1.1 About hormonal therapy
Hormonal therapy is an important treatment method for breast cancer. It works by either suppressing the production of hormones in the body or altering the response of breast cancer cells to hormones, thereby controlling their growth.
Our body primarily produces two types of female hormones: estrogen and progesterone. Before menopause, estrogen and progesterone are mainly produced by the ovaries, while after menopause, estrogen is primarily produced by the adrenal glands. When female hormones are produced in the body, they travel through the bloodstream to reach the breast tissue, where they can bind to hormone receptors on breast cells, stimulating their growth.
Medical research has shown that female hormones play a crucial role in the growth of breast cancer cells. Therefore, any factors that increase the levels of female hormones in the body, such as taking hormonal contraceptives, can potentially increase the risk of developing breast cancer. Conversely, by suppressing the production of female hormones or altering the response of breast cancer cells to these hormones, the growth of breast cancer cells can be inhibited. This forms the fundamental principle of hormonal therapy.
1.2 What are hormonal receptors?
Hormone receptors are proteins that exist on the surface of cells. They function like messengers, transmitting the signals of female hormones in the bloodstream into the cells, thereby influencing various cellular functions and growth. Hormone receptors can be categorized into two types: estrogen receptors and progesterone receptors, corresponding to different female hormones.
Female hormones are produced by the ovaries or adrenal glands in the female body. When they reach the breast tissue through the bloodstream, they bind to hormone receptors. These hormone receptors then initiate a series of metabolic reactions within the cells, ultimately stimulating the growth and proliferation of breast cells.
Research has revealed that certain breast cancer cells have the ability to produce a large number of hormone receptors, promoting their own proliferation. These overexpressed hormone receptors, when exposed to female hormones in the bloodstream, stimulate the excessive growth of cancer cells, leading to rapid tumor growth. Conversely, if there are clinical methods to inhibit the response of these hormone receptors, there is a potential to suppress the growth of cancer cells.
If the tumor cells possess these hormone receptors on their surface, the tumor is referred to as hormone receptor-positive breast cancer. In such cases, the tumor is likely to respond to hormonal therapy, making patients suitable candidates for hormone therapy.
1.3 Am I suitable for hormonal therapy?
To assess the patient’s response to hormonal therapy, it is necessary to determine whether the tumor cells are hormone receptor-positive. The doctor can perform a core needle biopsy of the tumor to confirm if it belongs to the hormone receptor-positive category.
1.4 Different types of hormonal therapy
Hormonal therapy for breast cancer can be categorized as follows:
Anti-estrogen drugs
Anti-estrogen drugs target the estrogen receptors on the surface of breast cancer cells. When these drugs reach the cancer cells through the bloodstream, they selectively interfere with the estrogen receptors, weakening the stimulation of estrogen on the cancer cells and inhibiting their growth.
The most commonly used anti-estrogen drug is Tamoxifen, which is effective for premenopausal and postmenopausal women. In addition to treating breast cancer, Tamoxifen is also used for preventing osteoporosis and reducing cholesterol levels.
Aromatase inhibitors
Aromatase inhibitors are primarily used in postmenopausal breast cancer patients. After menopause, estrogen is primarily produced by the adrenal glands. The adrenal glands first secrete androgens, which are then converted into estrogen by the enzyme aromatase. Aromatase inhibitors specifically inhibit the function of aromatase, thereby reducing estrogen levels in the body and suppressing the proliferation of breast cancer cells.
Commonly used aromatase inhibitors include:
- Anastrozole (Arimidex)
- Letrozole (Femara)
- Exemestane (Aromasin)
Ovarian treatments
In premenopausal women, estrogen is mainly produced and secreted by the ovaries. Ovarian treatments aim to suppress the ovarian production of estrogen. Ovarian treatment options include:
- Medication: Goserelin (Zoladex) effectively inhibits the ovarian production and secretion of estrogen, thereby controlling the growth of breast cancer tumors.
- Ovarian surgery: Surgical removal of the ovaries permanently stops estrogen production and secretion.
- Ovarian radiation therapy.
1.5 Side effects of hormonal therapy
Due to the principle of hormonal therapy, which aims to reduce the levels of female hormones in the body, patients undergoing hormonal therapy may experience discomfort associated with the decrease in estrogen levels. These symptoms are similar to those experienced during menopause and may include:
- Hot flashes: Sudden feelings of warmth, often accompanied by sweating and a flushed face.
- Vaginal dryness and itching: Decreased estrogen levels can lead to changes in the vaginal tissues, resulting in dryness, discomfort, and itching.
- Mood swings: Hormonal fluctuations can affect mood stability, leading to emotional ups and downs, irritability, or mood swings.
- Decreased libido: Changes in hormone levels can contribute to a decrease in sexual desire or changes in sexual function.
It’s important to note that not all patients will experience these symptoms, and the severity and duration can vary. Healthcare providers can offer strategies to manage these side effects and improve the patient’s overall comfort and well-being during hormonal therapy.
1.6 Side effects of hormonal therapy
The side effects of Tamoxifen include:
- Thickening of the uterine lining, which increases the risk of endometrial cancer. Therefore, doctors may recommend regular gynecological screenings for patients undergoing Tamoxifen treatment.
- Increased risk of blood clots, pulmonary embolism, and stroke.
The side effects of Aromatase Inhibitors include:
- Decreased estrogen production, leading to an increased risk of osteoporosis and fractures.
- Joint pain or stiffness.
1.7 Treatment tips
- Please quit smoking and drinking alcohol.
- Maintain a healthy diet by consuming adequate amounts of fresh vegetables, fruits, and whole grains. Choose low-fat foods such as lean meats or low-fat dairy products whenever possible.
- Engage in regular aerobic and weight-bearing exercises to help maintain overall physical health and prevent osteoporosis.
Hormonal therapy may cause early menopause. If you are considering fertility, discuss your treatment options in detail with your doctor. - If you are undergoing Tamoxifen treatment, please undergo regular gynecological examinations.
- Maintain a relaxed mindset.