April 15~April 21 is the National Cancer Prevention and Treatment Week , Mijian will act together with you. Today I will bring you knowledge about endocrine therapy of breast cancer.
Estrogen is a "double-edged sword", it can maintain female secondary sex characteristics at normal levels and relieve menopausal symptoms, but when levels are too high, it can cause breasts Cancer and other diseases.
Hormone receptor-positive breast cancer, that is, estrogen receptor (ER) and/or progestrogen receptor (PR) is positive at the time of diagnosis. Its development Dependent on sexHormonal regulation, so endocrine therapy can be used clinically.
Image source: Photograph.com
Endocrine therapy uses drugs to block the effects of sex hormones on cancer cells, thereby inhibiting the proliferation of cancer cells. About 70% of the basic treatments for breast cancer are endocrine therapy, which has become one of the most mainstream treatments for breast cancer.
1 Three advantages of endocrine therapy
Jiang Zefei, director of the Department of Breast Oncology, Affiliated Hospital of the Academy of Military Medical Sciences, said: Hormone receptor-positive advanced breast cancer patients, As long as the metastasis is notRapid development, not life-threatening, endocrine therapy should be preferred. The doctor will take targeted treatment according to the individual condition of the patient.
01 Prolong survival
After treatment, breast cancer will still develop into advanced metastatic breast cancer. Advanced breast cancer is difficult to cure. The purpose of treatment is to prolong the patient’s survival as much as possible and improve the patient’s quality of life. Endocrine therapy has unique advantages, with less side effects, longer survival, and even long-term survival.
02 Simple treatment method
Endocrine treatment is much simpler than chemotherapy. Generally, there is no need to change the plan frequently. The patient only needs to take the medicine on time as prescribed by the doctor, which is convenient for long-term medication.
03 Side effects are less than chemotherapy
Severe toxic reactions such as nausea, vomiting, hair loss, and leukopenia caused by chemotherapy are often unbearable for patients, and chemotherapy may even be terminated midway. The side effects of endocrine therapy are much smaller than that of chemotherapy, which greatly improves the life of patients and helps to keep the treatment going.
2 How much do you know about endocrine drugs?
Four common categories Endocrine drugs
1) Estrogen receptor antagonist: Tamoxifen (tamoxifen, TAM)
2) AromatizationEnzyme inhibitors: letrozole, anastrozole and exemestane
3) Gonadotropin releasing hormone drugs: goserelin, triptorelin, leuprolide
4) Estrogen receptor modulators: toremifene, fulvestrant
Adjuvant endocrine therapy for premenopausal women generally has three options: tamoxifen, tamoxifen combined with ovarian Inhibitors, ovarian inhibitors combined with third-generation aromatase inhibitors.
Estrogen can promote the growth of breast tumors. Controlling women's estrogen levels is to cut off the "nutrient" of cancer cells. Therefore, the principle of this endocrine therapy is very simple, which is to inhibit the production of estrogen by the ovaries through a variety of methods, thereby achieving the purpose of inhibiting the growth of breast cancer cells.
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Ovarian function suppression, English name ovarian function suppression (OFS for short). Ovarian function suppression has been applied In the treatment of breast cancer for decades, suppression methods include: bilateral ovarian surgical castration, ovarian radiotherapy and medical castration.
For premenopausal women, if ovariectomy is used to achieve ovarian suppression As a result, the risk of other diseases will increase, so the ovaries cannot be cut casually. However, now the same ovarian suppression effect can be achieved with ovariectomized drugs (goserelin). Ovarian ovariectomy is suitable for ages 35 ~45 years old, have axillary lymphatic metastasisOr patients with subclavian lymph node metastasis.
Postmenopausal women can switch to aromatase inhibitors for 5 years after tamoxifen treatment for 2 to 3 years, or directly switch to aromatase inhibitors for 5 years; After tamoxifen has been used for 5 years, the aromatase inhibitor can be used for 5 years, and tamoxifen can be used for 5 years after the aromatase inhibitor has been used for 2 to 3 years. Different types of aromatase inhibitors are available.
3 Side effects and treatment of endocrine drugs
Although estrogen-positive breast cancer patients can use endocrine therapy, they only need to take the drugs at home after surgery. The tumor can be effectively controlled, but many Miyou are also troubled by the side effects of a series of drugs.
01 Hot flashes
Under normal circumstances, hot flashes often occur in pre-menopausal women. This is caused by decreased ovarian function and decreased estrogen levels. It is called "perimenopausal syndrome", which is our Often referred to as menopause.
The typical manifestation of hot flashes is a sudden onset of the front chest, a fever that slowly spreads from the neck and face to the whole body, which lasts for a few seconds to a few minutes and then quickly subsides, the core body temperature drops, and the whole body chills. It usually occurs at night and dusk, and it may occur once every few days. Hot flashes are accompanied by palpitations, anxiety, and panic, which seriously affect the quality of life.
In breast cancer patients, chemotherapy causes premature ovarian failure, and taking tamoxifen, aromatase inhibitors and other endocrine therapy drugs can lead to low levels of estrogen in the body, and hot flashes often occur.
Therefore, hot flashes in breast cancer patients do not have to be too anxious, it is not a disease. When hot flashes occur,Patients should avoid spicy foods and use meditation exercises to relieve the symptoms of hot flashes.
Another function of estrogen is to prevent the loss of calcium in the bones. Endocrine drugs inhibit the effect of estrogen and cause calcium loss and osteoporosis in patients. Master the correct method of calcium supplementation, and patients can easily resolve this side effect.
For breast cancer patients undergoing endocrine therapy, calcium and vitamin D supplementation, together with exercise, can effectively prevent osteoporosis.
Image source: Photograph.com
03 Reproductive system problems
While endocrine drugs inhibit estrogen levels, they also affect the normal operation of the reproductive system. Patients will experience reactions such as intimal thickening, painless vaginal bleeding, low libido, and vaginal dryness.
Premenopausal women who take drugs have endometrial thickening, as long as it does not exceed 19mm, it is within the normal range, and regular gynecological examinations can be maintained;
Abnormal endometrial hyperplasia and abnormal vaginal bleeding should be treated immediately and actively treated;
If the patient has vaginal dryness while taking the drug, vaginal lubricating fluid can be used to improve it; when the libido is low, explain to the partner And gain the understanding and support of the other party.
Cover image source: Photograph.com Genuine Gallery
Editor in charge: Breast Cancer Mutual Helper
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