Kate Middleton is undergoing “preventative chemotherapy” for cancer: what is it?
In her video posted on social networks on Friday March 22, Kate Middleton claims to have started preventative chemotherapy after her doctors discovered that she was suffering from cancer following a major abdominal operation carried out last January. “ The operation was carried out successfully. However, tests carried out after the operation revealed the presence of cancer. My medical team therefore advised me to undergo preventative chemotherapy and I am now in the early stages of this treatment. “, she says in front of the camera. If no other details have been disclosed on the treatment reserved for the Princess of Wales, this announcement raises questions about what preventive chemotherapy is and, above all, about its effectiveness. As the Gustave Roussy Institute points out on this subject, chemotherapy refers to drug treatments aimed at destroying cancer cells by non-specific mechanisms. Some chemotherapies can be administered orally, others intravenously, some are less toxic, others more.
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Likewise, different tumors are not sensitive to the same chemotherapies. Chemotherapy therefore does not designate a drug, but a principle of treatment which brings together a wide range of drugs. “ The frequency of administration depends on the chemotherapy protocol chosen by the doctor. This can be daily chemotherapy (especially if taken orally), or chemotherapy every week, or chemotherapy every 15 days, 3 weeks… Likewise, the total duration also depends on the protocol. However, there are some standards. For example, in testicular tumors, the number of cycles generally varies from 2 to 4. In breast cancer after surgery, 6 cycles of chemotherapy are generally carried out. “, specifies the organization. But what do we mean by “preventive chemotherapy” which also goes by the name “adjuvant chemotherapy”? According to the HUG*, we speak of adjuvant chemotherapy when chemotherapy is offered after surgery, knowing that it “ is indicated in particular when analyzes of the tumor suggest that the risk of recurrence of the disease is significant. »
How can chemotherapy be used as a preventative treatment?
Adjuvant chemotherapy therefore aims to reduce the risk of developing metastases and increase the chances of cure. It can, in certain cases, be associated with immunotherapy. Treatment begins 3 to 6 weeks after surgery. The observation is the same for the National Cancer Institute (INCa) which underlines “ that adjuvant chemotherapy is indicated particularly when clinical and pathological examinations suggest that the risk of recurrence is significant. The aim of chemotherapy here is to reduce it and improve the chances of recovery. In certain cases it can be associated with targeted therapy. Treatment is started within 3 months after surgery. » It also turns out that the term “adjuvant” can apply to any treatment (chemotherapy, radiotherapy, hormonal therapy, immunotherapy) administered after surgery and intended to increase its positive effects. Less common, “neoadjuvant chemotherapy” is offered before surgery to reduce the size of a tumor that is too large to be operated on straight away or to allow conservative surgery.
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Chemotherapy can therefore also be used as a preventive treatment, to reduce the risk of cancer reappearing and spreading in the body via the spread of cancer cells in the blood. “ The other use of chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer from recurring. Surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread through the bloodstream to distant sites. This will cause the cancer to return months or years later. In some cancers, treatment with chemotherapy, given before or after local surgery or radiation therapy, can kill these cells and prevent the cancer from coming back. »attests for his part to the journal The ConversionProfessor Ian Olver, member of the Faculty of Health and Medical Sciences, at the University of Adelaide. But if doctors can't see these cells, how do they know that additional chemotherapy to prevent recurrences is effective?
What factors lead to recommending adjuvant chemotherapy?
The answer lies in clinical trials. Studies have compared patients who underwent surgery only with those whose operation was followed by adjuvant chemotherapy and the results showed that “ the additional treatment allowed patients not to relapse and survive longer. “, specifies the specialist. As for its effectiveness, the INCa recalls that adjuvant chemotherapy is frequent, but not systematic because it is only considered when it can reduce the risks of the appearance of metastases. However, the latter depends on the stage of evolution of the cancer, itself linked to: the size of the tumor, the presence of cancer cells in the lymph nodes (small swellings distributed along the lymphatic vessels which play a role in protection against infections), the type of cancer cells and whether or not they invade blood or lymphatic vessels. “ The decision to offer adjuvant chemotherapy takes into account these risk factors, but also age, general condition as well as medical and surgical history. »he notes.
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Prof. Ian Olver gives the example of bowel cancer, which has a high risk of recurrence after surgery due to its size or spread to local lymph nodes. “ The first chemotherapy tested improved survival by 15%. With more intense chemotherapy, the chances of surviving six years approach 80%. “, he says, specifying that preventive chemotherapy is generally administered for three to six months. The Mayo Clinic (American university hospital and research federation) affirms that “Treating certain types of cancer, such as breast and colon cancer, with adjuvant therapy can be very beneficial. For some other types of cancer, there may be no benefit. » Furthermore, “ If the cancer is at a very early stage, before it has had time to spread, the risk of the cancer coming back after surgery may be very low. Adjuvant therapy may offer little benefit in this case. But if the cancer is in an advanced stage or has spread to nearby lymph nodes, adjuvant treatment may be more beneficial. »
How long does it take to recover?
What about the number of lymph nodes involved? “The more lymph nodes involved, the greater the risk that cancer cells will be left after local treatment, such as surgery. “, responds the body. Finally, another question remains, whether Kate Middleton's age (42) can make a difference. On this subject, Professor Bob Phillips, pediatric oncologist at the University of York, informed the Reuters agency that “Younger patients tend to be healthier at diagnosis and are therefore more likely to resist optimal doses of chemotherapy given at ideal intervals. » Because there is indeed a risk of adverse effects given that chemotherapy affects cancer cells, but also healthy cells which divide rapidly, such as the cells of the bone marrow, the mucous membrane of the mouth, the stomach, intestine or hairline cells. Among the most common, HUG cites nausea, skin problems, vomiting, fatigue and temporary hair loss.
Of course, these effects vary depending on the medication and the person, but it is known that as younger people tend to be healthier and fitter than older people, their recovery time is also shorter. . Note, however, that doctors specializing in the treatment of cancer have declared that there is vagueness around the expression “preventive chemotherapy” used by Kate Middleton. If in doubt, it could also be “chemoprevention”, an intervention which consists of administering drugs, vitamins or other substances to prevent the appearance of cancer. This method can be used according to three distinct processes according to the Oncolink website: in primary prevention (preventing cancer in a healthy person), in secondary prevention (preventing a precancerous area from becoming cancerous) in tertiary prevention (used in a person with already had cancer, to prevent her from developing another cancer). Still, Prince William's wife addressed people facing this illness “ in any form » to call them not to lose « faith nor hope.
*THE Geneva University Hospitals