What is Neo Adjuvant Chemo Therapy (NACT)
for Breast Cancer?
Breast Cancer, broadly, has three different treatments - surgery, chemotherapy and radiation therapy. All patients do not need all of them, but most of them do. Some patients undergo surgery first and then chemotherapy, while some receive chemo first and then surgery. This 'sequence' of chemo and surgery is decided by the stage of breast cancer. If you have not already read about Breast Cancer treatment planning, I request you to read that section first by clicking here - Breast Cancer Treatment Planning. Please read about what is 'Locally Advanced breast Cancer' and then you can close that page and come back here to read further.
So what is 'Neo Adjuvant Chemo Therapy?
When we treat any cancer, we make our treatment decisions based on 'how much bulk' or 'how much burden' or 'how much volume' of the cancer seems to be there in the patient's body. Basically, we try to assess - is it an 'early' cancer or is it 'advanced'. There are certain 'indicators', which, an Oncologist 'notices' and 'assesses' during the breast examination, which tell him that the cancer looks advanced - the Oncologist then confirms his assessment, with findings on a mammography, PET CT, core biopsy and other tests.
In simple terms, for breast cancer, the Oncologist tries to see whether is it just a 'small lump' with maybe a few 'tiny' nodes in the armpit (indicators of an early cancer); or is it a 'larger tumour', with skin thickening and lots of nodes in the arm pit (indicators of an advanced cancer). This second description - 'larger tumour' with 'skin thickening', 'enlarged nodes or lots of nodes in the arm pit' definitely tell us that this cancer looks a 'bit advanced'. And in such advanced cancers, the 'chances' that cancer cells are moving around in the blood, all over the body, is very high (even though PET CT may show no 'distant' spread). Such 'advanced' cancers (they are 'advanced' where they are - in and around the breast- but they have not spread to other organs like liver, lungs, bones) are called 'Locally Advanced breast Cancer' (LABC). If a cancer has spread to any organ, like liver, lung, brain, bone etc., it is called 'Metastatic breast Cancer' (MBC). Our discussion below, is limited to Locally Advanced Breast Cancer (LABC). In such advanced cancers, it is not advisable to operate because of the following two reasons:
Apart from the tumour and skin involvement, there will be lots of cancer cells in a wide area around the tumour and the breast; if we try to operate, easily we will 'leave behind' many cells which will grow within no time and cancer will come back at the same site.
If we operate, we are tackling the cancer in and around the breast. What about the of cancer cells in the blood, moving around? We want to control those cells first, as they are the ones which are going to cause a 'recurrence' of cancer
In LABC, surgery is not feasible or advisable. We first want to 'reduce the burden' of cancer cells in the body and then consider to operate later. And how do we do it? We have to kill the cancer cells. That is done by chemotherapy. A Chemotherapy, which is given before surgery, with an aim to reduce the cancer burden in the body, and to make the cancer operable, is called 'Neo Adjuvant Chemo Therapy' (NACT).
Please note, NACT is not given only for LABC (Locally Advanced breast Cancer). Sometimes, the tumour is a little larger (especially in a smaller breast), but the skin is normal, there are no nodes or barely a few nodes- this situatuion is not advanced. But if we operate directly, we may not be able to preserve (conserve) the breast. We want to 'reduce' the size of the tumour, so we can do a breast conserving surgery later. Here also, an NACT is given.
So to sum up, Neo Adjuvant Chemo Therapy (NACT) is given in two situations:
Locally Advanced breast Cancer
Non Advanced but 'larger' breast tumour