When Do You Get Chemotherapy?

Chemotherapy after or before surgery

It's fairly common for chemotherapy to be given after surgery, as soon as you recover. The time between surgery and chemotherapy depends on each person's unique situation, so don't worry if you start sooner or later than someone else. Doctors call this "adjuvant" chemotherapy because it's given in addition to surgery, which is considered the primary treatment.

In some cases, chemotherapy is given before surgery to shrink the cancer so less tissue has to be removed. When chemotherapy is given before surgery, it's called "neoadjuvant" chemotherapy. Only certain types of cancers respond well to chemotherapy before surgery.

Chemotherapy treatment schedule

Chemotherapy usually is given in cycles -- a specific period of treatment followed by a period of recovery. For instance, you may get chemotherapy on the first day of the cycle and then have a few weeks of recovery with no treatment. That is one cycle. Or you may get chemotherapy for several days in a row, or every other day, and then have a recovery period. A complete chemotherapy treatment is made up of several cycles. The number of cycles in a regimen and the total time of each regimen varies depending on the medicines used, but most regimens take 3 to 6 months to complete.

In some cases your doctor may recommend a "dose-dense" chemotherapy schedule. Dose-dense chemotherapy usually means that the chemotherapy medicines are given about every 2 weeks, instead of a more routine schedule of every 3 weeks. Research has shown that dose-dense chemotherapy can improve survival and lower the risk of the breast cancer coming back compared to a traditional chemotherapy schedule.

Dose-dense chemotherapy doesn't allow as much time for the immune system and red blood cells to recover between chemotherapy cycles. Doctors sometimes use the medicines Neupogen (chemical name: filgrastim) or Neulasta (chemical name: pegfilgrastim) to strengthen the immune system, and Procrit (chemical name: epoetin alfa), Epogen (chemical name: epoetin alfa), or Aranesp (chemical name: darbepoetin alfa) to strengthen the red blood-cell system during dose-dense chemotherapy.

The decision to have a dose-dense or traditional chemotherapy schedule will be based on the chemotherapy being considered and your specific situation.