Endocrine Therapy for Postmenopausal Women: Positive Early Breast Cancer

Endocrine Therapy for Postmenopausal Women

Endocrine therapy is an important systemic treatment for all stages of hormone receptor-positive breast cancer and has seen significant advances since Beatson first made the link between the endocrine system and breast cancer more than 100 years ago. In the past few decades, modern endocrine therapies, such as the orally administered selective estrogen receptor modulator (SERM) tamoxifen, have revolutionized early breast cancer therapy, offering a real improvement in terms of both disease-free (DFS) and overall survival. Treatment guidelines now call for the determination of estrogen and progesterone receptor status in all primary breast tumors and endocrine therapy for postmenopausal women. Nonetheless it is important to note that these therapies are only recommended for women with known hormone receptor-positive disease.

Experts at AWAREmed Health and Wellness Resource Center under the able leadership of Doctor Akoury’s care are stating that unlike advanced disease, early detection of breast cancer is hypothetically curable. However treatment of early breast cancer may involve adjuvant therapy consisting of systemic endocrine therapy, chemotherapy or both. This can be done after initial surgery to remove the tumor to prevent or delay tumor recurrence. The ultimate goal of adjuvant endocrine therapy is to increase the chances of curing invasive early breast cancer, with as low a level of adverse side-effects as possible.

Historically, tamoxifen was the first successful hormonal treatment and became the ‘gold standard’ adjuvant endocrine therapy in postmenopausal women. It has been shown to be more effective than chemotherapy in women of over 50 years of age with hormone receptor-positive early breast cancer. These findings have prompted its investigation as a chemo-preventive agent in women at risk of breast cancer. Bearing in mind that this study had a short follow-up, tamoxifen was found to be associated with almost 50% reduction in new tumors compared with placebo. As a result, Nolvadex™ (tamoxifen citrate) was approved by the US Food and Drug Administration (FDA) for reducing the incidence of breast cancer in women at high risk of developing the disease. However, despite its proven effectiveness, tamoxifen therapy is still linked to a number of serious side-effects including an increased risk of endometrial cancer and sarcoma and thromboembolic disorders all of which are potentially life-threatening. This clearly limits its use both as adjuvant therapy (where it is usually recommended for up to 5 years) and in particular, as a preventative therapy. This shortcoming has prompted the search for, and development of, new agents with equal or improved efficacy and fewer side-effects.

Alternatively postmenopausal women with hormone receptor positive breast cancer may be offered adjuvant therapy with either tamoxifen or with an aromatase inhibitor. Aromatase inhibitors belong to a class of drugs that work by reducing the levels of estrogen in the body. Even if you have stopped menstruating, your body may still produce small amounts of estrogen in the adrenal glands, fat tissue and even breast tissue. These drugs for over two decades have been shown to reduce the risk of breast cancer recurrence in postmenopausal women with early stage breast cancer. Such drugs include anastrozole (Arimidex^®), exemestane (Aromasin^®) and letrozole (Femara^®).

Postmenopausal women with hormone-positive tumors may do just as well or perhaps a bit better with an aromatase inhibitor when compared to tamoxifen. It is not recommended for these women to undergo ovarian suppression as adjuvant treatment since their ovaries are not producing estrogen. Oophorectomy would be considered in this case in women who are BRCA 1 or 2 mutation carriers or have a strong family history of ovarian cancer as a preventive measure. Experts recommend that patients who are diagnosed with early stage non-invasive breast cancer (DCIS) may be given tamoxifen to prevent breast cancer from occurring in the unaffected breast. But in all this, it is important to understand that the use of aromatase inhibitors in postmenopausal women with DCIS is under investigation.

Many women stop menstruating after receiving chemotherapy, often for several months or even a few years. This does not necessarily mean they are postmenopausal. It is possible that these women could still have functioning ovaries and premenopausal hormonal levels despite the absence of their menstrual periods. Also, ovarian function could still return unexpectedly. That said, women who are premenopausal, regardless of whether they experience temporary menopause because of treatments, should not be prescribed aromatase inhibitors (unless they are participating in specific clinical research studies). Aromatase inhibitors are typically reserved for postmenopausal women with breast cancer.

Endocrine Therapy for Postmenopausal Women: Side effects of aromatase inhibitors

Like in all other medications aromatase inhibitors are also having their side effects which are generally mild and well-tolerated. They may include the following:

High cholesterol – You may need routine screenings. If cholesterol becomes a problem, you may be asked to reduce your intake of fat from meats and other animal products.
Hair thinning
Hot flashes
Decreased interest in sexual activity
Mood swings
Joint stiffness and pain, including carpal tunnel symptoms – In a small number of patients, this can be quite severe. If you develop severe symptoms your doctor may recommend that you temporarily stop taking it and then try another kind of aromatase inhibitor or tamoxifen.

Endocrine Therapy for Postmenopausal Women: Complications

The use of aromatase inhibitors may trigger complications where the patient loses the bone density. It is therefore advisable that all women who are considering using aromatase inhibitors to consult with their doctors about having a bone density study (DEXA scan). Besides that such patients should also take at least the minimum recommended daily allowances dose of calcium and vitamin D. and for those patients with some evidence of bone loss, your doctor may recommend that you increase your exercise level or take a calcium supplement. However if you are still experiencing problems with bone loss, a prescription of bone building drugs like a class of medications called bisphosphonates may be recommended. The drug Evista^® (raloxifene) is quite similar to tamoxifen and in general should be avoided by women who were previously diagnosed with breast cancer.

Endocrine Therapy for Postmenopausal Women: Positive Early Breast Cancer

Neuroendocrine Restoration: Overcome addiction through Neuroendocrine

April 5, 2014

Overcome addiction through Neuroendocrine-Restoration of neuroendocrine system

Neuroendocrine system

Restoration of neuroendocrine system helps over come addiction and stress.

The neuroendocrine system is made up of a network of cells that are distributed throughout the body. The word neuroendocrine refers to 2 qualities of these cells: they have a similar structure to nerve cells (neurons) and produce hormones like endocrine cells. Neuroendocrine cells release hormones into the bloodstream in response to chemical signals from other cells or messages from the nervous system. These hormones work like neurotransmitters.

Neurotransmitters are chemicals released by a nerve cell to transmit signals or impulses from one nerve cell to another nerve cell or other specialized cells.

Structure

The neuroendocrine system is formed by the diffuse neuroendocrine system and the endocrine system. It is made up of cells that produce and release hormones.

Overcome addiction through Neuroendocrine-Diffuse neuroendocrine system

The diffuse neuroendocrine system is made up of neuroendocrine cells scattered throughout the body.

Neuroendocrine cells in the digestive system regulate intestinal movements and the release of digestive enzymes.
Neuroendocrine cells in the respiratory system are believed to play a role in the developmental stages of the respiratory organs. They also regulate respiratory function.
There are small neuroendocrine organs, known as paraganglia, along the spinal column. They include the adrenal medulla inside the adrenal gland and paraganglia outside the adrenal gland. They produce the hormones epinephrine and norepinephrine. These hormones control blood pressure and heart rate.
Neuroendocrine cells are also found in non-neuroendocrine glands and are scattered in the skin, thymus, prostate and other tissues.

Overcome addiction through Neuroendocrine-Endocrine system

The endocrine system is formed by the endocrine glands, which are ductless glands that secrete hormones directly into the blood or lymph fluid. The actions of these hormones vary according to the gland and specific type of hormone produced.

The endocrine system is made up of pituitary, pineal, thyroid, parathyroid and adrenal glands, pancreatic islet cells (also known as islets of Langerhans) and the ovaries or testicles.

The pituitary, pineal and parathyroid glands are neuroendocrine glands.
The thyroid gland is not a neuroendocrine gland, but it contains scattered neuroendocrine cells known as C cells.
The adrenal glands are made up of a non-neuroendocrine area called the cortex, and a central neuroendocrine gland called the medulla.
The pancreas is an exocrine gland, but contains scattered groups of neuroendocrine cells called pancreatic islets.
The ovaries and testicles are not neuroendocrine glands, but contain scattered neuroendocrine cells.

Overcome addiction through Neuroendocrine-Function

Neuroendocrine cells are highly specialized nerve-like cells that release hormones in response to a neurological or chemical signal. The hormones released by the cells enter the blood and travel throughout the body to reach their target cells. Each type of hormone binds to a specific receptor on the target cell. The target cell responds to this hormone by changing specific cellular functions, such as metabolism, growth and reproduction. Complex feedback mechanisms involving the nervous system, endocrine system and diffuse neuroendocrine system control the levels of hormones in the body.

Examples of hormones and their action include:

Insulin is produced by the pancreatic islet cells. It reduces the sugar levels in the body when they are too high. (Hypoglycemia is too little sugar in the bloodstream. Hyperglycemia is too much sugar in the bloodstream.)
Serotonin is released by the neuroendocrine cells of the gastrointestinal tract. It regulates intestinal movement.
Growth hormone is produced in the pituitary gland. It stimulates growth of bone and tissue.

It therefore explains why it is important to have a properly functioning neuroendocrine system and if it’s not then a speedy restoration needs to be done for proper control of addiction.
Food, drugs or alcohol or any other substance does not matter. Addictions can be successfully treated. And addicts need to be completely treated because despite the feeling that they may be in, some way helping, the truth is, they simply get in our way and need to be pushed aside. But how do we push them aside? If the complex neuroendocrine systems of the body are well balanced, a state of well-being or fulfillment will be achieved. If we feel fulfilled and live with a sense of well-being we will adopt behavior patterns which are in sync with internal state. Addictions will not get in our way and we will achieve growth.

However, if the nervous system is in disequilibrium, especially as it is always when addictions are involved, the resulting loss of fulfillment prompts the desire to restore an experience of greater well-being or happiness. Chemical dependency represents maladaptive behavior which may arise in a misguided effort to restore well-being. In other words when you take that substance be it alcohol, a drug, or an over-indulgence of food, in order to make yourself feel better. You should know that the substance will only give you a temporary feeling of well-being and happiness by confusing the real problem, you may feel better during the time when the

Substance is in your system but as soon as it is over you pick the Pease’s from where you left. In other words it is never helpful and does not give lasting fulfillment and well-being, and, in fact, guilt and remorse often follow the addictive behavior.

The mind-body is one seamless energetic system. Since the mind-body is a whole, any attempt to use will power alone to cure addiction can be a difficult exercise. Because the neuroendocrine system is out of balance, cravings for the substance become exceedingly powerful and difficult to overcome. It has been said that only a new seed can create a new crop and if you are struggling with addiction I strongly suggest that you work on the restoration of your neuroendocrine system by visiting AWAREmed Health and Wellness Resource Center under Doctor Akoury’s care. At this facility we focus on Neuroendocrine Restoration (NER) to reinstate normality through realization of the oneness of Spirit, Mind, and Body, Unifying the threesome into ONE. With us you will get your life back and live it to the fullest.