Are There Complications Of Breast Cancer
Possible complications from breast cancer treatment include:
- Lymphoedema in some cases, removing your lymph nodes may cause swelling, discomfort and pain in the arm, shoulder and upper body.
- Early menopause certain treatments, especially chemotherapy and hormone therapy, can cause menopause symptoms, such as hot flushes, joint pain, or a change in sex drive, to occur earlier than usual.
- Anxiety and depression research shows that anxiety and depression are common among women with breast cancer. One study found that up to 50 per cent of women with early breast cancer may experience anxiety and/or depression in the year after diagnosis.
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It Will Also Be Important In The Future To Differentiate Prior To Treatment Patients Who Are At High Risk Of Relapse From Those At Lower Risk In Order To Tailor Hormone Treatment This May Be Done To Avoid Escalation Of Anti
The CANTO cohort comprises 12,000 women with breast cancer treated in 26 French centres. It is sponsored by Unicancer and directed by Professor Fabrice André, specialist breast cancer oncologist at Gustave Roussy, Inserm research director and responsible of the lab Predictive Biomarkers and Novel Therapeutic Strategies in Oncology . Its objective is to describe adverse effects associated with treatment, to identify the populations at risk of developing them and to adjust therapy accordingly, so as to afford a better quality of life following cancer.
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J Clin Oncol. 2019 Feb 10 37:423-438 : https://doi.org/10.1200/JCO.18.01160
TO CITE THIS POST :
1INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
2Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
3Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
4Department of Supportive Care, Gustave Roussy, Cancer Campus, Villejuif
5Medical Oncology, Centre François Baclesse Caen, Caen
6Unicancer, Paris, France
7Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
8Department of Internal Medicine and Medical Specialties , School of Medicine, University of Genova, Genova, Italy
9Surgical Oncology, Centre Georges-François Leclerc, Dijon
10Medical Oncology, Institut Curie, Paris
14Surgical Oncology, C.R.L.C Val dAurelle, Montpellier
Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
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Hormone Therapy Can Cause Side Effects
Because hormone therapy blocks your bodys ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.
Some common side effects for men who receive hormone therapy for prostate cancer include
Treatment To Lower Androgen Levels From Other Parts Of The Body
LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Some drugs can block the formation of androgens made by these cells.
Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.
Abiraterone can be used in men with advanced prostate cancer that is either:
This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.
Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.
Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .
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When Is Hormone Therapy Used
Hormone therapy may be used:
- If the cancer has spread too far to be cured by surgery or radiation, or if you cant have these treatments for some other reason
- If the cancer remains or comes back after treatment with surgery or radiation therapy
- Along with radiation therapy as the initial treatment, if you are at higher risk of the cancer coming back after treatment
- Before radiation to try to shrink the cancer to make treatment more effective
What If My Psa Rises While Im On Hormone Therapy
When the PSA is rising or cancer is spreading despite a low level of testosterone, prostate cancer is called castration-resistant, or hormone-refractory. Despite this name, some hormonal therapies may still work. But prostate cancer in this setting may progress and become more aggressive and resistant, and you should be prepared to discuss additional treatment strategies with your doctor. This is the time when a medical oncologist, if not already involved in your care, gets involved. These doctors specialize in medical, systemic treatments for prostate cancer, which is useful at this time given that your disease is typically metastatic, meaning that it is not confined to only one location. Cancer cells in this situation have typically spread through the blood stream or lymphatics to other places in the body, and localized treatments are rarely helpful except in circumstances where where you are having symptoms, such as problems with urination.
Fortunately, more and more treatments for metastatic castration-resistant prostate cancer have become available in recent years, including certain newer androgen directed therapies, taxane chemotherapy, immunotherapy, PARP inhibitors, and, in 2022, lutetium-PSMA radionuclide therapy. Additional tests are required for some of these treatments to see if your particular type of prostate cancer is likely to respond. See Chapter 5 in PCFs Prostate Cancer Patient Guide for more details.
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What Are The Side Effects Of Hormonal Therapy
Any disruption to the balance of hormoneswhether it occurs naturally or is part of treatmentcan cause side effects. The specific side effects that come from blocking a persons estrogen, progesterone or androgen production will depend on the individual and the type of hormonal therapy they receive. Some common side effects people experience are as follows:
Hormonal therapy can be administered in the following ways:
- Oral medications
- Injectable medications given under the skin
- Surgery to remove or ablate the hormone-producing ovaries or testicles
What Types Of Cancer Is Hormonal Therapy Used For
- Breast cancer: An estimated 80% of breast cancers are hormone-sensitive , which means they are fueled by hormones. More specifically, these are called estrogen-receptor-positive or progesterone-receptor-positive breast cancers. These terms mean this particular cancer has estrogen and/or progesterone receptors, which invite hormones to bind to them. Hormone-receptor-negative cancers are not influenced by hormones.
- Prostate cancer: Most prostate cancers are stimulated by male sex hormones called androgens, says Dr. Leapman this is why urologists also refer to this treatment as androgen deprivation therapy. These hormones are made in the adrenal glands and testicles. Hormonal therapy for prostate cancer is used in several ways, including as short-term therapy for men prior to and during radiation therapy, as well as for men with advanced or metastatic cancer.
Hormonal therapy is sometimes used to destroy hormone-sensitive cancer cells that have spread to other parts of the body or those that have returned .
Hormonal therapy can also be used to ease a cancer patients symptoms . This is especially helpful for patients who are not able to have surgery or radiotherapy because of other health concerns.
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How Is Hormone Therapy Used To Treat Breast Cancer
There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:
Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.
Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .
Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .
Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .
Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.
Other Key Findings In The Study
Patients who had lower PSA scores:
- Experienced an eight-year disease-free survival rate of 75 percent, compared with only 18 percent for those with the highest PSA scores.
- Had a 97 percent distant metastasis-free survival rate, compared with 73 percent for those with the highest PSA scores.
However, the study also indicated that, when a PSA is falling, there is no specific number that predicts future survivability.
While there is no magic number for the PSA that guarantees that prostate cancer has been cured in an individual patient, in general, the lower the PSA number, the better chances that the cancer will not return or spread, said Michael E. Ray, M.D., Ph.D., lead author of the study and a radiation oncologist at the University of Michigan Medical Center.
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How The Study Was Performed
During the study, scientists randomized 1,071 men with intermediate- or high-risk localized prostate cancer into four groups. One group received radiation and six months of an anti-testosterone drug called leuporelin, and the second group received radiation plus 18 months of leuporelin therapy. Two other groups were treated with the same regimens of either radiation plus six or 18 months of leuporelin therapy, along with another drug called zoledronic acid, which helps to limit skeletal pain and related complications should cancer spread to the bones. Study enrollment occurred between 2003 and 2007 at 23 treatment centers across New Zealand and Australia.
Having Hormonal Therapy For Breast Cancer
Hormonal therapy drugs reduce the risk of breast cancer coming back. It is important to take it for as long as you have been prescribed it for. Try to make taking it part of your daily routine so it becomes a habit.
Most women cope well with the side effects of hormonal therapy. They may be more of a problem in the first few months, but usually get better over time. If the side effects do not improve or are difficult to cope with, talk to your specialist nurse or cancer doctor. They can prescribe drugs to help and suggest ways of coping.
If you are still having problems after this, then your cancer doctor may suggest changing to a different type of hormonal therapy.
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Surgical Removal Of The Ovaries
The operation to remove the ovaries is called oophorectomy. Surgical removal of the ovaries is a permanent way to reduce the levels of oestrogen.
It is a very effective treatment to stop early breast cancer returning or to slow the progress of metastatic cancer. This can also reduce the risk of developing ovarian cancer.
Surgery to remove the ovaries can be done with keyhole surgery or with an open operation .
Your surgeon will discuss with you the pros and cons of these different techniques. Oophorectomy is done under a general anaesthetic .
Usually the fallopian tubes are also removed but the uterus is left intact. After oophorectomy, the symptoms of menopause may come on suddenly. This is different to turning off the ovaries with medication which brings menopausal symptoms on gradually
Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
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Evidence About Hormone Therapy And Prostatectomy
Gleave ME, La Bianca S, Goldenberg SL. Neoadjuvant Hormonal Therapy Prior to Radical Prostatectomy: Promises and Pitfalls. Prostate Cancer and Prostatic Diseases 2000 3:13644. PMID: 12497089.
Hurtado-Coll A, Goldenberg SL, Klotz L, Gleave ME. Preoperative Neoadjuvant Androgen Withdrawal Therapy in Prostate Cancer: The Canadian Experience. Urology 2002 60:4551. PMID: 12231047.
Kumar S, Shelley M, Harrison C, et al. Neo-adjuvant and Adjuvant Hormone Therapy for Localized and Locally Advanced Prostate Cancer. Cochrane Database of Systematic Reviews 2006 CD006019. PMID: 17054269.
Soloway MS, Sharifi R, Wajsman Z, et al. Randomized Prospective Study Comparing Radical Prostatectomy Alone Versus Radical Prostatectomy Preceded by Androgen Blockade in Clinical Stage B2 Prostate Cancer. The Lupron Depot Neoadjuvant Prostate Cancer Study. Journal of Urology 1995 154:4248. PMID: 7541859.
Hormone Therapy For Reducing The Risk Of Breast Cancer
Women at moderate or high risk of breast cancer because of their family history may be offered hormone therapy to reduce their risk of developing breast cancer.
Drugs used to reduce the risk of breast cancer in women who have not had breast cancer include:
These drugs are usually taken for five years.
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Risk Of Other Health Problems
Evidence suggests that having hormone therapy might increase the chance of developing heart disease, stroke and type-2 diabetes. There is also some research that suggests having hormone therapy can increase your risk of getting blood clots and anaemia. But more research is needed to help us understand the links between these conditions.
Research shows that hormone therapy can cause:
- an increase in weight, particularly around the waist
- an increase in cholesterol levels
- changes in insulin.
Talk to your hospital doctor and GP about how often you should have general health checks. You may be weighed and have your blood pressure checked regularly. You may also have blood tests to check for diabetes and to measure your cholesterol levels. Your GP may suggest you have these checks about every six months. Or you can ask for them yourself at your GP surgery.
If you already have heart problems or diabetes, talk to your doctor before you start hormone therapy. They will work with you to manage these conditions.
While the risk of getting these conditions may be worrying, its important to remember that hormone therapy helps men to live longer by controlling the cancer.
What can help?
A healthy lifestyle can help reduce your risk of heart disease, stroke and type-2 diabetes. This includes:
- eating a healthy diet
Drugs That Block Estrogen
Some drugs work by blocking estrogen from causing cancer cells to grow.
Tamoxifen is a drug that prevents estrogen from telling cancer cells to grow. It has a number of benefits:
- Taking Tamoxifen for 5 years after breast cancer surgery cuts the chance of cancer coming back by half. Some studies show that taking it for 10 years may work even better.
- It reduces the risk that cancer will grow in the other breast.
- It slows the growth and shrinks cancer that has spread.
- It reduces the risk of getting cancer in women who are at high risk.
Other drugs that work in a similar way are used to treat advanced cancer that has spread:
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Feminism And The Breast Cancer Wars
The breast cancer wars were a series of conflicts between advocates and others about the causes, treatments, and societal responses to breast cancer. Women in the late 1980s and 1990s followed the successful approach used by ACT-UP and other AIDS awareness groups, of staging media-friendly protests to increase political pressure. Prominent women who made the wrong choice were publicly excoriated, as when Nancy Reagan chose mastectomy over lumpectomy followed by six weeks of radiation therapy. The abortionâbreast cancer hypothesis was formulated when an early study showed a connection between voluntary abortions and the development of breast cancer in premenopausal women, which pitted breast cancer advocates against abortion rights advocates.