hormone therapy for breast cancerHormonal breast cancer therapy is a form of systemic treatment. The most often used as adjuvant therapy to reduce the risk of recurrence after surgery, but could be applied as neoadjuvant. In addition, hormone replacement therapy is prescribed for relapse and advanced disease.

The ovaries in women are the main source synthesizing hormone estrogen before menopause. In small quantities it is produced in breast tissue, liver and the adrenal glands, which as secondary sources are especially important for the female body after menopause.

Tlv.Hospital Coordination Center will assist in the organization of hormone therapy in breast cancer clinics in Israel, using extensive professional contacts. We will choose the best treatment option and will provide 100% quality and volume of medical care.

Estrogen - a female hormone that circulates in the blood circulation throughout the body and affects both healthy and tumor cells. Its influence is carried out using receptors which may be located on the cell surface, inside or outside. They are a kind of antennas that capture signals in the form of molecules of hormones. Connecting with the receptors, estrogen give direction to tumor cells to grow and multiply.

Almost 75% of breast cancers - hormone-dependent, have estrogen receptors (ER-positive) and / or progesterone (PR-positive). Without action tumors can not grow hormones, decreases in volume and die. Depending on the amount of estrogen receptors and progesterone hormone levels efficiency increases or decreases.

Types of hormone Most replacement therapy in the treatment of breast cancer in Israel Aimed AT ending the the actions of estrogen on cancer cells or Reducing ITS a levels in the old body. Hormone therapy (also called - anti- estrogenic) is indicated for the diagnosis of hormone-positive (or hormone-dependent) breast cancer.

Drugs that block estrogenHormone breast cancer

Hormone therapy of breast cancer: tamoxifen (Tamoxifen)

Tamoxifen blocks estrogen receptors in neoplastic breast cells. Although it acts as an antiestrogen in breast cells, it becomes estrogen in uterine tissues and bones. Due to the different effects it is called selective estrogen receptor modulator, or SERM.

Women with hormone-positive invasive breast cancer who take tamoxifen after surgery for 5 years, reducing the likelihood of relapse by about half. It also reduces the risk of developing a new malignancy in the other breast. According to recent studies, scientists have found that taking tamoxifen for 10 years can bring even greater benefits.

Tamoxifen is also able to stop the growth and even reduce tumor in metastatic breast cancer. Moreover, it is used to reduce the chance of cancer developing in women at high risk.

This drug is taken orally, usually in the form of tablets.

Common side effects include fatigue, hot flushes, vaginal dryness or isolation, mood swings.

Some patients with bone metastases may experience bursts of pain and swelling in the muscles and bones. Usually these symptoms pass quickly, but in some rare cases, the patient may also develop uncontrolled hypercalcemia. If this occurs, then treatment is stopped for a while.

Rarely develop more serious side effects. Tamoxifen can increase the risk of cancer of the uterus (endometrial cancer and uterine sarcoma) in women during menopause. Unusual vaginal bleeding is a common symptom of both types of cancer.

Blood clots are another possible undesirable hormone. Typically, they form in the legs (phlebothrombosis), but sometimes clot may block the pulmonary artery (pulmonary embolism). You should inform the doctor if you experience pain, redness or swelling in the lower leg (calf); with shortness of breath or chest pain.

Rarely tamoxifen can cause stroke in women during menopause. You must notify your doctor if there are strong headaches, confusion, speech or movement problems.

Tamoxifen increases the risk of heart attack.

This drug has a different effect on the bones. In premenopausal tamoxifen can cause a thinning of the bones, but the menopause it contributes to their strength.

In general, the benefits of tamoxifen outweigh the risks for almost all women with hormone-positive invasive breast cancer.

According to statistical data, every year is visited Israel about thirty thousand foreign patients, eighty percent of them are cancer patients.

Hormone therapy of breast cancer: toremifene (Fareston ®)

Toremifene is similar in effect to tamoxifen. This also is a selective estrogen receptor modulator, or SERM, and has similar side effects. It is approved only for the treatment of advanced breast cancer. This medication is not likely to be effective if used tamoxifen, but the desired effect he has not had.

Hormone therapy of breast cancer: fulvestrant (Faslodex ®)

Hormone breast cancerFulvestrant - a drug that blocks the action of estrogen receptors. It is not a SERM, but acts as an anti-estrogen throughout the body.

Fulvestrant is used in advanced breast cancer, usually after other hormonal drugs (eg, tamoxifen or an aromatase inhibitor), no longer work.

Common short-term unwanted effects may include receiving hot flashes, night sweats, mild nausea and fatigue. Because it blocks estrogen could theoretically weaken bones (osteoporosis), if it will take a long time.

He is currently approved by the FDA for the treatment of breast cancer in post-menopausal women, do not respond to tamoxifen or toremifene.

Treatment aimed at reducing estrogen levels

Hormone therapy of breast cancer: aromatase inhibitors

Aromatase inhibitors - are the three drug Letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin), which stop the production of estrogen. Indications are the earliest and most common breast cancer in post-menopausal women.

They block the enzyme aromatase in adipose tissue which synthesizes estrogen after menopause in small quantities. These drugs have no effect on the ovaries produce hormones, so they are effective only for postmenopausal women. They are taken daily in pill form.

Several studies have compared aromatase inhibitors with tamoxifen as adjuvant hormonal therapy (after surgery). Receiving them alone or after tamoxifen, showed a decrease in the risk of recurrence compared with one Tamoxifen for 5 years. Embodiments reception circuits:

  1. Tamoxifen two to three years, and then aromatase inhibitors to complete a 5 year treatment.
  2. Tamoxifen for five years after that aromatase inhibitors for five years.
  3. aromatase inhibitors for five years.Hormone breast cancer

Most of the doctors in Israel now recommend that post-menopausal women with hormone-positive invasive breast cancer use aromatase inhibitors in adjuvant therapy. Is now the standard treatment is taking these drugs for 5 years (or alternation with tamoxifen for less than 5 years).

We aromatase inhibitors generally less serious side effects than tamoxifen, they do not cause cervical cancer and very rarely cause blood clots. But they can provoke pain in the muscles and joint stiffness and / or pain in them. Joint pain similar to pain arising from arthritis. This side effect may eliminate, by clicking on another drug from this group, but in some cases, the medication is stopped. If this happens, most doctors recommend the use of tamoxifen to complete 5 years of hormonal therapy for breast cancer.

As aromatase inhibitors, estrogen remove all of the woman's body, they also cause thinning of the bones, sometimes leading to osteoporosis and even fractures. Many women in parallel give medicines to strengthen bone mass, such as bisphosphonates or denosumab.

Breast Cancer Hormone: spaying

Deletion or suppression of ovarian function, the primary source of estrogen in premenopausal women during the period of the actual results in the onset of menopause and expands treatment options, the use of other types of hormone therapy. This is an effective measure, is often used in advanced breast cancer.

It can be performed surgery to remove the ovaries - oophorectomy.

Hormone breast cancerBut most of all in Israel clinics suppress ovarian job with the help of drugs, so-called analogs of luteinizing hormone - Goserelin (Zoladex) and leuprolide (Lupron ®). These drugs block the signal which sends an organism ovaries of the need of estrogen synthesis. Are the prescribed drugs for These to alone or with tamoxifen is as with the hormonal therapy for breast cancer for women in the menopausal period. Sometimes they take women with aromatase inhibitors in premenopausal with advanced breast cancer.

Chemotherapy drugs can also interfere with the operation of the ovaries, and then they will not produce estrogen. In some women, ovarian function recovered after months or years, others - organ damage is permanent and leads to menopause.

All of these methods can lead to symptoms of menopause: hot flashes, night sweats, vaginal dryness and mood swings.

Breast Cancer Hormone: less common techniques

These options during hormone therapy for breast cancer in Israel were used more frequently in the past, now - are rare.

Acetate Megestrol (Megace ®) - similar to progesterone drug which is prescribed as hormonal treatment of advanced breast cancer, usually in women whose organism does not respond to Hormone breast cancertreatment with other hormonal agents. Its main side effect is weight gain, and sometimes megestrol acetate administered in higher doses to reverse weight loss in patients with advanced cancer.

Androgens (male hormones) in rare cases, considered as a treatment for hormone therapy after other drugs common breast cancer. Sometimes this treatment is quite effective, but can cause the development of male characteristics: an increase in body hair and a deep voice.

In the clinics of Israel is actively developing a new approach - personalized oncology. We use high precision diagnostic tests that make the most optimal treatment for selected patients. Furthermore, this approach allows to predict disease progression.

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