3 results
3 - Hormones in cancer
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- By Jacinta Abraham, Velindre Cancer Centre, Velindre Hospital, Cardiff, UK, John Staffurth, Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 05 November 2015
- Print publication:
- 19 November 2015, pp 24-41
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Summary
Introduction
Hormonal therapies are some of the oldest active systemic anti-cancer therapies in use today. In 1896, Beatson demonstrated that surgical oophorectomy resulted in tumour regression in some premenopausal women with metastatic breast cancer, and, by doing so, he was the first to identify a link between ovarian function and breast cancer (Beatson, 1896).
Substantial evidence now exists that hormones play a key role in both the cause and the outcome of several cancers. Although this is most clearly seen in breast and prostate cancer, other cancers that may exhibit hormone dependence include endometrial, ovarian and testicular cancers.
Hormones are classified into two groups:
• non-steroidal hormones including peptides, polypeptides or derivatives of amino acids, generally acting via cell-membrane-localised receptors which trigger second messengers within the cytoplasm; and
• steroidal hormones, such as oestrogens, androgens and progestins, bind to intracellular receptors to mediate their action.
This chapter will focus primarily on steroidal hormones that are of particular importance in breast and prostate cancer: oestrogens, progestins and androgens. It should be read in conjunction with the relevant site-specific chapters (Chapters 19 and 22). This chapter provides some background knowledge of the production and functioning of hormones and their receptors, which will help in the understanding of commonly used therapies. The aetiology of hormone-related cancers is discussed in the relevant site-specific chapters.
Steroidal hormones have the potential to activate oncogenes or inactivate tumour-suppressor genes, producing a sequence of changes within the cell that ultimately lead to cancer. The continued growth of the cancer often depends on continuing hormone stimulation and so removing the hormonal stimulus causes the cancer to regress. Anti-cancer hormone therapies work in a number of different ways – by affecting hormone synthesis, metabolism or action, or by altering hormone receptor expression within the cell.
A summary of the major historical landmarks in anti-cancer hormonal therapy since Beatson's observation in 1896 is listed here.
19 - Management of cancer of the breast
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- By Delia Pudney, South West Wales Cancer Centre, Singleton Hospital, Swansea, UK, James Powell, Velindre Cancer Centre, Velindre Hospital, Cardiff, UK, Jacinta Abraham, Velindre Cancer Centre, Velindre Hospital, Cardiff, UK, Nayyer Iqbal, Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 05 November 2015
- Print publication:
- 19 November 2015, pp 262-292
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- Chapter
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Summary
Introduction
Breast cancer accounts for 7% of all deaths from cancer and 15% of female deaths from cancer. It is the second most common cause of cancer death among women in the UK. Breast cancer most commonly presents as a lump in the breast, but the use of screening has also allowed very early cancers to be diagnosed before they can be detected clinically. The management of breast cancer has changed significantly over the past 50 years. Standard surgery used to be radical mastectomy and axillary node clearance, whereas today, patients are usually treated with breast-conserving techniques: wide local excision and sentinel lymph node biopsy followed by radiotherapy. The past few decades have also seen the development and wider use of systemic therapies: hormonal treatments, chemotherapy and targeted therapies such as trastuzumab. The mortality from breast cancer has steadily decreased over the last 20 years.
Anatomy
The female breast extends from the second to the sixth rib, and it is made up of 15–20 lobes which radiate out from the nipple. The nipple is surrounded by the areola. Each breast is divided into a central portion and four quadrants. The upper outer quadrant also contains the axillary tail. The lymphatic drainage from the breast is primarily to the axillary lymph nodes, but also to the internal mammary nodes, which lie in the thorax alongside the internal thoracic artery. A few lymphatic channels also communicate with those in the opposite breast and in the abdominal wall.
In the male and prepubertal female, the nipple and areola are small, and the breast tissue does not usually extend beyond the areola.
Types of tumour affecting the breast
Table 19.1 shows the range of tumours that can affect the breast. The most common are invasive ductal carcinoma and invasive lobular carcinoma. Invasive ductal carcinomas are positive for E-cadherin, whereas lobular carcinomas are negative for E-cadherin.
Incidence and epidemiology
Breast cancer is the most common malignancy in women in the UK and accounts for 30% of all new cancers in women. In 2011 there were 50,285 new cases of breast cancer in the UK, with 349 of these occurring in men.
3 - Hormones in cancer
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- By Jacinta Abraham, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, John Staffurth, Clinical Senior Lecturer in Oncology, Consultant Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 23 December 2009
- Print publication:
- 24 January 2008, pp 23-38
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- Chapter
- Export citation
-
Summary
Introduction
Hormonal therapies are some of the oldest active systemic anticancer therapies in use today. In 1896 Beatson demonstrated that surgical oophorectomy resulted in tumour regression in some premenopausal women with metastatic breast cancer, and, by doing so, he was the first to identify a link between ovarian function and breast cancer.
Substantial evidence now exists that hormones play a key role in both the cause and the outcome of several cancers. Although this is most clearly seen in breast and prostate cancer, other cancers that may exhibit hormone dependence include endometrial, ovarian and testicular cancers.
Hormones are classified into two groups:
Non-steroidal hormones include peptides, polypeptides or derivatives of amino acids, and they generally act via cell-membrane-localised receptors which trigger second messengers within the cytoplasm.
Steroidal hormones, such as oestrogens, androgens and progestins, bind to intracellular receptors to mediate their action.
This chapter will focus primarily on the steroidal hormones that are of particular importance in breast and prostate cancer: the oestrogens, progestins and androgens. It should be read in conjunction with the relevant site-specific chapters (Chapters 16 and 19). This chapter provides some background knowledge of the production and functioning of hormones and their receptors, which will help in the understanding of commonly used therapies. The aetiology of hormone-related cancers is discussed in the relevant site-specific chapters.
Steroidal hormones have the potential to activate oncogenes or inactivate tumour-suppressor genes, which can produce a sequence of changes within the cell that ultimately leads to cancer.
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