**Core Concept**
Chemotherapeutic drugs induce cell death through multiple mechanisms, primarily targeting rapidly dividing cells. While apoptosis is the intended, programmed form of cell death, some drugs cause uncontrolled cell lysis due to severe cellular damage, leading to necrosis.

**Why the Correct Answer is Right**
Many chemotherapeutic agents, such as cisplatin or doxorubicin, trigger DNA damage and mitochondrial dysfunction. This activates intrinsic apoptotic pathways via caspase cascades. However, at high doses or in cells with impaired apoptotic machinery, severe damage overwhelms cellular repair systems, resulting in necrotic cell death. Thus, both apoptosis and necrosis can occur depending on drug dose, cell type, and genetic background.

**Why Each Wrong Option is Incorrect**
Option A: Chemotherapeutic drugs do not exclusively cause necrosis; they often induce apoptosis, especially in sensitive tumor cells.
Option B: Apoptosis is a major mechanism, but not the only one—necrosis is also observed, especially in high-dose or resistant cells.
Option D: Anoikis is a form of apoptosis triggered by loss of cell adhesion and is not a primary mode of action of chemotherapy.

**Clinical Pearl / High-Yield Fact**
Chemotherapy-induced cell death is not uniformly apoptotic—understanding both apoptosis and necrosis helps explain treatment response, toxicity, and resistance mechanisms. Drugs like anthracyclines promote apoptosis, while others like cyclophosphamide can cause mixed cell death patterns.

✓ Correct Answer: C. Both necrosis and apoptosis