Kate Middleton’s Cancer: What to Know About ‘Preventative’ Chemotherapy

Following the announcement that Kate, the Princess of Wales, will undergo “preventative” chemotherapy — also known as adjuvant chemotherapy — oncologists told MedPage Today this is a common strategy in cancer treatment.

Adjuvant chemotherapy regimens vary based on the type of cancer, but they are typically given every 3 to 4 weeks for somewhere between 4 and 6 cycles, Julie Gralow, MD, chief medical officer of the American Society of Clinical Oncology (ASCO), told MedPage Today.

“There would be a defined number of treatments, planned upfront, somewhat based on the stage or the aggressiveness” of the disease, Gralow said. “The whole reason for adjuvant chemotherapy would be that there’s a high enough estimated risk that some cells were either left behind [after] surgery, or more likely, that there’s a fear that they might have already gotten into the bloodstream or the lymphatic system.”

“If there’s a 5% improvement in the cancer not coming back, that’s typically considered enough of a reason for many patients to go ahead” with adjuvant chemotherapy, she noted.

While the oncologists did not speculate on Kate’s case specifically, they said that pelvic cancers are one consideration in the context of abdominal surgery.

Cancers of the Abdomen and Pelvis

The underlying reason for Kate’s “planned abdominal surgery” in mid-January is not known, but abdominal surgery for a cancer would include those in the gastrointestinal tract, such as stomach or colorectal cancer. There are also genitourinary tract or kidney cancers, Gralow said.

Lymphomas can occur anywhere, and there are lots of lymph nodes in the abdominal area, she pointed out, adding that peritoneal cancers like sarcomas are “really rare.”

Pelvic cancers would include gynecologic organs such as the uterus and ovaries, she said.

“Ovarian cancer is the big one we routinely start with surgery,” Mark Einstein, MD, a gynecologic oncologist and chair of ob/gyn at Rutgers University in New Jersey, told MedPage Today, noting that cervical cancer, for instance, usually starts with chemotherapy and radiation followed by surgery.

Oncologists tend not to do CT-guided biopsies with ovarian cancer “because we’ve learned that by sticking a needle in a confined ovarian cancer, we can expose the rest of the peritoneum to that cancer, and cause that cancer to rupture and maybe even track outside where the needle came in,” Einstein said.

Thus, with an ovarian neoplasm, the approach is typically surgery first, then chemotherapy, he said.

Even if the tumor is entirely removed during surgery “to where there’s no evidence of any visible disease, we know there are cells that can still exist,” Einstein explained. That’s why adjuvant treatment is a standard part of multimodal first-line therapies for many gynecologic cancers, he said.

Adjuvant chemotherapy usually starts 4 to 6 weeks after surgery, and is done outpatient with a standard combination of intravenous therapies, he noted.

With ovarian cancer, for instance, a typical combination is paclitaxel and carboplatin, which is commonly given over 6 cycles every 21 days, said Don Dizon, MD, a gynecologic oncologist with Brown University in Providence, Rhode Island.

“We have really good drugs to help mitigate the side effects” of chemotherapy, Dizon told MedPage Today, including ondansetron to alleviate nausea and vomiting. There’s also a scalp-cooling device called Paxman that can help people keep their hair during chemotherapy: “It’s very effective with carboplatin and Taxol [paclitaxel], particularly for white women,” he said.

Fatigue is another common side effect, Dizon noted. “For people on carboplatin and Taxol, I tell them it feels like they have the flu for the first 4 or 5 days after treatment, and then they can expect to feel well, especially as they come into the next cycle.”

‘Cancer Is Not One Diagnosis’

Dizon noted that cancer “is not just one diagnosis. It covers a host of conditions that can happen in any organ and in any tissue of the body.”

With ovarian cancer, for instance, there are three main types, Einstein explained: epithelial, stromal, and germ cell tumors. Epithelial ovarian cancers are the most common, typically occurring in women in their mid-50s, and these can be high or low grade.

“High-grade serous cancers are what people typically think of when they hear ovarian cancer, but younger women can get low-grade serous cancers, which carry a better prognosis overall,” Dizon said.

Stromal tumors are tumors of the connective tissue in the ovaries, Einstein said, and germ cell tumors arise from the eggs in the ovaries. More often, germ cell tumors occur in younger women, though they account for only about 8% to 10% of ovarian cancers overall, he said. Germ cell ovarian tumors are comparable to testicular cancer, which has a very high long-term survival rate and low risk of recurrence, he added.

“The most important thing is that with the right treatment, survival is generally good” with ovarian cancers, Einstein said.

Dizon echoed those sentiments: “No one should hear that word ‘cancer’ and assume they’re going to die of it,” he said in a TikTok video. “People are living longer with, and after, a diagnosis of cancer.”

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