Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy (chemotherapy before surgery)
Neoadjuvant chemotherapy is chemotherapy given before breast cancer surgery. It is used to treat breast cancer systemically with chemotherapy agents, while also helping shrink the tumour to make surgery easier and, in many cases, to increase the chance of breast-conserving surgery (lumpectomy) rather than mastectomy.
Why do we use neoadjuvant chemotherapy?
Neoadjuvant chemotherapy may be recommended to:
Reduce the size of the tumour (and sometimes involved lymph nodes) before surgery.
Improve the likelihood of breast conservation where appropriate.
Treat microscopic cancer cells elsewhere in the body early (systemic treatment).
Allow your team to directly assess how the cancer responds to treatment (response can help guide the next steps after surgery).
Which breast cancers are most likely to benefit?
Neoadjuvant chemotherapy is commonly considered when the cancer subtype is expected to respond well to chemotherapy and when the overall disease burden suggests chemotherapy will be needed as part of treatment. This often includes triple negative breast cancer and HER2-positive breast cancer, and selected higher-risk hormone receptor–positive cancers.
In some situations, additional systemic treatments may be given alongside chemotherapy (for example, targeted therapy for HER2-positive disease, and in selected cases, immunotherapy). Your medical oncologist will tailor the regimen to your cancer biology and stage.
What happens before starting treatment?
Before chemotherapy begins, we aim to build a clear “road map” so treatment is safe, well-targeted, and measurable:
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Confirmation of diagnosis and tumour biology from biopsy (including receptor status such as ER/PR/HER2 and grade).
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Baseline breast imaging (often mammogram and ultrasound; MRI may be recommended in selected situations).
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A small marker clip is often placed in the tumour at biopsy so the original site can be accurately located later, even if the cancer shrinks dramatically.
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Assessment of lymph nodes (including ultrasound ± biopsy if indicated).
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Blood tests and an overall health assessment.
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Planning for chemotherapy access (many patients have a PICC line or a port to protect the veins and make treatment smoother).
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If specific drugs are planned, additional checks may be required (for example, heart function assessment when HER2-targeted therapy is used).
How long does treatment usually take?
Neoadjuvant chemotherapy is usually delivered over several months. Regimens vary, but many courses run for up to about 4–6 months, given every 1, 2, or 3 weeks depending on the drugs used.
Monitoring during treatment
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Your team will monitor you closely to maximise safety and track response:
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Regular reviews with your medical oncologist and treatment team.
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Blood tests before cycles to check blood counts, kidney/liver function, and overall fitness for treatment.
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Assessment of the breast and lymph nodes during treatment (clinical examination, and sometimes repeat ultrasound or MRI depending on the situation).
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Management of side effects early, so treatment can stay on track where possible.
How neoadjuvant chemotherapy affects surgery?
After chemotherapy, surgery is planned based on:
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How much the tumour (and any involved nodes) has responded.
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Your breast size/shape, tumour location, and preferences.
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The safest oncological operation for you (lumpectomy vs mastectomy).
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Lymph node surgery planning (for example, sentinel node biopsy or other tailored approaches depending on node status before treatment and response).
At the time of surgery, the pathologist examines the breast and any lymph nodes to determine how much cancer remains. If no invasive cancer is found in the breast and nodes, this is called a pathological complete response (pCR). In certain subtypes (particularly triple negative and HER2-positive disease), achieving pCR is associated with improved outcomes.
Common side effects (and what we do to help)
Side effects depend on the exact regimen, but may include:
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Fatigue, nausea, appetite change, altered taste, mouth ulcers
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Hair loss (often temporary)
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Low white blood cells (increased infection risk), anaemia, bruising
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Peripheral neuropathy (numbness/tingling in hands or feet) with some drugs
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Skin and nail changes
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Menstrual changes and potential fertility impact in premenopausal women
Your oncology team will provide preventative medicines (for nausea, reflux, constipation, etc.) and may use treatments to support your white cell count where appropriate.
When to seek urgent help during chemotherapy?
Contact your treating team urgently (or present to Emergency) if you develop:
Fever (for example 38°C or higher), chills, or feeling unwell and “fluey”
Shortness of breath, chest pain, or new calf swelling/pain
Uncontrolled vomiting, severe diarrhoea, dehydration, or inability to keep fluids down
New confusion, severe headache, or rapidly worsening symptoms
Neoadjuvant chemotherapy at Breast & Wellness
At Breast & Wellness Centre, your care is coordinated through a multidisciplinary team. We focus on:
Clear explanation of why neoadjuvant treatment is (or isn’t) recommended in your situation
Close coordination between radiology, surgery, pathology, and medical oncology
Planning surgery from the start (including marker placement and localisation strategies) so there is no loss of direction as the tumour responds