Why Should Adjusting Hormone Levels Help Treat Some Cancers?
As is evident from the above discussion, hormones stimulate the origination and propagation of certain cancers by giving a message for cells to reproduce, including cancerous ones. Preventing hormone release by destroying the pertinent gland, or giving counter-acting acting hormones thus turns off the message for these cells to divide. Unfortunately, once a cancer starts, it is rare to be cured by hormonal shutoff alone, but it is often slowed down by removing the stimulating hormone . However, newer studies are showing that appropriate “hormonal therapy” may help cure early cancers in conjunction with other treatments, or extend life in advanced cancers. Since hormones are naturally occurring substances that deliver specific messages, we often expect less side effects (“toxicity”) than other conventional treatments. Although hormones do not have the poisonous side effects of excessive chemotherapy or radiation, they do have side effects when adjusted (“modulated”) to help a cancer patient, as discussed below.
What are the Hormonal Adjustments used in Cancer Therapy?
There are basically 3 ways of modulating hormones– by doingsurgery to remove the hormone producing gland, by givingradiation treatments to the gland to lower hormone production, and/or by givingdrugs which either counteract the cancer-stimulating hormone (work in opposition to it) or damage the glands ability to produce the offending hormone. Drugs are being used more for this as they are discovered.
Surgery is the oldest therapy for modifying hormones, and is still done (though not as frequently as in the past). The surest, simplest way of modifying the amount of testosterone a man in making is by cutting off his testicles(“orchiectomy”) . This is often the least expensive way and least dependent upon the patient following future instructions. Note that the actual operation preserves the scrotal sac, the testicles are cut out and plastic or metal “balls” can be sewn into the sac to preserve the appearance and weight of testicles. The surgery can be done under general or spinal anesthesia. The operation takes only an hour or so, with about 3 days recovery time. There is 1% chance of operative death, and 10% risk of infection or other complications. Obviously, a man will be rendered infertile (“sterile”) and lose libido immediately. The biggest problem with castration alone for reducing testosterone is that some androgens (about 5%) are still made in the adrenal glands and body fat. Thus, a prostate cancer can continue to grow under some androgen stimulation, albeit more slowly. Another problem is the psycho-social issues involved in being castrated. Thus male castration alone is seldom used today for prostate cancer, although it was common in the past.
Female castration can also be done by removing the ovaries (“oophorectomy” ) under general or spinal anesthesia; an incision is made into the lower abdomen and the uterus and fallopian tubes are usually removed also. The complete operation is called “Modified Radical Hysterectomy with Bilateral Salpingo-Oophorectomy” or “TAH-BSO” for short. There is about 2% operative death rate, 10% infection rate, and 10% risk of other serious complications including heart attack, stroke, or blood clots in the lungs (“pulmonary embolism”). Recovery time is about 1 week, with the tissues being 75% back to normal strength at 3 weeks; at this point heavy lifting is again possible. The operation was commonly done for cancers of the breast, uterus and ovaries, with the primary aim of reducing estrogen production. Obviously, it induces an immediate menopause with mood changes, hot flashes, and long term bone weakening and heightened risk of heart attack. The main problem with female castration alone is similar to that of male castration– the adrenal glands and body fat continue to produce estrogens. If additional drugs are not given to block this other estrogen, the cancer will continue to be stimulated, albeit more slowly. Again, female castration is seldom used alone today for estrogen-sensitive cancers.
Another gland destruction which can reduce both male and female hormones, and relieve pain from advanced cancer is“pituitary ablation” . Ablation means destroying the gland, and it can often be done by inserting an instrument up through the nose, breaking through the thin bone at the base of the midbrain, and mashing the pituitary. This procedure is called a “trans-sphenoidal pituitary ablation”, and is relatively safe. Complications include destruction of needed pituitary hormones (i.e. thyroid hormone and adrenocorticotropic hormone) which will require replacement therapy. Problems with this operation include an infection risk of 5%, and a 10% risk of blood clots, bleeding, or drainage of the brain-cushioning cerebral-spinal fluid
(“CSF”) out of the nose (“rhinorrhea”). Besides for the latter problem, the risks of doing an open brain procedure (“craniotomy”) with with neurosurgery are about twice as high. In practice, pituitary ablation today is reserved for tumors of the pituitary unresponsive to radiation, or possibly for severe pain from metastatic cancer.
Another hormone producing gland that is surgically removed for treatment is the thyroid– the operation is called a“thyroidectomy” and is done under general anesthesia. It is important to remove and re-implant the four parathyroid glands, so that parathyroid hormone continues to be produced– these are often placed into the forearm. The operation carries a 2% death risk, and 15% risk of complications including infection, blood clots, heart attack, stroke or pneumonia. Obviously, thyroid hormone (thyroxine) will need to be forever replaced, by fortunately it comes as a simple pill taken daily. If the lower thyroid is also removed (for medullary carcinoma of the thyroid) calcitonin may also require replacement, it comes as an injection (“Calcimar”) which can be given under the skin several times per week.
For “insulinomas” and “glucagonaomas” of the pancreas, “gastinonomas” of the stomach , “vipomas” of the intestines, and “pheochromocytomas” of the adrenal glands, simple surgery to remove the hormone producing tumor is usually curative. Hormone levels should be carefully monitored afterwards by an endocrinologist, with appropriate replacement therapy if they drop too low.
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