Compare the criteria used for primary versus adjuvant therapy selection.

While carrying out primary therapy following criteria is used:

  • First of all, the stage in which cancer is taken into consideration. If cancer is in stage 0 (say for colon cancer), surgery is recommended. After surgery, adjuvant treatment is also recommended. But if cancer is in stage II, then adjuvant treatment is controversial.
  • Second, the age of the person is taken into consideration. For eg. for an elderly woman in postmenopausal phase, having breast cancer endocrine responsiveness of her endocrine system should be assessed.
  • A close assessment of the risk of relapse should also be done. Benefits and possible toxicity of treatment should also be seen. The toxicity is greater in older women than in younger age groups.
  • Life expectancy of the person should be taken into consideration.
  • Besides these, comorbid conditions, cognitive status, economic means, social support, and the viewpoints of both the physician and the patient are also taken into consideration

In carrying out adjuvant therapy, the doctor has to decide who can be given this therapy. He/She has to check out whether the tumor is likely to reoccur or not, and may decide this by using the following criteria:

  • First, as mentioned above, the stage of cancer should be seen. for eg: in the case of colon cancer, adjuvant therapy would be useless after stage I has passed by.
  • Second, the tumor grade is analyzed. for eg: Tumor cells which resemble normal breast cells are called as well – differentiated tumors and such tumor are likely to reoccur. And this patient requires adjuvant therapy.
  • Third, the hormone receptor status of the patient is seen. The cells of many breast tumors express receptors for the hormones estrogen and progesterone. Tumors with cells that do not express hormone receptors are more likely to recur.
  • In breast cancer case, HER2 status is also checked. Tumors that produce too much of a protein called HER2 are more likely to recur.