Hormone Therapy

What is hormone therapy?

Hormone or hormone therapy is one method for treating cancer. It works by blocking, eliminating, or adding particular hormones in the body.

Certain cancers depend on natural body hormones for growth and multiplication.  Hormone therapy works by denying cancer cells access to hormones. It may be used alongside other treatments like radiation therapy and chemotherapy.

What are hormones?

Hormones are natural chemicals processed by the endocrine system. Hormones assist with cell communication. Hormonal signals promote the target cells to grow and reproduce due to hormone signals. Hormones control certain body functions like:

• Reproduction

• Growth and development

• Mood

• Sexual function

• Conversion of food into energy

The glands involved in hormone products are:

• Thyroid glands

• Pancreas

• Ovaries

• Adrenal glands

• Testicles

Cancer cells can respond to hormonal signals. Hormone therapy seeks to block hormonal signals from accessing cancer cells as this will stimulate their multiplication. Hormone-based cancer drugs ensure hormones produced by signaling cells do not attach to the target cells.

Why do you need hormone therapy?

Hormone therapy for treating cancer serves to:

• Treating cancer – It does this by slowing down or stopping cancer growth. Hormone therapy further minimizes the risk of the cancer coming back.
• Reducing cancer symptoms – Hormone therapy has proven useful in relieving cancer symptoms in people who cannot undergo radiation therapy or surgery for their cancer.

Types of hormone therapy for treating cancer

The type of hormone therapy that works best for you is determined by the type of cancer diagnosed and your general health.

Below are some types of hormone therapy for treating various forms of cancer:

Hormone therapy to treat uterine cancer

If you have had surgery to treat uterine cancer, your healthcare provider may also hormone therapy after this procedure to remove any remaining tumors. The Hormone therapy is also useful in treating recurring or advanced uterine cancer.

In patients receiving palliative care due to uterine cancer, hormone therapy helps to reduce pain.

The mode of action of hormone therapy drugs for uterine cancer is by limiting cell growth.  Other drugs that can also treat uterine cancer include aromatase inhibitors or tamoxifen.

Some side effects of these drugs are as follows:

• Hot flashes

• Night sweats

• Weight gain

Prostate cancer hormone therapy

The male hormone testosterone aids in the growth of prostate cancer.

Hormone therapy for prostate cancer works to reduce or block testosterone levels in your body. This slows down the spread and growth of prostate cancer.

If you have advanced prostate cancer, hormone therapy helps to shrink the cancer cells.

Sometimes, surgery may accompany hormone therapy. Such surgery aims to remove one testicle or both.

Examples of medication for use in hormone therapy for prostate cancer include:

Luteinizing hormone (LM) blockers – They instruct the pituitary gland to cease the production of luteinizing hormones. The hormone is responsible for testosterone production by your testicles. Some cancerous cells grow by utilizing testosterone. When the testosterone supply gets cut off, there can be no further growth for such cells.

Abiraterone acetate – This drug controls the production of androgens. These hormones are useful in the development of sexual organs.

Abiraterone acetate is useful for individuals with returning prostate cancer or one who fails to respond to other hormone therapy.

Side effects:

Hormone therapy for prostate cancer may present with the following side effects:

• Erectile dysfunction

• Weight gain

• Osteoporosis

• Reduced interest in sex

Breast cancer hormone therapy

The female hormone estrogen causes certain cancers. It happens when estrogen aligns with hormone receptors in your bloodstream. Hormone receptors account for 8 out of 10 breast cancers.

The female hormones progesterone and estrogen affect certain types of breast cancer. The aim of hormone therapy for breast cancer is to ensure such hormones do not come into contact with breast cancer cells.

The following medication is useful in hormone therapy for breast cancer:

Selective estrogen receptor modulators (SERM) – This medication blocks estrogen from accessing cancerous cells. Without such a connection, cancerous cells stop growing and cannot multiply.

Aromatase inhibitors – This drug works by reducing estrogen levels. Aromatase inhibitors interfere with the activity of the enzyme aromatase that converts hormones into estrogen.

This kind of hormone therapy is especially useful to women who have reached the age of menopause with ER-positive cancer.

Estrogen receptors down regulators – This drug hinders estrogen. It restricts the connection between estrogen and cancerous cells.

People receiving hormone therapy for breast cancer may present with the following side effects:

• Fatigue

• Weight gain

• Swollen or tender breast

• Stiff or painful joints

• Hot flashes

• Nausea

• Ovarian cancer hormone therapy

Progesterone treatment aids in treating cancer of the womb by shrinking the cancer cells. Your doctor may prescribe Megace or Provera for this treatment.

The side effects of hormone therapy in treating ovarian cancer include:

• Hot flashes

• Osteoporosis

• Muscle or joint pain

• Vaginal dryness

How to give hormone therapy?

There are several ways of giving hormone therapy:

Injection – Your healthcare provider can decide to give hormone therapy via a shot. You will receive this injection in your belly, leg, or arm.

Other people receive a shot in the hip. You can receive the hormone injection at your doctor’s office or a clinic.

You can also do it at home with the guidance of your healthcare team.

Orally – Some hormone therapies are taken orally as a capsule. Pill or liquid.

Your doctor will prescribe the most suitable oral hormone therapy for use. You can also pick these at your local pharmacy and take them at home as per the prescription.

Surgical ablation – A surgical procedure is necessary when your healthcare provider needs to remove the organ responsible for producing particular hormones.

If you are being treated for prostate cancer, your doctor can recommend surgery to remove testicles. This will minimize testosterone levels.

Similarly, the surgical removal of ovaries may be recommended as part of the treatment for breast cancer. Removing ovaries stops the production of estrogen.

The surgical ablation takes place at a designated medical centre or hospital.

Your hormone therapy depends on several factors:

• Stage of cancer – The kind of treatment you may be receiving or are receiving for cancer

• Type of cancer – For women, the prescribed hormone therapy depends on whether you have attained menopause or not

• Recurrence of cancer after treatment

• Side effects suffered

The duration of hormone therapy varies from one person to another.

For some people, they require hormone therapy for the remainder of their lives. Others remain on hormone therapy for a few years.

With prostate cancer, hormone therapy may be given intermittently. Your healthcare provider will stop treatment for some time as deemed necessary.

Benefits of hormone therapy

• Hormone therapy is effective in managing cancer, including the cancer that has metastasized

• Hormone therapy can be effectively used with other treatments like chemotherapy or radiation

• It helps to ease the pain and other symptoms brought about by cancer

Side effects of hormone therapy

Hormone therapy is associated with the following side effects:

Fatigue

You are likely to feel extremely tired after receiving hormone therapy. This will impact your emotions and energy levels and may also interfere with your day-to-day activities.

Plan your day accordingly and maximize those times when your energy levels are high. Physical activities such as walking can also relieve fatigue.

Weight gain

Some people who are on hormone therapy may accumulate extra weight around the waste.

Proper dieting and physical activity can effectively deal with weight problems.

Hot flashes

Hot flushes are not unusual for people receiving hormone therapy. You may feel very hot in your chest, face, or back. You could also sweat for several hours.

Medication and lifestyle modification will help you deal with hot flashes.

Cognitive behavioural therapy (CBT) and acupuncture are also useful therapies in managing hot flashes.

Tender or swollen breasts

Breast tenderness or swelling is one of the side effects of hormone therapy.

Some people experience mild tenderness while others endure long-lasting pain.

Radiotherapy, surgery, or tablets are some ways to minimize tender or swollen breasts.

Bone thinning

In case you take hormone therapy for a long term, this can cause weak bones, leading to osteoporosis.

Testosterone plays a role in the strengthening of bones. Hormone therapy is a risk factor for fractures.

Before commencing hormone therapy, your healthcare provider will recommend a bone density scan. This will reveal any weak bones.

You can also reduce the risk of bone thinning by lifting light weights and changing of diet.

Memory and concentration

Hormone therapy affects your concentration and memory.

There is no strong evidence to show that hormone therapy affects memory and concentration. It could result from age or another underlying condition.

Skin problems

Hormone therapy can cause skin problems such as feeling swollen red or sore at the site of the injections.

The problem subsides after a few days of receiving the injection.

In case the problem persists talk to your doctor about it. He or she will recommend using a cool pack or medication to relieve the pain.

Mood swings

Hormone therapy may cause mood swings.

Some people report feeling depressed or experiencing anxiety after hormone therapy. It could be due to the effects of treatment or the effects of a cancer diagnosis.

Mood changes imply a loss of interest in things that you once enjoyed. It will also affect your appetite and sleeping patterns. If you notice such changes, talk to your doctor about it.

Risk to other health problems

Hormone therapy may predispose you to developing such health conditions as:

• Type-2 diabetes

• Cardiovascular disease

• Blood clots

• Stroke

If you have any of the aforementioned health problems, let your healthcare provider know about it before commencing on hormone therapy.

Let your doctor also know if you are taking medication to treat cholesterol or high blood pressure.

Lifestyle modification, including physical activities and eating a balanced diet, can minimize your risk of developing the aforementioned health problems.

Recovery after hormone therapy

Recovery following hormone therapy is based on the following:

• Your overall health – This determines how you cope with the treatment

• Type of hormone medication used

• Side effects

The healthcare team will monitor you closely to see how you are progressing after treatment.

In case of any special precautions that you require taking following hormone therapy, this will be communicated to you in good time.

Follow-up

Your oncologist will arrange scheduled follow-up appointments with the following goals:

• To check how the cancer has responded to treatment
• To assess your level of tolerance to hormone therapy
• To explore how side effects caused by hormone therapy can be reduced

Cost of hormone therapy in India

Hormone therapy cost in India starts from Rs. 10,000 up to Rs. 50,000. The cost of hormone therapy in India depends on the following factors:

• Dosage and medication – The dosage and type of hormone therapy will influence the overall cost.
• Hormone therapy can be administered daily, weekly, or monthly and this too will affect the overall cost. Generic medication is more affordable compared to branded ones.
• Healthcare facility – The cost of hormone therapy at a government hospital is cheaper compared to that administered at a private clinic.
• Private clinics have invested in specialized expertise and state-of-the-art facilities.
• Geographical location – Healthcare facilities that offer hormone therapy in India’s metro cities charge more than similar facilities in remote regions.
• Metro cities have better healthcare infrastructure.
• Diagnostic and consultation – Diagnostic tests and initial consultation also affect the cost of hormone therapy.
• The table below provides the average cost of administering hormone therapy to treat various forms of cancer in India:

References

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