Adjuvant chemotherapy is indicated in all breast cancers, basically because according to theory called biological theory there is an entity where in the cancer cells microscopically they spread all over the body and then go and sit inactively in the spine, in the lever, in the lungs and different parts according to the brain without being active and these cancers may not be picked up even in the pet scan, so even in stage 1 or stage 2 disease of the breast cancer or in locally advanced breast cancers. We know that even if we don't pick up metastasis in pet scan this cancer cells may be sitting here and there being inactive, this is the reason to target these cells we give you what is called as chemotherapy. Chemotherapy is the drug that is given to cure any active and inactive cancer cells that are sitting in the body without any changes so, this is reason chemotherapy is given in all breast cancers. So there are two types of Adjuvant chemotherapy that is the routine Adjuvant chemotherapy that is we do surgery first either breast conservation surgery or mastectomy and then followed by cubic chemotherapy, whereas if the tumour is locally advanced that is it is bigger in the breast to conserve the breast, to reduce the size of the tumour we do neoadjuvant chemotherapy that is 3 to 4 cycles of chemotherapy is given before the surgery and then followed by reassessing the patients for the stage of the disease of size of the lump and to consider if breast conservation surgery is possible after giving neoadjuvant chemotherapy. To give this chemotherapy drugs also by Adjuvant therapy you might have to put what is called chemo port that has be inserted in the chest wall which goes into the main vanes of the heart and later to enter into the circulation directly, so this will prevent damage to the hand that can happen because of the chemotherapy.

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