Dr. Muralidhar

Chemotherapy has been the remedy for cancer since the late 90s. But in today’s world the medical field has been improved so much that new methods have been invented. One of them is Hormonal therapy. It is used to cure some types of breast cancer that are affected by hormones. Receptor proteins in the breast cancer cells attach to estrogen and help the cells grow. This therapy stops the receptors attaching to estrogen in various ways.

When it is used?
Hormonal breast cancer therapy is performed after surgery to prevent the cancer from coming back. It is also applied to treat the cancer that has come back or to prevent the cancer from spreading to other parts of the body. Sometimes, if needed, it starts before the surgery. It takes five years, generally.

How it works?
Hormonal therapy mainly stops estrogen from acting on the cancer cells or lowers the estrogen level. There are different ways to do that.

1. Blocking Estrogen Receptors: These drugs stop estrogen from helping breast cancer cells.
   • Tamoxifen: It acts as anti-estrogen in the breast cells, but acts like estrogen in other cells. It lowers the risk of breast cancer and also stops cancer from coming back.
   • Toremifene: It works in a similar way, but it is only used in metastatic breast cancer. It also decreases the pain and swelling in the muscles and bones.
   • Fulvestrant: It blocks and damages estrogen receptors. It is given by injections after other drugs stop working.
2. Lowering Estrogen Levels: These drugs slow the growth of cancer by lowering estrogen levels.
   • Aromatase Inhibitors: These drugs stop estrogen production in women whose ovaries are not working due to menopause or other treatments. There are three types of this drug- Letrozole, Anastrozole and Exemestane.
   • Ovarian Suppression: In this method, ovaries are removed or shut down to turn pre-menopausal women to post-menopausal. There are several ways to do this, and they are- Oophorectomy or surgery, LHRH analogs and applying chemotherapy drugs.

There are some other types of hormone therapy that are less common. They were used more in the past. They are:

1. Megestrol acetate
2. Androgens
3. High doses of estrogen

Side Effects:
Unfortunately, Hormonal breast cancer therapy has lots of side effects. They are-

1. Hot flashes
2. Mood swings
3. Vagina discharge or dryness
4. Developing uterine cancer
5. Blood clots
6. Stroke
7. Night sweat
8. Headache
9. Mild nausea
10. Bone pain
11. Injection site pain
12. Muscle pain and joint stiffness and pain
13. Bone thinning
14. Menopause

Although hormonal therapy has lots of side effects, they are limited to different kinds of hormonal therapies and it is not necessary that they will surely happen. But it is best to undergo any kind of treatment with a doctor’s advice. So patients should consult the doctor first. In case you have a concern or query you can always consult an expert & get answers to your questions!

The uterus or womb, is a muscular structure and is held in place by ligaments and pelvic muscles. If these muscles or tendons become weak, they cause prolapse and are no longer able to hold the uterus in its place.

Uterine prolapse happens when the uterus falls or slips from its ordinary position and into the vagina or birth waterway. It could be complete prolapse or even incomplete at times. A fragmented prolapse happens when the uterus is just hanging into the vagina. A complete prolapse depicts a circumstance in which the uterus falls so far down that some tissue rests outside of the vagina. Likewise, as a lady ages and with a loss of the hormone estrogen, her uterus can drop into the vaginal canal. This condition is known as a prolapsed uterus.

Risks: The risks of this condition are many and have been enumerated as follows:

1. Complicated delivery during pregnancy
2. Weak pelvic muscle
3. Loss of tissue after menopause and loss of common estrogen
4. Expanded weight in the stomach area, for example, endless cough, constipation, pelvic tumors or accumulation of liquid in the guts
5. Being overweight
6. Obesity causing extra strain on the muscles
7. Real surgery in the pelvic zone
8. Smoking

Symptoms: Some of the most common symptoms of prolapse involve:

1. Feeling of sitting on a ball
2. Abnormal vaginal bleeding
3. Increase in discharge
4. Problems while performing sexual intercourse
5. Seeing the uterus coming out of the vagina
6. A pulling or full feeling in the pelvis
7. Constipation
8. Bladder infections

Nonsurgical medications include:

1. Losing weight and getting in shape to take stress off of pelvic structures
2. Maintaining a distance from truly difficult work
3. Doing Kegel workouts, which are pelvic floor practices that strengthen the vaginal muscles. This can be done at any time, even while sitting down at a desk.
4. Taking estrogen treatment especially during menopause
5. Wearing a pessary, which is a gadget embedded into the vagina that fits under the cervix and pushes up to settle the uterus and cervix
6. Indulging in normal physical activity

Some specialists use the following methods to diagnose the problem:

1. The specialist will examine you in standing position keeping in mind you are resting and request that you to cough or strain to build the weight in your abdomen.
2. Particular conditions, for example, ureteral block because of complete prolapse, may require an intravenous pyelogram (IVP) or renal sonography. Color is infused into your vein, and an X-ray is used to view the flow of color through your urinary bladder.
3. An ultrasound might be utilised to rule out any other existing pelvic issues. In this test, a wand is used on your stomach area or embedded into your vagina to create images of the internal organ with sound waves. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

Breast cancer is a form of cancer which develops from the breast tissue. Breast cancer is indicated by signs such as a lump in the breast, changes in breast shape, fluid flowing from the nipple, dimpling of skin, or the development of red scaly patches. Breast cancer is a fatal form of cancer in women and immediate diagnosis is required on observing the symptoms.

Diagnosis of breast cancer
Other than the regular breast screening, the diagnosis of breast cancer involves the following steps and methods:

1. Seeing your general practitioner (GP): It is very important to visit your GP soon after noticing the symptoms of breast cancer. Your GP will examine you properly and in case your symptoms need more assessment, he/she will refer you to a breast cancer clinic.
2. Mammogram and breast ultrasound: You will be required to have a mammogram, as recommended by a specialist breast unit. This is an X-ray of the breasts. An ultrasound scan may also be required. Breast ultrasound should be undertaken only if you are less than 35 years of age. This is because, young women have denser breasts and a mammogram is not as effective as ultrasound in the diagnosis of breast cancer. In ultrasound, high frequency sound waves are used for obtaining an image of your breasts. It is observed to notice any abnormality or lumps. A breast ultrasound is also important for determining whether a lump is solid or contains liquid.
3. Biopsy: In this diagnosis process, a sample of the tissue cells is taken from the breasts and tested under a microscope to find out if it is cancerous. A scan and needle test for the lymph nodes present in your armpit is also done to check whether they have also been affected. A biopsy is undertaken in several ways, depending upon the condition and severity. A needle aspiration biopsy is used for testing a sample of your breast cells without the removal of the tissues. This is the most common form of biopsy and it is also used for draining a small fluid-filled lump or benign cyst. During the process, you will be given a local anesthetic. Usually, a needle biopsy is carried out guided by an X-ray, ultrasound and an MRI scan as well. This helps in distinguishing it from non-invasive changes such as ductal carcinoma in situ.

Another form of biopsy used for the diagnosis of breast cancer is called vacuum assisted biopsy or mammotome biopsy. In this process, a needle gets attached to a suction tube, which helps in obtaining the sample and for clearing the bleeding.