What Are Hormonal Therapies For Cancer Treatment?

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Cancer is a complex disease that requires a range of treatments. There are several options available, including surgery, chemotherapy, and radiation therapy. Another treatment option becoming increasingly popular is hormonal therapy, also called hormone therapy or endocrine therapy. Hormonal therapy generally involves blocking hormones that stimulate the growth of cancer cells. 

What Is Hormonal Therapy?

Hormones are chemicals in the body that control many different functions, including growth and development. Some cancer cells use your body’s hormones to fuel their own growth. Hormone-sensitive cancers are stimulated by hormones such as oestrogen, progesterone, or testosterone. 

Hormonal therapy is a form of cancer treatment used to treat hormone-sensitive cancers, such as breast and prostate cancer. Hormone therapy may slow or stop their spread by blocking the body’s ability to produce the particular hormones used by the cancer or by changing how hormone receptors behave in the body. 

Hormonal Therapy Vs Hormone Replacement Therapy (HRT)

Hormonal therapy as a cancer treatment should not be confused with hormone replacement therapy (HRT). Hormonal therapy prevents cancer cells from using your hormones to grow. Hormone replacement therapy is a medication used to treat menopausal symptoms by replacing the hormones that your body ceases to create during menopause. 

What Cancers Are Treated With Hormone Therapy?

Hormone therapy can be used to treat several types of hormone-sensitive cancers. The specific type of hormone therapy used will depend on your cancer type and your individual needs. While other cancers may benefit from this treatment, hormonal therapy is often recommended for breast, prostate, and endometrial cancers.

Hormonal Therapy For Breast Cancer

Breast cancer is one of the most common cancers worldwide, and hormone-sensitive breast cancers, such as oestrogen receptor-positive (ER+) and progesterone receptor-positive (PR+), are the most common. Hormonal therapy is an important treatment option for patients with hormone-sensitive breast cancer. 

Types of hormonal therapy used for breast cancer include selective oestrogen receptor modulators (SERMs), aromatase inhibitors (AIs), and luteinising hormone-releasing hormone (LHRH) agonists or blockers. SERMs, such as Tamoxifen, prevent oestrogen from binding with breast cancer cells. AIs work by blocking aromatase activity, which is used in producing oestrogen, thereby lowering the oestrogen levels in the body. 

Another option for pre-menopausal women is ovarian ablation, or ovarian suppression, which prevents the ovaries from working. This can be achieved via hormone therapy medication such as LHRH or surgically by removing the ovaries (oophorectomy).

Hormonal Therapy For Prostate Cancer

In prostate cancer, one of the most common cancers in men worldwide, the cancer cells use androgens (testosterone and dihydrotestosterone) to grow. Hormonal therapy can suppress or lower androgen levels, shrinking the cancer or preventing it from spreading. 

This option is generally not curative and is often used alongside other treatments. Androgen deprivation therapy (ADT) can be administered via medications such as LHRH or be delivered surgically by removing the testicles (orchidectomy).  

Hormonal Therapy For Endometrial Cancer

Endometrial cancer is a type of cancer that develops in the lining of the uterus. This cancer is usually treated with surgery, but hormonal therapy may also be used, especially in cases where surgery is not possible or as a fertility-preserving option for some early-stage endometrial cancers.

Hormonal therapy for endometrial cancer typically involves the use of progestin, a synthetic form of the hormone progesterone, which can slow down the growth of cancer cells.

What Are The Advantages And Disadvantages Of Hormonal Therapy?

Hormonal therapy has several advantages. It can be used alone when other treatments are not necessary, or used in combination with other treatments to reduce the risk of cancer recurrence. It is particularly useful in patients who do not need chemotherapy or who have limited fitness to undergo it. Hormonal therapy is generally easy to take, and its side effects may be less severe than other forms of cancer treatment.

While hormone therapy can be a useful treatment option for certain hormone-sensitive cancers, it has drawbacks. Patients undergoing hormone therapy should be aware of the potential side effects and possible resistance or limited effectiveness. 

Side effects of hormone therapy vary depending on the type, drug, and treatment duration. Some of hormonal therapy's most common side effects include menopause-like symptoms such as hot flushes, night sweats, and vaginal dryness. Other side effects include sexual dysfunction, fatigue, nausea, and mood changes.

One of the drugs often used to treat hormone receptor-positive breast cancer, Tamoxifen, slightly increases the risk of endometrial cancer and blood clots. Joint and muscle pain or stiffness are common side effects of aromatase inhibitors and can also cause bone density loss which might lead to osteoporosis and an increased risk of fractures.

Many of the side effects go away on their own or can be managed with medication. It is important to discuss the risks and benefits of hormonal therapy with your healthcare provider to determine whether it is the right treatment option for you.

How Is Hormonal Therapy Done?

Hormonal therapy can be used alone or in combination with other treatments, such as surgery, radiation therapy, or chemotherapy. In some cases, hormonal therapy is used as a neoadjuvant therapy, which means it is given before the main treatment to shrink the tumour and make it easier to remove. Hormonal therapy can also be used as adjuvant therapy after the main treatment to reduce the risk of cancer recurrence.

Hormonal therapy is administered as pills or injections. The treatment course and regularity of dose depend on many factors, varying from daily to weekly or monthly, and can last for many years.

Even if you have hormone-sensitive cancer, hormonal therapy may not be suitable for you, and the decision to use it should be made on a case-by-case basis, with your healthcare provider taking into account the type and stage of cancer, age and overall health, whether you have been through menopause, and the potential benefits and risks of the treatment.

Is Hormonal Therapy Worth It?

Hormonal therapy is a valuable treatment option for hormone-sensitive cancers like breast and prostate cancer. It works by blocking or interfering with the hormones that fuel the growth and spread of cancer cells. 

Hormonal therapy has several advantages over other forms of cancer treatment, including ease of use and relatively milder side effects. However, it may not be effective for all types of cancer, and its use should be assessed on an individual basis. 

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