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Adjuvant chemotherapy

This term is used to describe the delivery of chemotherapy after a definitive surgical (usually) procedure for a cancer (i.e. its intended curative removal), in the absence of overt residual cancer. The rationale for this usage is in patients who have a moderate to high risk of subsequent relapse. This relapse is due to microscopic amounts of residual cancer that the surgeon has not removed, despite his impression that he has performed a curative resection.
 
In that current chemotherapy for most cancers is not capable of curing the patient when there is a large tumour bulk but is capable of cure when there is a small amount of cancer cells, so the best time to deliver chemotherapy with curative intent is when the tumour burden is least (i.e. just after the operation). The reason that cancer chemotherapy is not capable of curing very large tumour burdens (an expression used to denote an amount of cancer that runs into tens of millions of cells) is because of drug resistance to the drugs, which, just as in drug resistance to infections such as tuberculosis, is more easily achieved (either by Darwinian or Lamarckian methodology) when the number of target cells is greatest.
 

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