In contrast to surgery or radiotherapy, which are local treatments, chemotherapy uses one or more medicines that are spread all over the body. Depending on the situation, it is administered before or, more often, after the surgical procedure.
When chemotherapy is given after the procedure, the doctors speak of adjuvant chemotherapy. This term means that chemotherapy aims to destroy the cancer cells that may be present in any micrometastases that cannot be detected, or in proven metastases, that are not involved in topical treatments. Chemotherapy treatment usually begins during the first month after surgery.
Sometimes chemotherapy precedes surgery to reduce the volume of the tumor and allow less invasive surgery. In that case we speak of neoadjuvant chemotherapy.
Chemotherapy side effects
The drugs used destroy not only cancer cells, but also a certain number of healthy cells that can divide quickly. This is especially true of the cells of the bone marrow (which produces the red and white blood cells and platelets), the cells that line the walls of the digestive tract and the cells that make the hair grow.
The main side effects of chemotherapy are:
- General tiredness, often due to a reduction in the number of red blood cells (anemia);
- Increased susceptibility to infectionsdue to a reduction in the number of white blood cells, which sometimes means that antibiotics are indicated;
- A risk of bleedingand the appearance of hematomas (bruising) due to a reduction in the number of platelets;
- Nausea, vomiting, and a lack of appetite due to an attack on the cells of the digestive tract (there are medicines to reduce these symptoms);
- Hair loss(you can try to prevent this by wearing a cooling helmet).
Just like chemotherapy, hormone therapy is an adjuvant treatment that complements the surgical procedure. Hormone therapy aims to reduce the risk of distant metastases and reduces the risk of new breast cancer. Hormone therapy blocks the production or action of certain hormones to slow down or stop the growth of cancer cells.
A hormone sensitive tumor
Not all cancers respond to hormone therapy. This treatment can only be used if the cancer is ‘hormone sensitive’. This is the case when the cancer cells contain hormone receptors on their surface (these allow the hormones to attach to the surface of the cells). These receptors are compared to locks whose opening through the appropriate key (in this case a hormone of the estrogen class) stimulates the multiplication of cancer cells. Through laboratory tests, it is possible the presence or absence of hormone receptors on the surface of the cancer cells to detect.
Hormone therapy medicines
Hormone therapy consists of administering medicines (in the form of tablets and / or by injection) that prevent the hormones from working, thereby counteracting their influence on the proliferation of breast cancer cells. We distinguish between two major categories of these drugs:
The SERMs (from the English ‘Selective Estrogen Receptor Modulators’)
The SERMs battle the estrogens by taking their place at the hormone receptors. In this way they prevent the hormone from affecting the cancer cells. The main drug in this category is Tamoxifen, which is taken in the form of tablets.
Although this medicine has relatively few side effects, some patients experience nausea, hot flashes and irregular periods. A slightly increased risk of endometrial (uterine) cancer has also been reported. This risk could be more pronounced if the medicine is given for a longer time. An annual gynecological examination by ultrasound is recommended.
The AIs (aromatase inhibitors)
The anti-aromatases prevent the action of an enzyme called ‘aromatase’, which contributes to the production of estrogens (hormones that promote the multiplication of certain cancer cells). These medicines are used to block the production of estrogens in various tissues (including fat, liver, muscle, breast) after menopause.
Finally, another technique consists of using surgery or external radiation therapy that produce the hormones organs to (the ovaries or adrenal glands) removal. In medical terms this procedure is called ‘ castration ‘.
Side effects of hormone therapy
- In a young woman, anti-estrogens lead to symptoms typical of menopause:
- Hot flashes
- Sweating a lot
- Sudden mood swings