» Methods cessation of ovarian function in breast cancer
Methods cessation of ovarian function in breast cancer
Methods cessation of ovarian function in breast cancer
In premenopausal women the main source of estrogen are the ovaries. Therefore, if a woman found in premenopausal hormone-positive breast cancer, the cessation of ovarian function (namely - to develop their hormones) can provide effective results. Such termination of ovarian function can be achieved either by medication effects, or by its surgical removal.
Although the most frequently used methods of hormonal therapy in patients with breast cancer is tamoxifen, your doctor may also recommend to you, depending on the specific situation of cessation of ovarian function.
The difference between these two types of hormonal treatment is as follows: Tamoxifen blocks estrogen receptors, thereby preventing estrogen exert stimulatory effect on cells. The suppression of ovarian function and their removal leads to a decrease in the body of estrogen. The suppression of ovarian function and their removal can be combined with tamoxifen.
The principle effect on the ovaries
If the patient is found in premenopausal hormone-positive breast cancer, drug suppression of their function or removal of the ovaries leads to the fact that menopause occurs. As drug suppression of ovarian function, and surgical removal of them are equally effective in reducing estrogen levels in the blood. And this leads to the fact that breast cancer cells to a lesser extent are the stimulating effect of the hormone.
If the ovaries are removed surgically, the patient immediately begins menopause. More gradually with medical menopause "shut down" the ovaries, which can occur within a few months. In this case, there are side effects of this treatment: hot flashes, vaginal dryness, mood swings, depression, weight gain and edema. All these phenomena are related to the sharp decline in estrogen levels. C of these side effects can be overcome.
It should be understood that such a treatment, which affects the ovaries, shown only in premenopausal women, that is, those whose ovarian function is preserved, and, of course, when breast cancer is hormone-positive. So, before you perform this treatment the physician should make sure that the patient has retained ovarian function. Some women who were premenopausal at the time of diagnosis of breast cancer, chemotherapy can be found that ovarian function is suppressed. But that menopause is caused by chemotherapy, usually only temporary. And usually by the time ovarian function is restored within a year, sometimes two.
If the patient is already in the menopause, which usually begins at age 50 - 52 years, the suppression of ovarian function, or their removal is not shown. If after the last menstrual period more than two years, it means that the ovaries no longer ovulate and, therefore, does not form estrogen. Therefore, surgical removal of the ovaries or the suppression of their functions by medication does not make sense.
As a physician determines the onset of menopause
In order to determine the onset of menopause, a woman doctor conducts ongoing identification of certain hormones in the blood. These are the hormones:
Follicle-stimulating hormone (FSH),
Luteinizing hormone (LH).
If you have observed a very low level of estrogen in the blood and at the same time, high levels of FSH and LH, it is likely that you have been in menopause, and the likelihood of recovery of ovarian function is unlikely.
Menopause as a result of chemotherapy may be constant in the following cases: * If during the course of chemotherapy, the patient was older than 40 years * If more than one year has passed, as the menstrual cycle stopped, * If the dose of chemotherapy drugs themselves, were used for chemotherapy, can increase the likelihood of permanent menopause.
In that case, if you are already in menopause, you show a different type of hormone therapy - aromatase inhibitors such as Arimidex, Femara or Aromasin. At present, studies the role of aromatase inhibitors in patients who were premenopausal, and after removal of the ovaries in their menopause.
To date, there are three methods of Mammalogy cessation of ovarian estrogen production.
This method consists in the fact that the patient designate specific hormonal drugs that suppress the production of pituitary hormones that stimulate the ovaries. One of the brightest representatives of the drug is Zoladex (goselerin). Zoladex is a synthetic analogue of natural luteinizing hormone-releasing hormone, the pituitary gland. This drug is used in various tumors, both women and men (prostate cancer). The mechanism of action of it is that it suppresses pituitary FSH and LH - the hormones that regulate the menstrual cycle.
Zoladex is given as an injection into the abdomen once in 28 days. Perhaps a local anesthetic during injection. But since the syringes are adapted specifically for this procedure, often in pain relief is not necessary. The first injection is done in a hospital, and later in the clinic or at home nurse, who comes from the clinic. Zoladex Side effects are almost the same as when taking other drugs that suppress the action of estrogen in the body (as well as in menopause) are hot flushes, sweating, decreased sexual desire, and sometimes there are headaches, depression, vaginal dryness.
In the first month of the drug may appear bloody discharge, which is associated with a decrease in estrogen levels. Sometimes there are pains in the joints, skin itching and soreness at the injection site. Rarely observed changes in blood pressure that does not lead to the cessation of the use of drugs and to any special treatment. Zoladex should not be used during pregnancy, as this there is some risk of miscarriage or fetal abnormalities.
Before treatment in women who have the potential to become pregnant, should conduct a thorough examination to rule out pregnancy. During therapy, you should use non-hormonal methods of contraception as long as menstruation does not resume. In addition, the use of the drug Zoladex not recommended during lactation, that is, feeding breast milk. Surgical removal of the ovaries (oophorectomy surgery, or oophorectomy)
At the present time for this operation is commonly used endoscopic technique that allows to perform the surgery using a small incision. Removal of the ovaries leads to a drastic reduction in the level of sex hormones in women. However, it should be remembered that in the body except the ovaries of estrogen, although in very small quantities, produced, and adrenal glands.
This procedure was used extensively before, and now she rarely finds its application.
Cessation of ovarian function also leads to a decrease in the level of hormones in the blood, making possible pregnancy. The possibility of getting pregnant in the future depends on whether the function of the ovaries cease temporarily or permanently. The possibility of pregnancy in the future depends on various factors, such as chemotherapy, hormonal therapy, the patient's age and stage of disease.