What the pathology report decides
The specimen is staged for tumour depth, number of positive lymph nodes, margin status, lymphovascular and perineural invasion, and tumour grade. Molecular tests such as MMR/MSI status, HER2 or hormone receptors are added where relevant. Together these define recurrence risk and therefore the benefit of systemic treatment.
Before or after surgery
Some cancers are treated with chemotherapy or chemoradiotherapy first, to shrink the tumour and treat micrometastatic disease — locally advanced rectal, gastric, oesophageal and many ovarian cancers. Others receive it only afterwards. Timing is guideline-driven, using NCCN and ESMO recommendations adapted to the individual.
Timing after the operation
When adjuvant chemotherapy is indicated it is usually started within six to eight weeks, once wounds have healed. Faster surgical recovery is clinically valuable partly because it protects this window.
Common questions
- Can I refuse chemotherapy?
- Yes. You will be given the absolute benefit in your case, the side-effect profile and the alternatives, so the decision is genuinely yours.
- When is radiotherapy needed?
- Most commonly for rectal cancer before surgery, after breast-conserving surgery, and in selected cervical, sarcoma and head and neck cancers.
Related reading
This page is general education, reviewed by Dr. Ishaan Allahabadi, MCh Surgical Oncology (Edge Hill, UK) · MS Surgery · MBBS (Accredited by the Royal College of Surgeons of England). It is not a substitute for individual medical advice. Treatment decisions are made after reviewing your imaging and pathology, in a multidisciplinary tumour board.