Kate Middleton, Princess of Wales, on Friday opened up about her cancer diagnosis in a video message released by Kensington Palace. The princess said tests post her major abdominal surgery in London found cancer had been present and her medical team advised her to undergo a course of preventative chemotherapy. She added that she was in early stages of the treatment. Kate did not mention the type of cancer she was diagnosed with. 

“The surgery was successful. However, tests after the operation found cancer had been present. My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said.

Preventative chemotherapy isn't a clinical term but experts agree it could refer to adjuvant chemotherapy that is used to help destroy cancer cells that may remain after surgery or radiotherapy.

What is chemotherapy?

Chemotherapy is a cancer treatment that uses powerful drugs to kill cancer cells or slow their growth. It is commonly used to treat various types of cancer and may be used alone or in combination with other therapies like surgery or radiation.

Different types of chemotherapy are used as per requirement of a patient. Neo-adjuvant therapy is given before surgery or radiotherapy to shrink the tumour. Peri-operative therapy is given both before and after surgery. Palliative chemotherapy helps relieve symptoms if cancer has spread.

What is adjuvant chemotherapy?

"Adjuvant chemotherapy is strategically employed post-primary preventive treatment, such as surgery or radiation therapy, aiming to eradicate any residual cancer cells. Its primary objective is to prevent the risk of cancer recurrence by targeting potentially undetectable malignant cells, thereby enhancing the prospects of achieving long-term remission and potentially curing the disease," says Dr Rajat Bajaj, Director- Medical Oncology, Fortis Hospital, Noida.

What is palliative chemotherapy?

"Conversely, palliative chemotherapy is enlisted when cancer has progressed to an incurable stage, focusing on symptom management, enhancing quality of life, and extending survival by impeding disease progression. This approach addresses pain, nausea, fatigue, and other symptoms associated with cancer and its treatment, aiming to optimize the patient's overall well-being and provide comfort during advanced stages of the illness," says Dr Bajaj.

Adjuvant chemotherapy vs palliative chemotherapy: what's the difference?

While adjuvant chemotherapy is a preventive treatment used in early-stage cancers, it is more aggressive in nature. Palliative chemotherapy on the other hand focusses on symptom relief and is used in advanced cancers.

"Typically administered in early-stage cancer, adjuvant chemotherapy may entail more aggressive preventive treatment protocols aimed at complete eradication of cancer cells, albeit with potentially intensified side effects due to higher doses and extended durations. Palliative chemotherapy, often used in metastatic or advanced cancers, prioritises symptom relief and quality of life enhancement, albeit with limited efficacy in controlling disease progression," adds Dr Bajaj.

"Both adjuvant and palliative chemotherapy confer their own sets of benefits and challenges. Adjuvant chemotherapy holds promise for long-term disease control and survival, yet may induce more severe side effects owing to its aggressive nature. Palliative chemotherapy, by contrast, focuses on symptom alleviation and quality of life enhancement, albeit with constrained effectiveness in controlling advanced cancer progression," says the expert.

Dr Bajaj says the selection between adjuvant and palliative chemotherapy hinges on various factors including cancer stage, type, patient health, treatment goals, and the associated benefits and risks.

"A multidisciplinary team comprising oncologists, nurses, and palliative care specialists collaborates to guide treatment decisions, ensuring personalized, comprehensive care tailored to individual patient needs. Through such concerted efforts, patients receive optimal support and treatment, enhancing their overall experience and outcomes in the complex landscape of cancer care," concludes the expert.

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