From surgery to hormone therapy, learn how a team-based approach is revolutionizing cancer care.
BY DR. T. Vishnu Murthy
Malignant tumors are best managed through local excision, destruction via radiation, or a combination of both. However, when a tumor has metastasized beyond its primary site, local treatment alone becomes insufficient. Addressing metastatic disease necessitates systemic therapy aimed at either slowing tumor growth or attempting eradication. While the factors influencing tumor growth remain incompletely understood, the endocrine environment can play a critical role in some cases. Endocrine manipulations are particularly beneficial for hormone-sensitive cancers, such as those of the breast and prostate.
Effective cancer treatment should adopt an integrated approach, combining surgery, radiotherapy, endocrine therapy, and chemotherapy as appropriate. Coordination among a multidisciplinary team of experienced professionals ensures that treatment decisions are informed by the latest research and clinical outcomes. Modern cancer care demands collaboration; there is no room for independent, uncoordinated treatment strategies in this complex field.
Epidemiology and Early Diagnosis
Breast cancer is a prevalent disease, with a higher incidence observed in certain families and among childless women. Conversely, early pregnancies appear to reduce the risk. At initial presentation, 4% to 10% of cases may show bilateral involvement, highlighting its potential multicentric origin. Early detection is critical, especially in women over 30 with a family history, previous breast cancer, or no pregnancies. Regular examinations and histological confirmation of diagnosis are recommended. Prognosis improves with early intervention, particularly in well-differentiated tumors or those exhibiting high levels of lymphocyte infiltration and lymph node histiocytosis.
Treatment Approach
Designing an effective treatment strategy begins with accurately determining the tumor’s distribution. Localized disease is often managed with surgery, supplemented by radiation for affected lymph nodes. For large primary tumors, initial radiation therapy, potentially followed by surgery, may be appropriate. However, when distant metastases are evident, local treatments are generally limited to palliative care for symptomatic relief. A comprehensive evaluation, including skeletal radiographs, chest X-rays, and bone scans, is essential before planning surgical intervention. Elevated urinary hydroxyproline or carcinoembryonic antigen levels can also indicate metastatic disease.
Endocrine Factors in Treatment
Endocrine therapy plays a significant role in breast cancer treatment, especially in hormone-sensitive cases. Premenopausal patients may experience tumor regression following castration, whereas postmenopausal patients often respond to estrogen administration. However, cessation of menstruation alone is not a reliable indicator of reduced ovarian function. Persistent estrogen production can occur even after menstrual flow ceases, necessitating measurements of plasma estrogen or follicle-stimulating hormone (FSH) levels to accurately determine menopausal status.
Assessing Hormone Sensitivity
Tumor sensitivity to hormones is primarily evaluated through clinical responses to castration or hormone administration. Tumors lacking cytoplasmic estrogen-binding proteins are less likely to respond to hormonal therapy. Clinical improvement is confirmed when tumor volumes reduce by at least 50%, with symptomatic relief alone being an unreliable indicator. Biomarkers like urinary hydroxyproline and carcinoembryonic antigen levels offer additional monitoring tools.
Metastatic Distribution and Treatment
The site of metastases influences therapeutic options. For instance, soft tissue metastases in postmenopausal women often respond to estrogen therapy, while bone metastases are more amenable to androgen or chemotherapy treatments. Skin metastases may respond better to norethisterone in postmenopausal women than to other endocrine therapies.
Specific Considerations in Breast Cancer
• Prophylactic Castration: This approach is not recommended due to limited benefits in prolonging survival. Castration before recurrence complicates the assessment of subsequent endocrine treatment effectiveness.
• Oophorectomy Method: Surgical oophorectomy offers faster results than radiation-induced castration but involves additional procedures.
• Chemotherapy: Typically considered a last resort, endocrine therapy often yields longer remissions. However, combining chemotherapy with endocrine therapy in patients with a poor prognosis is an area requiring further exploration.
• Hypophysectomy: The success of this procedure depends on complete excision. Persisting prolactin secretion after surgery indicates incomplete tumor removal, emphasizing the need for meticulous postoperative monitoring.
Male Breast Cancer
Malignant breast tumors in men are rare but tend to be more aggressive than in women. The treatment principles remain similar, with castration often deemed essential regardless of age.
Precautions and Traditional Remedies
While modern medical treatments are critical, avoiding synthetic materials like nylon in undergarments is sometimes suggested to reduce potential radiation exposure to breast tissue. Cotton alternatives are preferred. Additionally, some traditional herbal remedies have been historically used for breast cancer management, though these should complement, not replace, evidence-based medical care.
The views expressed in this article are solely those of the author and do not necessarily reflect the opinions or views of this Magazine. The author can be reached at [email protected]
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