Longer Term Side Effects
Tiredness is commonly reported during treatment. This may be a direct effect of the drugs or may be due to other factors such as disrupted sleep patterns.
- Try to get adequate rest but also try to exercise regularly. Go for a walk outside each day as this can actually give you more energy.
- Find something that you actually enjoy doing and also try to incorporate exercise into your usual day, e.g. walk upstairs rather than taking the lift, park further away from where you want to go and walk the extra distance. Build this up gradually.
- Your GP, practice nurse or a physiotherapist can work with you to devise a specific exercise plan for you.
- Let others help when your energy levels are low.
If your fatigue doesnt allow you to exercise, discuss this with your GP.
Usually energy levels recover after treatment finishes but this commonly takes time. In some cases full recovery may take 12 months or more.
Some people notice they are having concentration and short-term memory problems following their chemotherapy. This is often referred to as chemo brain. The severity and duration of symptoms differ from person to person. For some people the symptoms are very mild and resolve soon after treatment stops, but others may find their daily life is noticeably affected for a much longer period, restricting their ability to return to work in their pre-treatment capacity.
Hormone Therapy For Reducing The Risk Of Breast Cancer
Women at moderate or high risk of breast cancer because of their family history may be offered hormone therapy to reduce their risk of developing breast cancer.
Drugs used to reduce the risk of breast cancer in women who have not had breast cancer include:
These drugs are usually taken for five years.
When Are Hormone Therapy Given
Hormone therapy medications control hormones by blocking the bodys hormone production or altering the way hormones work in the body. Organs that secrete hormones may be removed by surgery, radiation, or the drug goserelin to fight cancer.
Before Surgery: This is called neoadjuvant treatment. The goal is to reduce the tumors size, so there is less to remove during surgery. Not everyone has treatments before surgery. Your oncologist will let you know if this is right for you.
Adjuvant therapy for early-stage breast cancer uses hormone therapy after surgery to stop cancer from coming back. It blocks the effects of estrogen or progesterone on cancer cells but does not stop the hormone from being produced.
After cancer has gone into remission, women with estrogen-positive breast cancer can use a hormone therapy regimen for about five years to help keep it from returning. Some women may benefit from treatment periods that last longer than five years.
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An Increased Psa Level
A biochemical relapse is when your PSA level rises after having treatment that aims to cure your cancer.
You might not need to start treatment straight away. Your doctor will continue to monitor your PSA levels regularly to see if your PSA rises quickly or stabilises. You might have a scan if your PSA rises quickly.
The choice about whether to have treatment and what treatment to have will depend on:
- the treatment you have already had
- your general health
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Common Thoughts And Feelings
You may feel all sorts of things after you finish treatment. Some men are relieved and feel ready to put the cancer behind them and get back to normal life. But others find it difficult to move on. Adjusting to life after cancer can take time.
For some men, the emotional impact of what they have been through only hits them after they have finished treatment. You might feel angry for example, angry at what you have been through, or about the side effects of treatment. Or you might feel sad or worried about the future.
Follow-up appointments can also cause different emotions. You might find it reassuring to see the doctor or nurse, or you may find it stressful, particularly in the few days before your appointments.
Worries about your cancer coming back
You may worry about your cancer coming back. This is natural, and will often improve with time. There are things you can do to help manage your concerns, such as finding ways to reduce stress. Breathing exercises and listening to music can help you relax and manage stress. Some people find that it helps to share what theyre thinking with somebody else, like a friend. If you are still struggling, you can get help for stress or anxiety on the NHS you can refer yourself directly to a psychological therapies service or ask your GP.
If youre worried about your PSA level or have any new symptoms, speak to your doctor or nurse. If your cancer does come back, youâll be offered further treatment.
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Hormone Therapy Has A Bigger Impact Than Chemotherapy On Womens Quality Of Life
Cellules cancéreuses. Expression de la protéine PML en rouge et du gène ZNF703 en vert dans des cellules de la lignée de cancer du sein MCF7. ©Inserm/Ginestier, Christophe
Analysis of the CANTO cohort published in the journal Annals of Oncology will upset received wisdom on the effects that hormone therapy and chemotherapy have on the quality of life in women with breast cancer. Contrary to the commonly held view, 2 years after diagnosis, hormone therapy, a highly effective breast cancer treatment worsens quality of life to a greater extent and for a longer time, especially in menopausal patients. The deleterious effects of chemotherapy are more transient. Given that current international guidelines recommend the prescription of hormone therapy for 5 to 10 years, it is important to offer treatment to women who develop severe symptoms due to hormone antagonist medication and to identify those who might benefit from less prolonged or intensive treatment strategies.
This work was directed by Dr Inès Vaz-Luis, specialist breast cancer oncologist and researcher at Gustave Roussy in the lab Predictive Biomarkers and Novel Therapeutic Strategies in Oncology .
Ovarian Ablation Or Suppression
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
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Salvage Radiotherapy And Androgen Deprivation Therapy
GETUG-AFU 16 was the first randomized trial comparing SRT vs. SRT and short ADT as salvage treatment for biochemical recurrent prostate cancer after radical prostatectomy and was presented in abstract form at the American Association of Clinical Oncology 2015 Annual Meeting. The trial randomized 743 patients most of them having high intermediate risk features . The 5-year PFS was 62.1% vs. 79.6% for SRT and SRT + ADT, respectively . The 5-year OS was 94.8% for RT vs. 96.2% for SRT + ADT . Cause of death was progressive disease in 2.1% of the patients on SRT arm vs. 0.8% in the SRT + ADT arm. Acute toxicities occurred more frequently in SRT + ADT arm . This trial will require longer follow-up to see if the benefits observed in progression-free survival translate into the same OS benefit .
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Hormones And Breast Cancer
The hormones estrogen and progesterone make some breast cancers grow. They are called hormone-sensitive breast cancers. Most breast cancers are sensitive to hormones.
Estrogen and progesterone are produced in the ovaries and other tissues such as fat and skin. After menopause, the ovaries stop producing these hormones. But the body continues to make a small amount.
Hormone therapy only works on hormone-sensitive cancers. To see if hormone therapy may work, doctors test a sample of the tumor that has been removed during surgery to see if the cancer might be sensitive to hormones.
Hormone therapy can work in two ways:
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Breast Cancer: Types Of Treatment
Have questions about breast cancer? Ask here.
ON THIS PAGE: You will learn about the different types of treatments doctors use for people with breast cancer. Use the menu to see other pages.
This section explains the types of treatments, also known as therapies, that are the standard of care for early-stage and locally advanced breast cancer. Standard of care means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug and how often it should be given, a new combination of standard treatments, or new doses of standard drugs or other treatments. Some clinical trials also test giving less drug or radiation treatment or doing less extensive surgery than what is usually done as the standard of care. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.
Psa Levels 5 Years After Radiation Therapy Predict Survival From Prostate Cancer
The level of prostate-specific antigen in the blood of prostate cancer patients five years after radiation treatment can help predict their disease-free survival for the next several years, according to the October 2002 issue of the International Journal of Radiation Oncology, Biology and Physics, the official journal of ASTRO, the American Society for Therapeutic Radiology and Oncology.
Researchers have discovered that patients who maintain very low five-year PSA levels have a very low probability of relapse at 10 years and beyond.
The study identified 328 men treated with external beam radiation therapy to the prostate who were biochemically disease-free five years after treatment. The median follow-up was 7.4 years. The patients were divided into four groups according to their PSA values five years after treatment: PSA less than or equal to 0.5, 0.5 to 1.0, 1.0 to 2.0 and 2.0 to 4.0 ng/mL. PSA progression-free rates were calculated in each subgroup at 10 years after treatment.
Researchers concluded that when PSA levels remain low five years after external beam radiation therapy, the great majority of patients will be biochemically disease-free at 10 years. The hazard rates of biochemical progression in the 6 to 10 years after treatment are low and are comparable to rates seen when prostatectomy is the chosen treatment modality.
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Selective Estrogen Receptor Modulators
Selective estrogen receptor modulators including tamoxifen , raloxifene and toremifene selectively block estrogen from certain tissues, namely the breast, while increasing its availability in other areas such as the bones.
When and why theyre used: Doctors may recommend SERMs after surgery for early ER-positive breast cancer in men or women, to reduce the chances that it recurs. Theyre also approved to treat advanced breast cancer, and may be used to prevent breast cancer in high-risk individuals. Toremifene is only approved for advanced stage breast cancer that has spread.
Risks: In addition to more common side effects of hormone therapy such as hot flashes, tamoxifen risks may include blood clots, stroke, bone loss, mood changes, depression and loss of sex drive. Men who take tamoxifen may experience headaches, nausea, vomiting, rashes, impotence and loss of sex drive. Raloxifene may increase a patients chances of having a stroke or developing potentially fatal blood clots in the lungs or legs. Fortunately, these side effects are considered relatively rare. Have your doctor explain the potential side effects associated with each SERM when discussing the pros and cons of these medications with you.
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It Will Also Be Important In The Future To Differentiate Prior To Treatment Patients Who Are At High Risk Of Relapse From Those At Lower Risk In Order To Tailor Hormone Treatment This May Be Done To Avoid Escalation Of Anti
The CANTO cohort comprises 12,000 women with breast cancer treated in 26 French centres. It is sponsored by Unicancer and directed by Professor Fabrice André, specialist breast cancer oncologist at Gustave Roussy, Inserm research director and responsible of the lab Predictive Biomarkers and Novel Therapeutic Strategies in Oncology . Its objective is to describe adverse effects associated with treatment, to identify the populations at risk of developing them and to adjust therapy accordingly, so as to afford a better quality of life following cancer.
Watch the video on YouTube :
J Clin Oncol. 2019 Feb 10 37:423-438 : https://doi.org/10.1200/JCO.18.01160
TO CITE THIS POST :
1INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
2Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
3Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
4Department of Supportive Care, Gustave Roussy, Cancer Campus, Villejuif
5Medical Oncology, Centre François Baclesse Caen, Caen
6Unicancer, Paris, France
7Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
8Department of Internal Medicine and Medical Specialties , School of Medicine, University of Genova, Genova, Italy
9Surgical Oncology, Centre Georges-François Leclerc, Dijon
10Medical Oncology, Institut Curie, Paris
14Surgical Oncology, C.R.L.C Val dAurelle, Montpellier
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How Are Hormone Therapies For Prostate Cancer Administered
LHRH agonists, the most commonly used drug class for hormone therapy, are given in the form of regular shots: once a month, once every three months, once every four or six months, or once per year. These long-acting drugs are injected under the skin and release the drug slowly over time. LHRH antagonists include degarelix and relugolix, an oral form.
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Will I Be Able To Work While I Am Having Treatment
Most women are able to continue working during chemotherapy if they wish to. If you plan to keep working, it helps to have a supportive work place that gives you flexible work hours. You may need to have a few days off after each cycle of chemotherapy and when you get back to work you may find it difficult to work long hours. Your doctor can provide a medical certificate for time off this can be just a few days or a few months depending on your individual situation.
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What Are Hormone Inhibitors And How Do They Work
Hormone inhibitors also target breast cancer cells with hormone receptors, but unlike hormone blockers, they work by reducing the bodys hormone production. When breast cancer cells are cut off from the food supply the tumor begins to starve and die.Generally, the benefits of using hormone therapy and chemotherapy together have a much greater combined effect than using either alone. If your breast cancer is positive for hormone receptors, your doctor may recommend both therapies.
Hormone Therapy Vs Targeted Therapy For Breast Cancer Treatment
5 min read
The landscape of breast cancer treatment has been rapidly changing. Advances in diagnosis and treatment provide very effective options for breast cancer and dramatically improve survival rates when breast cancer is diagnosed and treated early. One of the biggest changes are treatments that can target specific receptors or proteins on breast cancer cells to further help patients in their fight against breast cancer.
Breast cancer tumors are tested for molecular and genetic changes as well as the presence of hormone receptors and HER2 receptors. The findings of a breast biopsy reveal if specific receptors are present in the cancer cells. There can be receptors present for:
Identifying which receptors are present makes it possible for the oncologist to develop the best treatment plan available today to destroy the cancer cells while protecting your healthy cells from as much damage as possible.
Some of these treatments are in a category called hormone therapy, while other drugs are considered targeted therapies. Not every type of breast cancer can be treated with hormone therapy and/or targeted therapy, depending on the molecular findings. Lets take a look at what hormone and targeted therapies do, who can use them, and the types of side effects breast cancer patients might expect from each type of treatment.
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Psa Levels After Treatment
A continuous rise in your PSA level can be the first sign that your cancer has come back. This should be picked up by your regular PSA tests.
The exact change in PSA level that suggests your cancer has come back will depend on which treatment you had. Speak to your doctor or nurse about your own situation.
Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery. This is because the prostate, which produces PSA, has been removed. A rise in your PSA level may suggest that you still have some prostate cancer cells.
After radiotherapy or brachytherapy, your PSA should drop to its lowest level after 18 months to two years. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA.
Your PSA level may actually rise after radiotherapy treatment, and then fall again. This is called PSA bounce. It could happen up to three years after treatment. It is normal, and doesnt mean that the cancer has come back.
If your PSA level rises by 2 ng/ml or more above its lowest level, or if it rises for three PSA tests in a row within six months, this could be a sign that your cancer has come back. Your doctor will continue to check your PSA level and will talk to you about further tests and treatment options.
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