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Hormone Therapy
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 Hormones
are chemicals produced by glands, such as the ovaries and testicles.
Hormones help some types of cancer cells to grow, such as breast cancer and
prostate cancer. In other cases, hormones can kill cancer cells, make cancer
cells grow more slowly, or stop them from growing.
Hormone therapy as a cancer
treatment may involve taking medications that interfere with the activity of
the hormone or stop the production of the hormones. Hormone therapy may
involve surgically removing a gland that is producing the hormones.
Your physician may
recommend a hormone receptor test to help determine treatment options and to
help learn more about the tumor. This test can help to predict whether the
cancer cells are sensitive to hormones.
The hormone receptor test
measures the amount of certain proteins (called hormone receptors) in cancer
tissue. Hormones (such as estrogen and progesterone that naturally occur in
the body) can attach to these proteins. If the test is positive, it is
indicating that the hormone is probably helping the cancer cells to grow. In
this case, hormone therapy may be given to block the way the hormone works
and help keep the hormone away from the cancer cells (hormone receptors). If
the test is negative, the hormone does not affect the growth of the cancer
cells, and other effective cancer treatments may be given. Always discuss
the results of the hormone receptor test with your physician.
If the test indicates that
the hormones are affecting your cancer, the cancer may be treated in one of
following ways:
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Treating cancer cells to keep them from receiving the hormones they need to
grow.
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Treating the glands that produce hormones to keep them from making hormones.
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Surgery to remove glands that produce the hormones, such as the ovaries that
produce estrogen, or the testicles that produce testosterone.
The type of hormone therapy
a person receives depends upon many factors, such as the type and size of
the tumor, the age of the person, the presence of hormone receptors on the
tumor, and other factors.
Your physician may
prescribe hormone therapies before some cancer treatments or after other
cancer treatments. If hormone therapy is given before the primary treatment,
it is called neoadjuvant treatment. Neoadjuvant treatments help to kill
cancer cells and contribute to the effectiveness of the primary therapy. If
hormone therapy is given after the primary cancer treatment, it is called
adjuvant treatment. Adjuvant therapy is given to improve the chance of a
cure.
With some cancers, patients
may be given hormone therapy as soon as cancer is diagnosed, and before any
other treatment. It may shrink a tumor or it may halt the advance of the
disease. And in some cancer, such as prostate cancer, it is helpful in
alleviating the painful and distressing symptoms of advanced disease. The
National Cancer Institute (NCI) states that although hormone therapy cannot
cure prostate cancer, it will usually shrink or halt the advance of disease,
often for years.
Hormone therapy may be used
to prevent the growth, spread, and recurrence of breast cancer. The female
hormone estrogen can increase the growth of breast cancer cells in some
women. An example of this type of medication is tamoxifen (Nolvadex®), which
works by blocking the effects of estrogen on the growth of malignant cells
in breast tissue. However, tamoxifen does not stop the production of
estrogen. Men who have breast cancer may also be treated with tamoxifen.
Tamoxifen is currently
being studied as a hormone therapy for treatment of other types of cancer.
There are several other hormonal agents for breast cancer that work like
tamoxifen, including raloxifene (Evista®), toremifene (Fareston®), and
fulvestrant (Faslodex®).
Hormone therapy may be
conafterred for women whose breast cancers test positive for estrogen and
progesterone receptors.
Newer medications approved
by the US Food and Drug Administration (FDA), called aromatase inhibitors,
are used to treat advanced breast cancer or to prevent the recurrence of
breast cancer in postmenopausal women. These drugs, such as anastrozole (Arimidex®), letrozole
(Femara®), and exemestane (Aromasin®), prevent estrogen production.
Another new drug for
recurrent breast cancer is fulvestrant (Faslodex®). Also approved by the
FDA, this drug binds with the estrogen receptor and eliminates it, rather
than than just blocking it, making it less effective in promoting growth of
the cancer. After effects for fulvestrant include hot flashes, mild nausea,
and fatigue.
With prostate cancer, there
may be a variety of medications used in hormone therapy. Male hormones, such
as testosterone, stimulate prostate cancer to grow. Hormone therapy is given
to help stop hormone production and to block the activity of the male
hormones. Hormone therapy can cause a tumor to shrink and the
prostate-specific antigen (PSA) levels to decrease.
The following are some
potential after effects that may occur with hormone therapy. However, the
after effects will vary depending upon the type of hormone therapy that is
given. Every person’s hormone treatment experience is different and not
every person will experience the same after effects. Discuss the potential
after effects of your hormone therapy with you physician.
As each person's individual
medical profile and diagnosis is different, so is his/her reaction to
treatment. After effects may be severe, mild, or absent. Be sure to discuss
with your cancer care team any/all possible after effects of treatment before
the treatment begins.
For
prostate cancer, either the surgical removal of the testes or hormone
drug therapy can improve the cancer. Both surgery and drugs may cause hot
flashes, impotence, a loss of desire for sexual relations and male breast
enlargement.
For
breast cancer, some women may experience after effects from tamoxifen
that are similar to the symptoms some women experience in menopause. Other
women do not experience any after effects when taking tamoxifen. The
following are some of the after effects that may occur when taking tamoxifen:
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Hot flashes.
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Nausea and/or vomiting.
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Vaginal spotting (a blood stained discharge from the vagina that is not
part of the regular menstrual cycle).
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Increased fertility in younger women.
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Irregular menstrual periods.
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Fatigue.
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Skin rash.
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Loss of appetite or weight gain.
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Headaches.
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Vaginal dryness or itching and/or irritation of the skin around the vagina.
Taking tamoxifen also
increases the risk of endometrial cancer (involves the lining of the uterus)
and uterine sarcoma (involves the muscular wall of the uterus), both cancers
of the uterus. There is also a very small risk of blood clots and stroke,
eye problems such as cataracts, and liver toxicities. Tamoxifen should be
avoided during pregnancy.
Tamoxifen is used to treat
men with breast cancer as well. As each person's individual medical profile
and diagnosis is different, so is his/her reaction to treatment. After
effects may be severe, mild, or absent. Be sure to discuss with your cancer
care team any/all possible after effects of treatment before the treatment
begins.
Men may experience the
following after effects:
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Headaches.
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Nausea and/or vomiting.
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Skin rash.
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Impotence.
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Decrease in sexual interest.
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