomiting
  • Diarrhea or constipation
  • Infections
  • Nerve problems like numbness or tingling 
  • Problems thinking clearly or concentrating

Your treatment team can give you medicine to manage these problems. If side effects really bother you, your doctor may change your chemotherapy drug or dose. 

And if you don’t have side effects, it doesn’t mean the treatment isn’t working.

The type of neoadjuvant chemotherapy drugs you get depends on which cancer you have. Some of the same chemotherapy drugs that doctors use for adjuvant treatment are also part of neoadjuvant treatment.

Examples of neoadjuvant chemotherapy drugs include:

  • 5-FU
  • Anthracyclines such as doxorubicin (Adriamycin)
  • Cisplatin
  • Cytoxan
  • Epirubicin (Ellence)
  • Methotrexate (Rheumatrex, Trexall)
  • Taxanes

You get neoadjuvant chemotherapy before a main cancer treatment like surgery or radiation. Chemo comes as an infusion into a vein, or as pills that you take by mouth.

Your doctor might recommend neoadjuvant chemotherapy to:

  • Shrink your tumor to make it easier to remove.
  • Make your tumor smaller so you can have a less invasive surgery, such as lumpectomy instead of mastectomy for breast cancer.
  • Reduce the number of lymph nodes that your surgeon needs to remove.
  • Slow the cancer to help your treatment work better and improve your outcome.
  • Give you more time to get genetic tests or other test results.

These are some questions to ask your doctor if they recommend neoadjuvant chemotherapy for you:

  • How will I get neoadjuvant chemotherapy?
  • Which chemo drugs will I get?
  • How long will I need to take them?
  • How will neoadjuvant chemotherapy affect which treatment I get?
  • What are the possible side effects? How long will they last? 
  • How will you manage any side effects I have?
  • What are the alternatives to neoadjuvant chemotherapy?

Doctors use neoadjuvant chemotherapy to treat:

Breast cancer. It can shrink the tumor so you can have a less invasive lumpectomy instead of a mastectomy. Or it can shrink your lymph nodes to make them easier to remove.

Bladder cancer. Chemotherapy shrinks the tumor to make it easier to remove during surgery. It may also lower the chance that the cancer will come back after surgery.

Laryngeal cancer. You can get chemotherapy to make the tumor in your larynx (voice box) smaller. If the cancer shrinks enough, you may be able to get radiation instead of surgery.

Ovarian cancer. Neoadjuvant chemotherapy is a treatment for late-stage ovarian cancer. You might get it before surgery.

Rectal cancer. You may get chemotherapy before surgery to shrink the tumor and make it easier to remove.

This therapy aims to shrink your cancer to help your other treatments work better. How well it works depends on things like:

  • The type of cancer you have
  • Your cancer stage – whether the cancer has spread into your lymph nodes or other organs
  • Which chemotherapy medicines you get
  • How well your body responds to them
  • Features of your cancer, such as whether it grows when exposed to certain hormones

Chemotherapy medicines you get before surgery or radiation can cause side effects like these:

  • Nausea and vomiting
  • Hair loss
  • Infections 
  • Tiredness
  • Bleeding
  • Muscle and joint pain
  • Numbness and tingling
  • Diarrhea or constipation

Tell your doctor if you have side effects. There are treatments to make them less severe.

Adjuvant chemotherapy – sometimes called preventive chemotherapy – is a type of cancer medicine that you get after another treatment, like surgery. Neoadjuvant chemotherapy comes before another treatment. Adjuvant chemotherapy destroys any cancer cells that treatments like surgery or radiation left behind. Neoadjuvant chemotherapy shrinks the tumor to make it easier to treat. 

Why would I need adjuvant therapy if I don't have signs of cancer on imaging tests?

Cancer cells are so small that imaging tests like MRI and CT scans can't always detect them. Adjuvant chemotherapy gets rid of any stray cancer cells that other treatments left behind. It lowers the chance that the cancer will grow or come back.

How successful is adjuvant chemo?

This treatment may help shrink your tumor to make it easier to remove or reduce the chance of it coming back. How well it works depends on things like your cancer type, stage, and the kind of medicine you get.

What is the survival rate for neoadjuvant chemotherapy?

The survival rate differs based on your cancer type and stage, and what treatment you get after chemotherapy.