- How do hormones affect tissues?
- Hormone-dependent tumors: types
- Hormone-dependent neoplasms: diagnosis
- Cancer hormone therapy
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Hormone-dependent neoplasms are those neoplasms whose development depends on the state of the body's endocrine system. Check which tumors belong to the hormone-dependent group, what hormones influence their development and what is the hormone therapy of cancer?
Hormone-dependent neoplasmscan develop only under a specific hormonal situation in the body. You need to know that hormones have a huge impact on the growth, development and functioning of many tissues in our body.
In the case of hormone-dependent neoplasms, the influence of hormones leads to an excessive and uncontrolled multiplication of cells. The discovery of the relationship between hormonal stimulation and the development of certain cancers has led to the development of new therapeutic methods, generally referred to as hormone therapy.
Hormone-dependent cancers include, but are not limited to, breast cancer, lung cancer, endometrial cancer, colon cancer, ovarian cancer, cervical cancer, rectal cancer, gastric cancer, thyroid cancer, and kidney cancer.
How do hormones affect tissues?
Before we look at the relationship of hormones to cancer development, let's take a general look at the role they play in the body. Hormones are tiny signaling molecules that carry vital information to tissues.
The production of hormones is done by the organs of the endocrine system, which include the hypothalamus and pituitary gland, the thyroid gland, adrenal glands, ovaries and testes. The hormones produced in them are released into the blood (hence the name endocrine system), with which they are then transported to the tissues. There they have their functions to fulfill.
Hormones regulate a multitude of processes, such as digestion, excretion, sleep, reproductive function and mood. An important role of hormones is also the regulation of tissue activity and the influence on the multiplication and division of cells.
How do hormones end up in their intended cells? This is done through the receptors. Receptors are special structures within cells; their task is to bind the appropriate hormones. After the hormone molecule binds to its receptor, the hormone is transmitted and the cell activity changes.
The functioning of the endocrine system is based on a multitude of interrelationships. It would be difficult to briefly describe such a large number of complex onesmechanisms. In short, it is worth saying that the hormonal economy is strictly controlled.
Hormones are not released accidentally - they must be released into the blood at the right time and concentration. The endocrine system seeks to maintain homeostasis, i.e. internal balance. However, there are circumstances that may contribute to this imbalance.
Disorders of hormonal regulation can result from both internal and external factors.
Age is a common example of an intrinsic factor: menopausal women experience large changes in the production of sex hormones.
Obesity is another important factor, also associated with the risk of developing hormone-dependent cancers. A large amount of adipose tissue has a huge impact on the body's hormonal balance. Adipose tissue has the ability to transform and activate hormones. This relationship, for example, results in an increased risk of developing endometrial cancer among obese women.
An example of an external factor influencing the hormonal balance is the use of drugs containing hormones and their derivatives.
Hormone-dependent tumors: types
We already know where hormones are produced and how they work. So what is the relationship of hormones with the formation of cancer?
The most important seems to be the influence of hormones on the cell multiplication processes. Hormones can stimulate (drive) cell division.
Cancer cells are characterized by their ability to divide uncontrollably and constantly multiply. The more cells divide, the greater the risk of changes in their genetic material, which may lead to the process of cancer formation.
The group of hormone-dependent neoplasms, the development of which is related to the influence of hormones, includes breast, ovarian and endometrial cancer in women, prostate cancer and testicular cancer in men, and thyroid cancer in both sexes.
- breast cancer
Breast cancer is one of the most commonly known examples of hormone-dependent cancers. The breast tissue is strongly influenced by the female sex hormones estrogen and progesterone. Hormonal regulation is responsible for the growth and activity of acinar cells that produce secretions, the development of exit ducts and the course of the lactation process.
It is currently believed that overexposure to estrogen may be a factor that increases the risk of developing breast cancer. Prolonged estrogen stimulation applies to patients who started menstruating early and started menopause late.Having babies and lactating reduce the number of ovulations and therefore appear to be protective against the development of breast cancer.
It is also worth mentioning about estrogens supplied "externally" in the form of drugs. Pharmacological agents containing oestrogens, such as oral contraception or hormone replacement therapy, can also increase the risk of developing breast cancer.
It is worth knowing that the choice of a therapeutic path in breast cancer depends, among other things, on its hormone dependence. If there are receptors for estrogen (ER) or progesterone (PR) on the surface of neoplastic cells, the neoplasm belongs to the group of hormone-dependent neoplasms (in short, such neoplasm is often called ER- or PR-positive). One of the available methods of therapy is to block the stimulation of neoplastic cells by hormones.
- prostate cancer
Prostate cancer is a typical example of a hormone-dependent cancer in men. The development and functioning of the prostate is regulated by the male sex hormones - androgens (mainly testosterone and dihydrotestosterone). Unfortunately, androgens can also stimulate the growth of prostate tumors. Blocking the effects of androgens on cancer cells can slow down the growth of the cancer or stop it altogether (more on hormone therapy for prostate cancer below).
- testicular cancer
Testicular neoplasms are a group of diseases with a multifactorial etiology. They are the most common malignant neoplasms diagnosed in men aged 20-40. Recent scientific reports on their development particularly emphasize the role of genetic, environmental and hormonal factors.
In terms of the endocrine system, there is mainly a disturbance of the balance between the concentrations of androgens and estrogens. The exact effect of hormones on the development of testicular cancers, however, remains the subject of ongoing research.
- Endometrial cancer (cancer of the endometrium)
Endometrial cancer (cancer of the endometrium) is an example of a cancer that is dependent on the female sex hormone estrogen. The factor contributing to its formation is the excessive effect of estrogens, unbalanced by the sufficient effect of progesterone (which has a protective effect against the development of endometrial cancer).
Estrogens stimulate the growth of the uterine mucosa, and in excessive amounts they may promote tumor formation within this tissue. For example, the unbalanced effect of estrogens applies to obese patients, whose adipose tissue shows hormonal activity.
Obesity is one of thethe most important risk factors for the development of endometrial cancer. Others include long periods of menstruation (early onset, late menopause), not having children, and taking estrogen as a medication (without progesterone).
- ovarian cancer
Research into the effects of individual hormones on ovarian cancer is ongoing. The production of ovarian hormones is regulated by the level of other hormones - gonadotrophins produced by the pituitary gland.
One hypothesis regarding the development of ovarian cancer relates this type of cancer to gonadotropin overstimulation. This is the case, for example, in postmenopausal women - their ovaries are already "inactive", but the pituitary gland is constantly trying to stimulate them, producing large amounts of gonadotropins.
In the postmenopausal age, the incidence of ovarian cancer increases significantly - some believe that it is caused by the hormonal situation described above. There are also scientific studies confirming the stimulating effect of estrogen on the development of ovarian cancer.
- thyroid cancer
The thyroid is an endocrine gland that produces two basic hormones: triiodothyronine and thyroxine (often abbreviated as T3 and T4). The secretory activity of the thyroid gland is regulated by the influence of hormones produced by the pituitary gland, especially thyroid stimulating hormone (TSH).
The thyroid stimulating hormone causes the growth of the secretory cells of the thyroid gland and stimulates the thyroid to produce hormones. It is believed that TSH can also stimulate the growth of well-differentiated thyroid cancers (these are cancers whose cells are very similar to the cells that make up a normal thyroid).
For this reason, one of the adjuvant treatments for highly differentiated thyroid cancers is hormone therapy with thyroxine. By administering thyroxine to the patient, we inhibit the secretion of TSH by the pituitary gland. Thanks to this, we can block the stimulating effect of TSH on the growth of cancer cells.
Hormone-dependent neoplasms: diagnosis
Knowledge of cancer hormone dependency is of great clinical importance - in many cases it has a decisive influence on the choice of optimal therapy.
Confirmation of the hormone dependence of a given cancer may be an indication for hormone therapy. This type of treatment is intended to stop the hormones stimulating the growth of cancer cells.
But how do we know if the cancer diagnosed in a particular patient is hormone-dependent? In this case, the histopathological examination is of decisive importance. Toto conduct them, it is necessary to take a sample of neoplastic tissue (biopsy), and then subject it to detailed tests for the presence of receptors for specific hormones. Such a test is now a standard in the diagnosis and treatment planning of breast cancer.
Cancer hormone therapy
Hormone therapy is currently, apart from classic chemotherapy, one of the most important pharmacological methods used in the treatment of cancer. Unfortunately, it cannot be used to treat all types of cancer, but in the case of hormone-dependent tumors it is one of the basic methods of therapy.
Hormone therapy is also often used as complementary or palliative treatment of cancer.
The advantages of hormone therapy include lower intensity of side effects and a lower price compared to classic chemotherapy. Agents used in anti-cancer hormone therapy can work in different ways:
- inhibition of hormone synthesis
A group of drugs that act by inhibiting the synthesis of hormones are, for example, aromatase inhibitors. Aromatase is an enzyme that allows androgens to be converted into estrogens. Inhibiting its activity with aromatase inhibitors (e.g. anastrozole) reduces the concentration of oestrogens. This phenomenon is useful in the treatment of estrogen-dependent neoplasms. Aromatase inhibitors are currently used in the treatment of breast cancer, for example.
- removal of the hormone-producing organ
Removing the organ that produces hormones is admittedly a surgical procedure, but its effect is primarily on the body's hormonal balance. An example of such a procedure is orchiectomy, i.e. removal of the testicles - the main source of testosterone. Orchidectomy is sometimes used in the treatment of prostate cancer, although nowadays it is more and more often replaced by various types of pharmacological therapy (see below).
- blocking hormone receptors
It is one of the most important mechanisms of action of agents used in hormone therapy. By blocking the receptors for hormones on the surface of cancer cells, it inhibits the stimulating effect of these hormones on the growth of the cancer.
Drugs belonging to this group are, for example, androgen receptor blockers, which are used to treat prostate cancer (e.g. flutamide). Another example is estrogen receptor blockers (e.g. tamoxifen), used in the treatment of hormone dependent breast cancer.
In turn, blocking gonadoliberin receptors (degarelix), located in the pituitary gland, inhibits the secretion of the pituitary hormones FSH and LH. This in turncauses the inhibition of testosterone production, which is a desired phenomenon in the treatment of prostate cancer.
- hormone administration
The methods of hormone therapy described above focused on blocking the influence of hormones stimulating the growth of cancer cells. Sometimes, however, the goal of hormone therapy is to administer hormones that can limit the growth of the tumor. A good example is the progesterone derivatives (medroxyprogesterone) used in the treatment of endometrial cancer.
About the author
Krzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. She is particularly interested in gynecology and obstetrics, paediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.
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