Hormone Replacement Therapy And Breast Cancer Risk
Taking a combination of estrogen and a progestin for postmenopausal symptoms is associated with a slightly increased risk of breast cancer, based on a large study conducted many years ago . The longer a woman is on hormone replacement therapy , the higher the risk. HRT is also associated with greater breast density, which makes it harder to find signs of breast cancer on a mammogram.
Most providers advise only taking hormones if your symptoms are affecting your quality of life, and to re-evaluate your needs every year. Talk with your Ob/gyn or primary healthcare provider about the benefits and risks of HRT based on your personal and family medical history.
Breast Cancer That Has Spread To The Brain
This is known as secondary breast cancer in the brain. It can also be called brain metastases or brain mets.
Its not the same as having cancer that starts in the brain. The cancer cells that have spread to the brain are breast cancer cells.
For most people with secondary breast cancer in the brain, breast cancer has already spread to another part of the body such as the bones, liver or lungs.
For some people, the brain may be the only area of secondary breast cancer.
What Are The Potential Complications Of Breast Cancer
Complications of breast cancer are caused by a rapid growth of abnormal cells. These cells can travel through the bloodstream and lymphatic system to other areas of the body, most often the bones, lungs and liver. There they can multiply rapidly and develop new malignant tumors that interfere with normal organ function.
Complications of breast cancer metastasis include:
Hip and other bone fractures and bone
, , or
Secondary cancer , such as brain or
You can best lower your risk of complications by following the treatment plan you and your healthcare team design specifically for you.
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Treatment Options For Breast Cancer
Breast cancer treatment may include a combination of:
drugs to kill actively growing cancer cells
Dietary counseling to help people with cancer maintain their strength and nutritional status
Hormone therapy drugs to block the effects of estrogen for certain types of breast cancer that are stimulated by estrogen
Immunotherapy drugs to stimulate the bodys ability to target and fight off cancer cells
to remove a cancerous breast lump in early stage cancer while leaving the rest of the breast intact
Mastectomy to remove part or all of the affected breast, which may include removal of nearby lymph nodes and part of the chest muscles
to improve the overall quality of life for families and patients with serious diseases
Participation in a clinical trial to test promising new therapies and treatments for breast cancer
to help strengthen the body, increase alertness, reduce , and improve functional ability during and after cancer treatment
Radiation therapy to destroy cancer cells. Radiation therapy can also be useful to relieve symptoms of metastatic breast cancer tumors.
- drugs to kill specific types of breast cancer cells with less damage to healthy cells
What Are The Symptoms
Breast cancer can cause:
- A change in the way the breast feels. The most common symptom is a painless lump or thickening in the breast or underarm.
- A change in the way the breast looks. The skin on the breast may dimple or look like an orange peel. There may be a change in the size or shape of the breast.
- A change in the nipple. It may turn in. The skin around it may look scaly.
- A fluid that comes out of the nipple.
See your doctor right away if you notice any of these changes.
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Symptoms Of Metastatic Breast Cancer
When metastatic breast cancer stops responding to treatment, the focus may shift to end-of-life care.
The symptoms of metastatic breast cancer are different to those of early-stage breast cancer. This is because the cancer has spread to other organs and is affecting other body systems, as well as the affected breast.
Most of the time, metastatic breast cancer affects the bones, lungs, brain, or liver.
Having one or more of the following symptoms does not mean that a person has metastatic breast cancer. However, anyone who experiences these symptoms should see a doctor for an evaluation.
Hair Loss And Your Children
If you have young children, you may be concerned about how theyll react to seeing you lose your hair as a side effect of chemotherapy.
Experts say that no matter the age of your kids, its best to prepare them before your hair falls out with honest, age-appropriate information about what to expect.
Since kids often follow your lead, try not to get too upset yourself during the conversation. Reassure them that your hair will grow back. It might also make them feel better to participate in some of the things youre doing to prepare, such as picking out hats, scarves, or other head coverings, or shaving off your hair.
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Persistent Headache Or Blurred Vision
Occasional headaches are common and generally dont need medical attention. However, if you are experiencing two or more headaches a week, are taking pain relief for headaches most days or your headaches become disabling, you should see your doctor.
People can experience blurred or double vision in one or both eyes and this may be caused by eye conditions such as difficulty focusing your eyesight, an eye infection, astigmatism, dry eye syndrome, cataracts or an injury to the eye so you should consult your doctor or optometrist. Blurred vision can also be caused by diabetes, migraine, stroke or a brain tumour. It is important to seek medical attention if the blurred vision persists or appears suddenly.
If Youre Getting Radiation Therapy To The Head Or Neck
People who get radiation to the head and neck might have side effects such as:
- Soreness in the mouth or throat
- Dry mouth
- Jaw stiffness
How to care for your mouth during treatment
If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:
- Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
- Dont eat or drink very hot or very cold foods or beverages.
- Dont smoke, chew tobacco, or drink alcohol these can make mouth sores worse.
- Stay away from sugary snacks.
- Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
- Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed.
- Sip cool drinks often throughout the day.
- Eat sugar-free candy or chew gum to help keep your mouth moist.
- Moisten food with gravies and sauces to make it easier to eat.
- Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.
If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.
How to care for your teeth during treatment
Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.
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Radioprotective Drugs For Reducing Side Effects
One way to reduce side effects is by using radioprotective drugs, but these are only used for certain types of radiation given to certain parts of the body. These drugs are given before radiation treatment to protect certain normal tissues in the treatment area. The one most commonly used today is amifostine. This drug may be used in people with head and neck cancer to reduce the mouth problems caused by radiation therapy.
Not all doctors agree on how these drugs should be used in radiation therapy. These drugs have their own side effects, too, so be sure you understand what to look for.
Cancer In The Tissue Around The Brain And Spinal Cord
Sometimes breast cancer spreads to tissues and fluid that surround the brain and spinal cord. This is known as leptomeningeal metastases.
Symptoms are similar to those of secondary breast cancer in the brain, but may be less obvious and more difficult to diagnose.
Its usually diagnosed using an MRI scan, but you may also have a lumbar puncture to take a sample of fluid to be looked at under a microscope.
Treatment can include steroids, radiotherapy and chemotherapy. Chemotherapy or targeted therapy drugs may be given directly into the fluid surrounding the brain and spinal cord to treat the cancer.
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Unexplained Bleeding Or Blood
Unexplained bleeding can be caused by something less serious than cancer but you should check with your doctor.
Blood in your faeces or urine or coughing up a vomiting blood could be a sign of cancer.
Unexplained vaginal bleeding, including between periods, after sex or after menopause should be investigated by your doctor.
What Is Hormone Receptor
Breast cancer tumors that are hormone receptor-positive need the hormones estrogen or progesterone to grow. Approximately 75% of breast cancers are hormone-positive in post-menopausal patients. Your healthcare provider will perform a biopsy and laboratory testing to determine the cancer type and most effective treatment.
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Why Does It Get Worse
The main reason for worsening migraine during menopause is the fluctuation of estrogen. This is also responsible for initial worsening of migraine at puberty, as it can take a few years for the hormones to reach the settled pattern of the menstrual cycle. From late teens to mid 30s, most women have a regular pattern of menstrual cycle hormones. For some women, the natural drop in estrogen that occurs around menstruation and during the pill-free week of oral contraception, can trigger. Others find that heavy, painful periods are linked to migraine. From early 40s, the menstrual cycle can become more erratic, with much more variable fluctuation in estrogen levels. Periods themselves can be more troublesome, with more pain and heavier bleeding. All these factors can make migraine more likely. As periods lessen, so the hormonal trigger for migraine lessens, which is why many women find migraine improves after the menopause.
How Long Do Side Effects Last
Remember that the type of radiation side effects you might have depends on the prescribed dose and schedule. Most side effects go away within a few months of ending treatment. Some side effects may continue after treatment ends because it takes time for the healthy cells to recover from radiation.
Side effects might limit your ability to do some things. What you can do will depend on how you feel. Some patients are able to go to work or enjoy leisure activities while they get radiation therapy. Others find they need more rest than usual and cant do as much. If you have side effects that are bothersome and affecting your daily activities or health, the doctor may stop your treatments for a while, change the schedule, or change the type of treatment youre getting. Tell your cancer care team about any side affects you notice so they can help you with them.
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How Are Metastatic Brain Tumors Treated
Treating a brain tumor is usually only one step in treating metastatic cancer. At Yale Medicine, treatment is carefully coordinated among the neurosurgery, radiation oncology and medical oncology teams.
Traditionally, treatment for brain metastases involves radiation and surgery, since chemotherapy has limited ability to penetrate into the brain.
Patients whose brain scans reveal only a few metastases can be considered for a targeted radiation treatment called radiosurgery. At Yale Medicine, this treatment is delivered using a machine known as the Gamma Knife. If this procedure is appropriate, then imaging required for treatment, treatment planning and radiation delivery can all be done in one day. This has the advantage of minimizing interruption of chemotherapy.
For those with larger or more widespread brain tumors, Yale Medicine also offers the more comprehensive treatment options, including:
- Hippocampal sparing whole brain radiation therapy with memantine
- Surgical resection or laser ablation guided by use of MRI in the operating room
- Microsurgical resection of tumor
Lastly, for select patients, clinical trials are available for the treatment of newly diagnosed brain metastases using chemotherapy alone. At this time, this option is available for patients with lung and melanoma brain metastases.
Preparing For Scalp Cooling
Whether you use cold caps or a scalp cooling system, its important to make sure the cap fits correctly to increase the chance it will be effective. Carefully follow the manufacturers instructions on how to fit the cap on your head, and practice before your first treatment.
Both scalp cooling methods get very cold, so some people get headaches while wearing the caps. Other possible side effects include:
- neck and shoulder discomfort
Most people get very cold during scalp cooling, so you should dress warmly and bring warm blankets with you, or ask the cancer treatment center if they have blankets you can use. People tend to feel colder wearing cold caps than they do using scalp cooling systems. Its common for people to feel the most discomfort during the first 10 minutes of treatment and then feel less discomfort as they adjust to the cold.
When using cold caps or a scalp cooling system throughout chemotherapy treatment, its smart to be extra gentle with your hair to prevent damage and help maintain hair quality. Its recommended that you:
- use a gentle shampoo
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Ascertainment Of Outcomes: All
For the primary outcome, all reported deaths of all causes were confirmed using information from autopsy reports, death certificates, medical records, and information obtained from next of kin or family members. Disease-specific causes of death due to cardiovascular diseases, any cancers, or female-specific cancers, the secondary outcomes, were confirmed by an Endpoints Committee of physicians using medical records. Female-specific cancers included breast cancer, cervical cancer, endometrial cancer, ovarian cancer, and uterine cancer.
Hormonal Therapy And Hair Loss
Some hormonal therapies used to treat breast cancer can cause mild to moderate hair loss, or hair thinning, often at the frontal hairline, the middle part, or the crown of the head. These medicines include:
- tamoxifen, a selective estrogen receptor modulator
- Faslodex , an estrogen receptor downregulator
- Arimidex , Aromasin , and Femara , which are called aromatase inhibitors
Hormonal therapies work either by lowering estrogen levels or by blocking the effects of estrogen in breast tissue. Researchers dont know exactly why hormonal therapies cause hair loss, but by lowering estrogen levels they reduce the growth of hair follicles.
If you experience hair loss as a side effect of hormonal therapy, it may take between 6 months and 2 years before you notice it. Often the hair loss will level off after the first year or so. But the thinning will last as long as you keep taking the medicine, which is often from 5 to 10 years. Hair will usually start growing back a few months after you stop taking hormonal therapy.
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If Youre Getting Radiation Therapy To The Chest
Radiation treatment to the chest may cause side effects such as:
- Sore throat
Radiation can also cause other problems in the heart or lungs.
Getting radiation to the middle portion of the chest can raise your risk of heart disease. This risk increases with higher radiation doses and larger treatment areas in this part of your body. Radiation can also cause hardening of the arteries , heart valve damage, or irregular heartbeats.
Radiation pneumonitis is inflammation of the lungs that can be caused by radiation treatment to the chest . It may occur about 3 to 6 months after getting radiation therapy. Its more likely if you have other lung diseases, like emphysema . Common symptoms of radiation pneumonitis include:
- Shortness of breath that usually gets worse with exercise
- Chest pain, which is often worse when taking in a deep breath
Sometimes there are no symptoms, and radiation pneumonitis is found on a chest x-ray.
Symptoms often go away on their own, but if treatment is needed, it is based on trying to decrease the inflammation. Steroids, like prednisone, are usually used. With treatment, most people recover without any lasting effects. But if it persists, it can lead to pulmonary fibrosis . When this happens, the lungs can no longer fully inflate and take in air.
Be sure you understand what to look for, and tell your cancer care team if you notice any of these side effects.
Models Of Metastatic Progression
A model of metastatic progression in cancer. Primary tumor growth and invasion occur through the gain of genetic or epigenetic changes in the primary tumor often in cells that have a change in character through the process of epithelial to mesenchymal transition . Individual cells, or groups of cells, that have gone through this transition, as well as those that have not , gain access to blood vessels through incompletely defined mechanisms. Some of the cells are targeted to specific organs and enter their new microenvironment. Cells that have dedifferentiated are likely able to modify the premetastatic niche to allow for proliferation and invasion with short latency in the metastatic site. Cells shed into the circulation that are more differentiated likely enter a period of prolonged dormancy controlled by a number of factors that may be released over time through changes in the tumor cells or the metastatic microenvironment. In both cases, metastatic progression at the metastatic site likely requires interactions with immune cells, endothelial cells, and the stroma.
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