Chemotherapy remains one of the most effective systemic tools in cancer treatment. Used before, during, or after surgery, it targets cancer cells throughout the body. Understand when, why, and how chemotherapy is used — and the role your surgeon plays in its planning.
Chemotherapy refers to the use of cytotoxic (cell-killing) drugs to destroy cancer cells or prevent them from dividing and growing. Unlike surgery, which removes cancer from a specific site, chemotherapy works systemically — travelling through the bloodstream to reach cancer cells anywhere in the body.
Chemotherapy drugs work by targeting rapidly dividing cells — a defining characteristic of cancer. Different drugs work in different ways: some damage DNA, some block cell division, and others disrupt signals that tell cancer cells to grow. Combinations of drugs (regimens) are often more effective than single agents.
In modern surgical oncology, chemotherapy is rarely used in isolation. It is carefully integrated with surgery, radiotherapy, and immunotherapy based on the cancer type, stage, and the patient's overall health — always with a clear goal, whether curative, downstaging, or symptom control.
In my practice, I always evaluate chemotherapy as part of the complete treatment plan — not as an alternative to surgery, but as a partner to it. The timing of chemotherapy relative to surgery is critical and must be individualised for each patient and each cancer.
I work closely with medical oncologists to ensure that every patient receives the right drugs, at the right time, in coordination with their surgical plan — maximising the chance of cure while protecting quality of life.
Chemotherapy is used in four distinct settings, each with a specific intent. Understanding the goal determines the timing and drug regimen.
Given before surgery to shrink the tumour, making it easier to remove. Helps downstage locally advanced cancers and assess tumour response to drugs. Also treats micrometastases early.
Common in: breast, rectal, oesophageal, bladder, ovarian cancers.
Pre-operativeGiven after surgery to eliminate residual microscopic cancer cells that may have spread beyond the surgical site, reducing the risk of recurrence.
Common in: colon, breast, stomach, lung, pancreatic, ovarian cancers.
Post-operativeChemotherapy given alongside radiotherapy to sensitise cancer cells to radiation — enhancing the effect of both treatments simultaneously.
Common in: cervical, head & neck, anal, oesophageal, lung cancers.
Combined ModalityUsed when the cancer is not curable but can be controlled — to shrink tumours, relieve symptoms, and improve quality of life and survival.
For metastatic or recurrent cancers where cure is not the primary goal.
Symptom ControlChemotherapy drugs are grouped by how they attack cancer cells. Most regimens combine two or more drug classes for greater effect.
| Drug Class | How It Works | Common Examples | Used In |
|---|---|---|---|
| Alkylating Agents | Damage DNA directly, preventing cancer cells from replicating | Cyclophosphamide, Cisplatin, Carboplatin, Oxaliplatin | Breast Ovarian Lung GI |
| Antimetabolites | Interfere with DNA/RNA synthesis, blocking cell division | 5-Fluorouracil (5-FU), Capecitabine, Gemcitabine, Methotrexate | Colon Breast Pancreas Head & Neck |
| Taxanes | Stabilise microtubules, preventing cell division from completing | Paclitaxel, Docetaxel, Nab-Paclitaxel | Breast Ovarian Lung Stomach |
| Anthracyclines | Intercalate DNA and inhibit topoisomerase II, causing DNA strand breaks | Doxorubicin (Adriamycin), Epirubicin | Breast Lymphoma Sarcoma |
| Vinca Alkaloids | Bind tubulin and inhibit microtubule formation during mitosis | Vincristine, Vinorelbine, Vinblastine | Lung Lymphoma Breast |
| Topoisomerase Inhibitors | Block enzymes needed for DNA replication and repair | Irinotecan, Etoposide, Topotecan | Colorectal Ovarian Lung |
| Targeted Chemotherapy | Target specific molecular pathways driving cancer growth | Trastuzumab, Bevacizumab, Cetuximab | HER2+ Breast Colorectal Lung |
The method of delivery depends on the drug, cancer type, and treatment setting. Your oncology team selects the safest and most effective route.
The most common route. Drugs are delivered directly into a vein via a drip, often through a PICC line or port — ensuring rapid, full-dose delivery throughout the body.
Convenient for outpatient use. Some drugs are as effective orally as IV — taken at home on a defined schedule. Requires strict adherence and monitoring.
Delivered directly into the abdominal cavity — used in peritoneal cancers. Heated chemotherapy (HIPEC) is given at the time of surgery for maximum tumour contact.
Chemotherapy affects normal rapidly-dividing cells alongside cancer cells, causing side effects. Most are temporary and manageable with modern supportive care. Knowing what to expect helps patients prepare and respond early.
Reduced blood counts — low RBC (anaemia), WBC (infection risk), and platelets. Monitored with regular blood tests. G-CSF injections may be given to boost WBC.
One of the most common side effects, now well-controlled with modern antiemetics (ondansetron, dexamethasone). Usually peaks 24–72 hrs after treatment.
Occurs with certain drugs (taxanes, anthracyclines). Usually temporary — hair regrows after treatment. Scalp cooling caps can reduce hair loss in some cases.
Very common — caused by anaemia, the metabolic demand of fighting cancer, and drug effects. Rest, nutrition, and graded activity help significantly.
Tingling, numbness, or pain in hands and feet — more common with platinum drugs and taxanes. Usually resolves after treatment but can occasionally persist.
Some drugs affect specific organs: platinum agents on kidneys, anthracyclines on the heart, bleomycin on the lungs. Pre-treatment evaluation and monitoring prevent serious harm.
Side effects vary significantly by drug, dose, regimen, and individual patient factors. Your oncology team plans supportive care proactively — most patients tolerate modern chemotherapy regimens well and continue normal activity during treatment cycles.
As a surgical oncologist, Dr. Gore does not administer chemotherapy — but he plays a pivotal role in determining when it is needed, in what sequence, and whether the patient is fit for surgery before or after it.
If you or a family member has been diagnosed with cancer or advised chemotherapy, speak with Dr. Gore for a surgical oncologist's perspective on the complete treatment plan.