Does a Patient Need Chemotherapy & Radiotherapy, Post a Cancer Surgery?

This is a very frequently asked question by the family & the cancer patient..”When my whole Tumor is removed & my reports do not show cancer anywhere else in the body, then why is the need for Radiotherapy & Chemotherapy.”

The need for Chemotherapy/Radiotherapy, amongest various cancers, depends upon many factors-

• Biological behavior of different cancer is different

Some cancers are more aggressive than others. Some cancers have hidden Metastasis (Micro-Metastasis) in the body, which are not picked up, even by our latest imaging studies- MRI, PET scan etc. eg. Lung & Liver cancers are much more aggressive then Prostate Cancers-stage by stage.

• Stage of Cancer

Normally locally advanced cancers like 3^rd or 4^th stage cancers have their tentacles spread more deeply into the tissues surrounding the primary tumor, into draining lymph nodes & even into other parts of the body, far off from the primary tumor (Distant Metastasis) so, such patients are given Radiotherapy, to prevent cancer coming up again at the operated/ primary site & are given Chemotherapy to prevent/decrease the chance of cancer coming back at other sites.

• Detail Biopsy Report, After Surgery

So many times the need of further Radiotherapy &/or Chemotherapy, depends on the final Biopsy Report. (Detail report of Surgical Specimen) Some of the bad/adverse factors are-

1. Positive Margins/ Close Margins

The normal tissue removed around the tumor is very less or not at all

• Large tumor
• High grade tumors- Aggressive tumor
• Regional lymph nodes are Harboring Disease
• Lympho-Vascular Spread-

The tumor has spread beyond the lymphatic, vessels.
If these factors are present in the Biopsy Report (Examination of Surgical Specimen), then these patients will require both or either of Chemotherapy & Radiotherapy.

Conclusion-

Except in very early tumors, with all favorable factors, Chemotherapy/Radiotherapy or other additional treatment is needed in all cases, after Surgery.

The type/schedule of Chemotherapy, Radiotherapy or other therapy will depends on following factors:

• Anatomical site of primary tumor
• Stage of tumor-extent of disease
• Final Biopsy report of surgery specimen & extent of surgery
• Grade of tumor (Aggressive nature of tumor)