Hormone Therapy For Cancer in Delhi, India

• Systemic Hormone Therapy

  Systemic estrogen in the form of pill, ring, gel, skin patch, cream, or spray contains a higher dose of estrogen absorbed throughout the body. It treats the typical menopausal symptoms.

• Low-dose Vaginal Products

  Vaginal estrogen preparations in the form of a ring, cream, or tablet, consist of low doses of estrogen. This minimizes the quantity of estrogen absorbed by the body. Hence, low-dose vaginal preparations are used to treat vaginal and urinary symptoms of menopause.

  In women with a uterus present, only estrogen therapy is not enough. Combining estrogen with progesterone or progestin will prevent the stimulation of the growth of the uterus lining, thereby increasing the risk of endometrial cancer. However, if the uterus has been removed, progestin is not required.

Hormone therapy is the choice of treatment for the following cases:

1. Prostate cancer
2. Breast cancer
3. In combination with other cancer treatments
4. To ease postmenopausal symptoms

Doctors record the patient's medical history and family history and perform a physical examination before the hormone therapy. The doctor enquires in detail about the patient's medical history and records questions such as:

1. Existing medical conditions or any recent ailments, such as a heart condition or blood clots
2. Medications or supplements are taken, such as aspirin, iron supplements, herbal supplements, ibuprofen, naproxen sodium, or blood thinners.
3. Allergic to any substances
4. History of menopause and related symptoms

Doctors may advise certain tests before the procedure. These may include:

• Blood tests: To assess levels of estrogen in the body
• PET Scan: To confirm the diagnosis of cancer

Hormone therapy can be delivered by various methods. Some of these are:

1. Oral Drugs

   Oral medicines in the form of pills, capsules, or liquids can be taken just like other medicines. However, this type of therapy is not applicable to all cases. It is important to follow the doctor's prescriptions thoroughly.

2. Injectable Drugs

   Some hormone therapy drugs can be injected into the leg, hip, or arm. These injections are given intramuscularly (IM). In addition, some drugs can be injected just under the skin of the abdomen by a method called subcutaneous injections (SC). The dose and frequency depend on the drug prescribed and the condition to be treated. Some injections may be given by the doctor, while others can be self-injected.

3. Surgery to Remove Hormone-Producing Organs

   The surgery for hormone therapy aims at removing the glands that produce these hormones. For instance, an orchiectomy, a surgical procedure to remove the testicles, which is the body's main source of testosterone, can be an alternative for some men with prostate cancer who need hormone therapy. Likewise, oophorectomy is a surgical procedure carried out to remove the ovaries, which are the body's primary source of estrogen and progesterone production. For women with breast cancer, this can be the treatment choice.

   Side effects from this type of hormone therapy occur from drugs that lower hormone levels in the body. An advantage of this therapy is that it doesn't require long-term treatment with medicines. A possible drawback is that it is permanent, so it can't be reversed once done.

Hormone therapy is recommended for women with the following conditions:

1. Have Hot Flashes

   Systemic estrogen therapy remains the most effective treatment to relieve bothersome menopausal hot flashes and night sweats that may be from moderate to severe in intensity.

2. Have Other Symptoms of Menopause

   Estrogen can control vaginal symptoms of menopause. These include itching, burning, dryness, and discomfort during intercourse.

3. Need to Prevent Bone Loss or Fractures

   Administration of systemic estrogen protects against osteoporosis- bone-thinning disease. However, doctors recommend bisphosphonates to treat osteoporosis. But estrogen therapy may help if other treatments fail to respond.

4. Experience Early Menopause or Have Estrogen Deficiency

   Estrogen helps decrease the risk of medical conditions such as osteoporosis, stroke, heart disease, dementia, mood swings, and more.

Hormone therapy is not recommended for women who:

1. Have a history of breast cancer or endometrial cancer
2. Have abnormal vaginal bleeding
3. Know or suspect pregnancy
4. Have liver disease
5. Have had blood clots
6. Personal history of stroke, heart disease or increased risk for vascular disease

Follow the instructions given by the doctor prior to the hormone therapy procedure. Some of which include:

1. At the consultation visit for the surgery, the doctor shares details of the procedure and answers queries. The doctor gives the post-operative instructions to follow. A consent form for the surgery is signed at this appointment.
2. The doctor reviews the medical history and enquires about any allergies or pre-existing medical conditions. The doctor may advise some blood tests before the procedure.
3. Inform the doctor about any ongoing healthcare supplements or prescribed medications being taken.
4. The doctor may stop certain medications such as blood thinners and NSAIDs before the operation.
5. Get all the tests done as prescribed by the doctor.
6. Maintain a healthy lifestyle. Eat nutritious food and consume a lot of leafy vegetables.
7. Inform the doctor about all the symptoms experienced.
8. Wear loose, comfortable clothing to the scheduled appointment.

No matter how beneficial for women going through menopause, hormone therapy carries certain risks. These include:

1. Endometrial cancer
2. Blood clots and stroke
3. Dementia if hormone therapy is started after midlife.
4. Hormone therapy started during midlife is related to a reduced risk of Alzheimer's disease and dementia
5. Breast cancer with long-term use
6. Gallbladder/gallstone problems
7. Irregular spotting
8. Breast tenderness
9. Monthly bleeding
10. Mood swings

Some less common side effects of hormone therapy include:

1. Fluid retention
2. Headaches (including migraine)
3. Increased breast density makes mammogram interpretation more difficult
4. Skin irritation under estrogen patch
5. Skin discolouration (brown or black spots)

It is essential to look for any signs and symptoms that may be discomforting. Report to the doctor immediately if any of the following is experienced so that the doctors can re-evaluate and adjust the dosage accordingly:

1. Breast tenderness
2. Muscle ache or joint pain
3. Bone thinning - weakness and fatigue

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