The main results of this paper are cancellation, n-th root, and isomorphic refinement theorems for finitely generated modules over algebras over commutative zero-dimensional rings. The cancellation and n-th root properties are established more generally for algebras over commutative rings which are von Neumann regular modulo their radicals. Analogues of the theorems of Serre and ForsterSwan are also obtained.Suppose that R is a ring which is either (a) an algebra over a zero-dimensional commutative ring S, or (b) a locally module-finite algebra over a commutative ring S which is von Neumann regular modulo its radical. In either case, it is shown that (i) if A and B are finitely presented R-modules and if for every maximal ideal M of S, AM --BM (as R M modules) then A ~ B, and (ii) irA and B are finitely generated with A finitely presented, then there is an epimorphism A~B if there is one locally. This implies analogues of the theorems of Serre and Forster-Swan in these situations. In case (b), it is also shown that (iii) (the cancellation property) if A is a finitely generated left R-module and B and C are arbitrary left R-modules such that AOB~AOC, then B~C, and (iv) (n-th root property) if A is a finitely generated R-module and A" ~ B", then A ~ B. If both (a) and (b) hold (so that R is a locally module-finite algebra over a zero-dimensional ring), then we obtain (v) an isomorphic refinement theorem, which is as close as one can hope to come to the Krull-Schmidt theorem in the non-Noetherian situation: any two direct sum decompositions of a finitely generated R-module have isomorphic refinements. (i)-(iv) hold, in particular, for modules over commutative quasi-local rings, and finite algebras over these rings, and even in this situation they were previously known only when the rings were Noetherian. (v) does not hold in that generality, but even in the case when R = S and S is commutative and von Neumann regular the resialt is new.All rings and algebras in this paper are associative with t, and all modules are unital.