Flax seed lignans – protection against estrogen-dependent tumors. In which organs can hormone-dependent tumors appear? What is this pathology?

Behind last years There has been a virtual explosion of new methods in the treatment of breast cancer, which has brought great hopes for good prognoses. If earlier oncology had only a couple of treatment methods in its arsenal, today there is a fairly large selection of such methods. These include various new improved surgical techniques, new chemotherapy drugs, new drugs for hormonal treatment, new methods of radiation therapy and immune therapy.

Hormonal (anti-estrogen) therapy is a very effective method of treating hormone-positive (or hormone-dependent) breast tumors.

Hormone therapy is fundamentally different from hormone replacement therapy for menopause in some women. In addition, replacement hormone therapy for breast cancer can be very unsafe.

Hormone therapy is a very effective treatment for hormone-positive breast tumors.

The goal of hormone therapy is to eliminate cancer cells after the primary surgical treatment, chemotherapy or radiation therapy.

Hormonal therapy is similar in principle to “insurance” after other treatments: surgery, chemotherapy or radiation therapy, allowing you to reduce the risk of breast cancer recurrence. After cancer treatment, the patient hopes that the tumor is completely destroyed. However, no one can give such a 100% guarantee. Therefore, the appointment of hormonal therapy, as it were, protects the woman from cancer recurrence.

For some patients with hormone-positive breast cancer, hormone therapy is as important as other treatments. In fact, hormone therapy may even be more effective than chemotherapy. Depending on the specific situation Hormone therapy may be prescribed alone or in combination with chemotherapy.

Effect various methods Hormone therapy is aimed at achieving one goal - reducing the effect of estrogens on a cancerous tumor. The mechanism of hormonal therapy is thus aimed at blocking the effect of estrogens on the tumor.

Hormonal therapy can be aimed at blocking estrogen receptors, destroying them, or reducing estrogen levels in the blood. Each of these methods has its own advantages and disadvantages.

What is the role of hormones in the treatment of breast cancer?

Hormone receptors on the surface of a cancer cell are like its ears or antennae, picking up signals in the form of hormone molecules. Estrogens, connecting with these receptors, seem to instruct tumor cells to grow and multiply.

After the tumor is removed, it is examined for hormone receptors. If these receptors are detected on the surface of cancer cells, there is a chance that hormonal therapy will be effective. And the greater the number of receptors, the more effective hormone therapy will be. If it is also noted big number both estrogen and progesterone receptors, the effectiveness of hormonal therapy will be much more effective.

Another name for hormone therapy is anti-estrogen therapy. This is because the main goal of hormone therapy is to suppress the effects of estrogen on the cancer cell.

How common are hormone receptors on the surface of breast cancer cells?

About 75% of all cancerous tumors mammary glands are hormonally positive in terms of estrogen receptors (ERZ-positive).
About 65% of these hormone-positive tumors also have progesterone receptors on their surface (Pr-positive).
About 25% of all breast cancers are hormone negative for both estrogen and progesterone or have unknown hormonal status.
About 10% of all breast cancers are hormone estrogen receptor positive and progesterone receptor negative.
About 5% of all breast cancers are hormone estrogen receptor negative and progesterone receptor positive.

In this context, “positive” means that there is a significant number of receptors on the cell surface, and “negative” means that the number of these receptors is not so significant.

In some cases, the laboratory may give an answer such as “the hormonal status of the tumor is unknown.” This could mean one of the following:

A test for hormonal status was not performed,
The tumor sample obtained by the laboratory was too small to give an accurate result,
Few estrogen and progesterone receptors were found.

In such cases, when hormonal receptors are not detected, or they cannot be counted, and the laboratory gives the answer “hormonal status unknown,” the tumor is called hormone-negative.

How do hormones work?

Estrogen and progesterone - female sex hormones - are found in the blood and circulating throughout the body, affecting both healthy cells and tumor cells. In this case, the hormone affects certain organs and tissues using receptors. Receptors are high molecular weight compounds. They are either on the surface of the cell, either outside or inside. Their action can be compared to switches of certain cell functions. hormone molecules act on these receptors by connecting to them, like a key entering a keyhole. Thus, each hormone has its own receptors on the surface of those cells on which this hormone should have an effect. That is, for example, the hormone progesterone will not have any effect on cells that do not have its receptors, but there are, for example, estrogen receptors.

As you have already seen above, the majority (75%) of breast cancers are hormone-dependent, that is, estrogen and progesterone have a stimulating effect on these tumors. Without these hormones, such tumors cannot grow. They decrease in size and gradually die.

Estrogen and progesterone themselves also play an important role in the formation of some types of breast cancer:

Estrogen is very important factor for estrogen receptor cells in many body tissues and some breast tumors.
Progesterone may also be a contributing factor to cancer.

In cases where cancer cells have few estrogen receptors on their surface (as we have already said, these are hormonal-negative tumors), hormonal therapy does not have any effect. However, if there are progesterone receptors on the tumor cells, then hormonal therapy can be effective in this case. It should be emphasized that in the case where cancer cells have progesterone receptors, but do not have estrogen receptors, the chance that hormonal therapy will be effective is 10%.

What is the effect of hormonal therapy in your case?

If studies of a tumor biopsy or a sample taken after surgery reveal that the tumor is hormonal-dependent, then it is quite possible that the effect of hormonal therapy will be very good:

If cancer cells have both estrogen and progesterone receptors, the effectiveness of hormonal therapy will be 70%.
If there is only one type of receptor on the surface of cancer cells (that is, an Erc+/Pr- or Erc-/Pr+ tumor), the chance of hormonal therapy being effective is 33%.
When the hormonal status of the tumor is unknown, the chance of hormonal therapy being effective is only 10%.

Estrogen plays an important role in a woman's body. In addition to regulating the menstrual cycle and influencing the development of secondary sexual characteristics, it also affects the structure bone tissue. But still, the chance to be cured of breast cancer is vitally more important than bone tissue.

I would like to note that some studies that were conducted among elderly women with high density their bone tissue was detected high risk development of breast cancer. This has led to the belief among patients that the thicker and stronger the bones, the higher the risk of breast cancer. Relatively high levels of estrogen in the body have all three effects: it increases bone density, makes bones stronger, and increases the risk of developing breast cancer.

To date, doctors have not been able to establish the exact cause affecting the development of human body cancer diseases. However, it was still possible to identify some prerequisites that contribute to the development of such dangerous pathological processes. Exists a large number of cancer diseases that attack human body, and estrogen-dependent tumors are no exception.

In this article we will look at the main reasons for the development of such ailments, and also learn how to diagnose them and how to treat them correctly. It is also very important to become familiar with the consequences that may occur against the background of estrogen-dependent tumors. Read carefully this information, in order to protect and arm yourself as much as possible.

What is this pathology?

Estrogen-dependent tumors are benign formations consisting of muscle cells. One such cell begins to actively multiply, which leads to a huge accumulation of other cells that can form nodules in the uterus or mammary glands. Such nodules are called fibroids.

Causes of mammary glands

There are no exact reasons why estrogen-dependent tumors of the uterus and mammary glands occur. Scientists are inclined to believe that such pathologies occur with excessive production female hormones estrogens.

However, there are other factors that can provoke the development of uterine fibroids:

Hormonal imbalance. This includes not only the improper functioning of female sex hormones, but also the activity thyroid gland and adrenal glands.
Emotional condition women. Frequent stress causes the development of estrogen-dependent tumors. Uterine fibroids can also attack women who are prone to obesity. After all, metabolic disorders also entail general hormonal imbalances in the body.
Heredity. Plays an important role in such a dangerous process for health. Those representatives of the fairer sex who had relatives with fibroids in their family will be more prone to developing such a pathology.
Abortion or a woman’s inability to have a child and breastfeed.
Availability of various inflammatory processes in the female genital organs.
Injury to the mammary glands.
Wearing uncomfortable and tight underwear.
Chronic processes occurring in the mammary glands.

All these reasons contribute to the occurrence of estrogen-dependent tumors in women. What it is, it is recommended that every lady know in order to stay healthy long years.

Symptoms of tumor formation in the breast area

In the presence of a hormone-dependent tumor, a woman usually endures very painful menstruation. However, these are not all the symptoms of pathology. When you feel the breast, you can find lumps ranging in size from a few millimeters to several centimeters. Sometimes one small compaction is felt in the gland, sometimes several at once. At the same time, when pressing on them, the patient will not feel pain, so it is not always possible to identify a life-threatening pathology at home.

Signs of uterine fibroids

Estrogen-dependent tumors are benign formations that can become malignant over time. Therefore, every woman should carefully monitor her own health.

The following signs may indicate that fibroids have appeared in the uterus:

Prolonged and painful menstruation, accompanied by excessive bleeding. Wherein bloody issues and pain can also occur in the middle of the cycle. Not only the lower abdomen can hurt, but also the back and legs. Sometimes discomfort is felt during sexual intercourse.
If the fibroids begin to rapidly increase in size, this can lead to increased urination, since the pathogenic cells have grown so much that they begin to squeeze bladder. Sometimes the formation also leads to the development of constipation, especially if it grows towards the rectum. Thus, the tumor begins to compress the organ, and this causes difficulty when going to the toilet.
Other symptoms may also develop. Patients may begin to experience pain in all organs if they have estrogen-dependent tumors. The list of such diseases is not very long. Most often these include pathologies of the uterus and mammary glands.

Diagnostic breast examinations

If you notice even the slightest changes in your mammary glands, go to the hospital immediately! The first thing the doctor will do is conduct a visual examination and also palpate the breast for tumors. In fact, with tactile diagnosis it is very difficult to distinguish fibroids from any other tumor. Therefore, other types of examinations will have to be carried out, such as:

Mammography. Most often, this procedure is prescribed to mature women.
Ultrasound examination, allowing to determine the blood flow in the formed nodes.
Biopsy. During this study, the doctor will take a small piece of deformed tissue and send it for histological examination. Only after receiving the results will it be possible to accurately determine the type of disease and prescribe the most appropriate treatment.

Features of diagnosing uterine fibroids

We have already looked at what estrogen-dependent tumors are. Now it’s worth understanding how to distinguish such a pathology from any other. First of all, you will have to go for a consultation and examination with a gynecologist, and after that the doctor will refer you for further diagnostics.

After initial examination The gynecologist refers the patient to an ultrasound, which is performed using two methods. It is very important to analyze the condition abdominal cavity. Also introduced special device in the vagina, allowing you to determine the pathology of the internal cavity.

Another diagnostic method is hysteroscopy. In this case, a special device will be inserted into the uterine cavity, with which you can see everything that happens inside the organ.

Treatment with conservative methods

Estrogen-dependent and uterine conditions are quite often treated with conservative therapy. In this case, doctors prescribe to their patients hormonal drugs, reducing the female body’s production of the hormone estrogen. Such drugs can cause a condition very similar to menopause. In this case, the patient stops significant bleeding, and the fibroid itself gradually decreases in size. After discontinuation of use of this medicine The menstrual cycle in the fairer sex is usually restored.

It is also very important to take medicines, which will stop the growth of fibroids. Every woman should come to the medical institution for passing the relevant tests.

Surgery

The list of estrogen-dependent tumors in women is not so extensive, but includes very dangerous diseases, which, if ignored, can turn into malignant tumors. Quite often, doctors recommend that their patients remove fibroids through surgery. Thus, the risk that the disease will occur again will be minimal.

Most often, estrogen-dependent tumors are removed in cases where there is suspicion of development malignant tumors. Sometimes this is damaged tissue, and sometimes the breast or uterus is completely removed. According to doctors, if the patient discovered fibroids mammary glands, then quite often subsequently learns about the developed pathology in the female genital organs.

Preventive measures

Of course, any disease is much easier to prevent than to treat. It is very important to try to avoid factors that can lead to the occurrence of malignant tumors. What do doctors advise their patients for prevention purposes:

protect your breasts from injury, and also do not wear too tight and uncomfortable underwear;
promptly treat any illnesses associated with activities hormonal system;
prevent the development of inflammatory processes in the genitals. To do this, it is recommended to wear warm natural underwear, as well as sex life only with a trusted partner;

and, of course, do not forget about the right lifestyle. You need to exercise and eat right. All kinds of bad habits. Doctors strongly recommend getting rid of stress, since a large amount of stress can lead to cancer;
it is advisable to refuse hormonal contraceptives. All hormonal pills should be taken only when absolutely necessary, as recommended by your doctor.

conclusions

Estrogen-dependent tumors can bring a lot of trouble to a woman. Therefore, a representative of the fair sex should start taking care of her health today. Take care of yourself, and then your body will begin to take care of you!

Estrogens are sex hormones that are produced in the body of women. Thanks to them, the development of the uterus and its appendages occurs, the maturation of the reproductive system and the acquisition of female beauty. But when increased quantity estrogen levels may occur various diseases. These include estrogen-dependent tumors.

Concept and reasons

Estrogen-dependent tumors are neoplasms of a benign or malignant nature that develop as a result of hormonal imbalance in the body. Female estrogens play a leading role in the occurrence of these diseases.

Such pathologies most often affect the uterus, ovaries and breasts of patients. The most common estrogen-dependent tumors include uterine fibroids, estrogen-dependent breast cancer, and malignant breast cancer. There are many reasons why a hormonal surge occurs in the body and the balance of hormones is disrupted. These include the following:

Inflammatory pathologies of the female genital organs.
Diseases of the uterus and its appendages that occur in a chronic form.
Frequent abortions.
The onset of menopause.
Irregular intimate life.
Damage to the uterus or mammary glands.
Frequent stress and depression.
Infertility.
Hereditary predisposition.
Smoking and excessive drinking.
Diabetes.
Impact on the body harmful substances and radiation.

The causes of fibroids of the uterus and ovaries do not end there. In the process of research, scientists are identifying more and more new predisposing factors.

Symptoms

The clinical picture of estrogen-dependent tumors depends entirely on the organ in which they develop. If a woman has uterine fibroids, the symptoms will be as follows:

Pain in the lower abdomen of a pulling nature.
Heavy uterine bleeding.
Problems with bowel movements and urination.
Difficulty conceiving a child.

When a hormone-dependent neoplasm appears in the area of the mammary glands in women, a lump is detected when palpating the breast. Patients also notice discharge from the nipple, which normally should only occur in pregnant and nursing mothers.

With a cancerous tumor in the breast, women notice that the nipple falls inward. As the lesion grows, one gland becomes larger than the other, and pain syndrome, skin acquire a reddish tint, peel and itch.

Diagnostics

To identify an estrogen-dependent tumor, a complex is required diagnostic measures. It includes laboratory and instrumental methods. First, the doctor conducts an examination himself, listens to complaints, and studies the medical history.

Then the woman needs to donate blood for analysis. Check clinical and biochemical parameters, as well as the concentration of hormones in the body. If cancer is suspected, blood will also be needed to identify tumor markers. Additionally, a urine test may be prescribed.

The following instrumental methods are used:

Ultrasonography.
Colonoscopy.
Mammography.
Computed and magnetic resonance imaging.
Radiography.

Diagnosis is completed with biopsy and histology. With their help, the doctor finds out whether the detected tumor is cancer or not.

Therapy

Treatment methods may vary for estrogen-dependent tumors. The main way to combat them is hormonal therapy. Patients are prescribed medications containing female reproductive cells to normalize the balance of hormones. Restoring hormonal levels allows you to suppress division and growth atypical cells, reduce tumor size.

In addition to hormone therapy, other methods are used to treat tumors. The choice of method to combat pathology depends on factors such as:

Nature of the disease: benign or malignant.
Patient's age.
Stage of disease development.
Presence of concomitant ailments.
Localization of the tumor focus.

Also in the best possible way treatment of formations is surgery. In case of a benign course of the pathology, only the tumor is removed; cancerous lesion The scope of the operation depends on the size of the lesion; quite often it is necessary to remove the affected organ completely.

In the development of cancer, radiation and chemical therapy are also used. They are combined with a surgical method or prescribed independently if the tumor is inoperable.

The prognosis for estrogen-dependent pathologies may be different. With it it is generally favorable, but with cancer it all depends on the stage of development. Doctors urge women to monitor their hormonal levels and in case of any changes, undergo the necessary treatment.

Oncological diseases Today they are one of the main reasons for the decline in living standards and high mortality in humans and animals. Currently

Time is paying more and more attention integrated methods treatment of cancer, although surgical method treatment, in many situations is a priority. Application integrated approach(mono- and polychemotherapy, immunotherapy, hormone therapy, radiation therapy and other methods of influence) in clinical oncology have improved survival rates and quality of life in patients suffering from severe oncological pathologies.

Endocrine therapy has found its place in the control of tumors arising in hormone-dependent organs. The latter include the mammary gland, prostate gland, uterine body, thyroid gland, hepatoid tumors of the perianal zone, etc.

Endocrine drugs are used in the treatment of carcinoid tumors and syndromes, as well as in the treatment of cachexia and paraneoplastic syndromes.

The fundamental difference in the mechanism of action of endocrine and chemotherapeutic drugs was outlined by Nikolai Nikolaevich Blokhin in one of his lectures at the end of the fifties: chemotherapy drugs have a detrimental effect on tumor cells because they differ in many respects from the normal cells from which they originated; endocrine drugs act on tumor cells because they have retained a number of properties of normal progenitor cells, because they are similar to them.

The first data on the hormone dependence of certain types of tumors were obtained more than a hundred years ago. In 1896 Beatson found that disseminated breast cancer in a menstruating woman regressed after oophorectomy (1). And in 1900 Boyd, using material from the London Red Cross Hospital, reported the palliative effect of oophorectomy in 18 of 54 menstruating women with disseminated breast cancer (2).

In 1939 Ulrich described two patients with breast cancer who responded to testosterone in remission (3).

Synthetic estrogens for the treatment of breast cancer were first used by Haddow in 1944.

In 1941 Huggins and Hodges surprised the world with their report of regression of prostate cancer metastases after orchiectomy (4).

The role of estrogens and antiestrogens, progestins and antiprogestins, androgens and antiandrogens, LH-RH analogues, corticosteroids today is no less important than surgical or any other methods of treating cancer.

The understanding of the hormonal sensitivity of tumor cells has been significantly expanded due to the discovery of steroid receptors in tumor cells of different origins. This direction in Russia is being developed by N. E. Kushlinsky. His laboratory has discovered significant levels of steroid hormone receptors in tumors not traditionally considered hormone-dependent (colon cancer, gastric cancer, osteogenic sarcomas, esophageal cancer, pancreatic cancer, and endometrial cancer cells).

Hormones cannot “start” the division of tumor cells except through interaction with the corresponding receptor. Hormones can stimulate the growth of tumors or cause them to regress. The hormonal dependence of tumors of different organs varies. For example, almost 100% of tumors prostate gland sensitive to antiandrogen therapy, but only one third of breast cancer patients are sensitive to antiestrogen treatment.

The discovery of receptors led to a new, very productive direction in oncology - the creation of antihormones (antiandrogens, antiestrogens, antiprogestins).

Currently great importance V clinical practice acquires an analysis of the state of hormonal receptors, cytoskeletal structure, DNA ploidy, cell proliferation rate, oncogene expression inside the tumor.

We hope that immunohistochemical analysis will become a routine method diagnostic pathology. In due course, these tests will not only help make the optimal clinical diagnosis and stage of the disease, but will also help identify affected patients and/or those at risk of this disease, will show the severity of tumor development, will be indicators of prognosis, will predict the age-related nature of the tumor and will serve auxiliary for selection effective methods treatment.

In order to understand the mechanisms of action of endocrine drugs, we will consider two of the most complete diagrams effects of hormones on the mammary gland and prostate:

1. The hypothalamus, through luteinizing hormone - releasing hormone, corticotropic releasing factor, stimulates the pituitary gland to produce adrenocorticotropic hormone, which, in turn, stimulates the production of androgens, estrogens, cortisone and progesterone by the adrenal glands, affecting the mammary gland;

2. The hypothalamus, through luteinizing hormone releasing factor and corticotropic releasing factor, stimulates the pituitary gland to produce, on the one hand, luteinizing hormone and follicle stimulating hormone, which act on the testes, and on the other hand, adrenocorticotropic hormone, which acts on the adrenal glands. The testicles produce testosterone, and the adrenal glands produce testosterone, androsterone, dihydroepiandrosterone, which affect the endocrine regulation of the prostate gland.

Steroid receptors are located in the nuclei of cells. To predict the response to endocrine therapy, not only the presence of specific receptors, but also their number is important. Knowledge of these points allows the clinician to predict the degree of risk of relapse and possible metastasis to organs.

ESTROGENS

Endogenous estrogens are the main target of endocrine therapy. Only the ways to control their action are varied: either they are antiestrogens, which interrupt the connection of circulating estrogens with receptors, or they are aromatase inhibitors, which interfere with the synthesis of estrogens from androstenedione, or they are manipulations on the pituitary gland or a group of LH-RH drugs that indirectly inhibit ovarian function. Estrogen biosynthesis occurs mainly in the ovaries and, partially, in the adrenal glands. It has already been proven that the level of estrogen in estrogen-dependent tumors is higher than in blood plasma. This is explained by the paracrine influence of tumor cells. They “create” something that will then stimulate their reproduction.

ANTIESTROGENS

After the discovery of estradiol receptors in tumor cells, a new scientific idea was formulated - to bind these receptors with substances similar in structure to estrogens, but not having their properties. The complex of estrogen and estradiol receptor should not combine with the DNA estrogen response element or, after the connection, should not “start” gene transcription with subsequent proliferation of tumor cells, and estrogens that are not combined with the receptors will remain “unemployed”. After the use of antiestrogens, which inhibit a number of processes, tumor cells stop cell division in the phase

G-1. Thus, the effect of antiestrogens is antagonistic to the effect of estrogens.

TAMOXIFEN

It is this drug that we decided to consider as a reference anti-estrogen. Tamoxifen (TAM) is a trans isomer of triphenylethylene. 32 years ago, the rationale-based antiestrogenic effect of TAM in disseminated breast cancer was first demonstrated.

Tamoxifen is metabolized in the liver and is completely absorbed in gastrointestinal tract. Peak serum concentration after taking one dose of the drug is 4-7 hours. TAM is excreted mainly in feces (65%), small amounts of metabolites are excreted in urine.

It has been proven that sensitive tumor cells under the influence of tamoxifen stop proliferation in the G-1 phase.

Usually modeling clinical trials in therapeutic experiments on animals is a very difficult task. Direct comparisons (eg dose) are often not possible. Effects in experimental leukemia are often provided by drugs that have been proven effective in humans only in solid tumors and vice versa. The antitumor effect of many drugs that seemed very promising, according to experimental chemotherapy in mice and rats, could never be confirmed, and they, these drugs, “died in the waste basket” during phases 1 and 2 of clinical trials. The prominent Russian clinical pharmacologist B.E. Votchal said: “And out of a thousand mice you cannot make one person.”

The opposite happened with tamoxifen. Jordan modeled the situation of adjuvant therapy and prophylaxis in rats in which mammary cancer was induced by DMBA (dimethylbenzanthracene). The tumors contained high levels of estradiol receptors. In 100% of rats in the control, they appeared by the 130th day; in the experimental group, by the 200th day, tumors appeared in 60% of the animals. It was concluded that there was a tumorostatic effect. What is no less gratifying is that an excellent tumorostatic effect was obtained with the use of tamoxifen in dogs, especially in older dogs. age group(10 years and older).

The duration of tamoxifen use lasts until progression or significant side effects at malignant neoplasms. Adjuvant therapy with tamoxifen is indicated after surgical treatment of early cancer and in the absence of affected regional lymph nodes. Relapse rates are reduced by 27% and mortality by 17%. A direct relationship has been established between the level of receptors and the effect of adjuvant therapy on the frequency of disease relapses and mortality rates.

The antitumor effect of tamoxifen is enhanced by simultaneous ovarian shutdown. The beneficial effects of tamoxifen include maintaining bone density in old patients, reducing total cholesterol and lipoproteins. Tamoxifen also reduces the risk of angina and heart attacks. Side effects such as nausea and vomiting are rare, and there is no need for antiemetics.

Among the undesirable side effects, it is necessary to know about the possible induction of uterine cancer by tamoxifen, but the risk of this pathology is approximately 6-8% with long-term use of tamoxifen, and, moreover, as a rule, dogs receiving TAM were castrated and we did not observe this side effect.

The incidence of embolism increases with joint use tamoxifen with chemotherapy (CMF or anthracycline combinations), in humans the frequency of these complications reaches 13.6%, in dogs, in our trials we never encountered this pathology, perhaps due to the insufficient number of animals tested.

Complete resistance to TAM can be explained by the absence of estradiol receptors, mutation of receptors, alternative pathways of interaction of receptors with estrogens, and peculiarities of TAM metabolism.

Tamoxifen is the first endocrine drug that began to be used for the prevention of breast cancer, long-term, in almost all healthy people with an increased risk group. Drug prophylaxis has become a reality. We hope that the use of TAM in animals will also lead to positive results for many oncological diseases.

To date positive effect tamoxifen has been confirmed in the treatment of many neoplasms that have estradiol receptors: breast cancer in men and women, uterine cancer, ovarian cancer, sarcomatous tumors of the uterus, malignant melanoma, pancreatic cancer, hepatocellular cancer, cacinoid tumors, non-small cell cancer lung, malignant mesothelioma, kidney cancer, prostate cancer, astrocytes, myeloma and desmoids.

ANDROGENS

The testicles are responsible for the synthesis of 95% of androgens in the form of testosterone, the adrenal glands produce 5% of androgens in the form of androstenedione and dihydroepiandrosterone - their further conversion into testosterone is carried out in the prostate gland and subcutaneous tissue.

The influence of androgens on gene regulation of normal prostatic cells is characterized by 3 processes:

1. Undifferentiated cells are stimulated by androgens to synthesize DNA and proliferate. This process is called initiation.

2. When cells reach maturity and what is necessary for them appears normal functioning quantity, a negative regulation mechanism operates, limiting their number and stopping further cell division and DNA synthesis. This mechanism works under conditions high concentration testosterone.

3. Removal or depletion of androgenic activity triggers the functioning of androgen-repressed genes. This mechanism regulates cell number and leads mature cells to apoptosis. The prostate shrinks and epithelial cells disappear from it.

In prostate cancer, there is a loss of various stages of hormonal control of tumor cells. Gene disorders lead to continuous proliferation. These cells remain androgen-dependent and may benefit from endocrine therapy. The role of androgens is similar in the genesis of breast cancer in men and, as we assume, in other pathologies where androgen-dependent receptors are detected.

ANTIANDROGENS

Antiandrogens are substances that are capable of binding androgen receptors in the nucleus of target cells, interrupting the interaction of androgens with receptors and the androgen receptor complex with DNA. The antiandrogen-androgen receptor complex is not capable, unlike the androgen-androgen receptor complex, of stimulating the transcription of androgen-regulated genes. Antiandrogens compete with androgens for receptors.

There are 2 classes of antiandrogens - steroidal and non-steroidal. Steroid antiandrogens, in addition to competing with androgens for receptors, act as progestins - they inhibit the gonadotropic function of the pituitary gland and inhibit 5-alpha reductase. Along with the beneficial antitumor effect, these effects are also affected by a “bouquet” of adverse reactions.

The most widely used in veterinary practice are two non-steroidal antiandrogens: casodex and androlaxin. The effect of these drugs is equally effective in comparison with medicinal or surgical castration on rats with hormone-dependent prostate tumors. In our case, both drugs have proven themselves as promising adjuvant therapy in the treatment of malignant carcinomas of the perianal region and the treatment of conditionally malignant neoplasms (epithelial hyperplasia with a tendency to proliferation and adenomas with a tendency to proliferation).

When antiandrogens were used to treat tumors that have the corresponding receptors, the risk of relapse was reduced by 45-50%, and survival time increased by approximately two times compared with surgical treatment alone.

Casodex and androlaxin have virtually no effect on the hypothalamic and pituitary secretion of gonadotropins, thus being strictly selective drugs. These are low-toxic drugs. They are absorbed very slowly, but absorption is almost 100%. Half-life is approximately 7 days. Slow elimination of drugs occurs in bile and urine. They are metabolized in the liver.

Like other antiandrogens, casodex and androlaxin are used mainly in the treatment of disseminated gonadal cancer either as monotherapy, or together with surgical castration, or together with LH-RH agonists. Androlaxin is more active than casodex in binding androgen receptors.

Side effects of antiandrogens - itching, gynecomastia, nausea, vomiting, diarrhea, visual disturbances, interstitial pneumonia, described in humans, were not encountered when used in dogs.

Thus, the use of antiandrogens as monotherapy or in combination with surgical or medicinal castration is justified, increasing the duration and quality of life of patients.

Before proceeding to specific recommendations for the use of certain endocrinological drugs, let us pay attention to some patterns. The main indicator of hormone sensitivity of a tumor is the presence of positive estradiol and/or progesterone receptors. If both receptors are contained in the tumor, it is possible to achieve its response to endocrine therapy in 50-70% of cases, with one type of positive receptor in 33%.

Preference for endocrine therapy is given when the disease progresses slowly, high levels receptors, preferential dissemination in the bones or soft tissues, in the absence of liver metastases.

The average time for an objective response to administered endocrine drugs is 2 months. In case of unknown receptors, hormones are prescribed for metastasis to bones or soft tissues, preferably for “switched off” gonads.

Hormones can also be used in cases of negative receptors, when there is uncertainty about the correctness of their determination, or when chemotherapeutic possibilities have been exhausted.

Good results were obtained with the use of hormonal and immunomodulatory treatment simultaneously.

Based on all of the above, we consider the use of antiestrogens and antiandrogens to be very promising ways in the formation of complex ways to treat cancer.

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Inna Bereznikova

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One of the common estrogen-dependent tumors is. Most doctors considered her benign tumor. However, since this neoplasm could develop into malignant after some time, most of specialists considered it necessary to remove it, and the uterus too, except in cases where the patient with fibroids had never given birth.

In this variant of the development of the disease, it is possible to remove only the fibroid nodes. However, with such an approach to the problem, the risk of re-formation of fibroids is quite high, especially if the patient subsequently gives birth to a child. In most of these cases, surgery was performed again.

In this regard, in the nineties, experts began a massive study of this disease and came to the conclusion that fibroids are completely curable without surgical intervention.

The result of the great work done by scientists is the fact that fibroids cannot be unambiguously classified as either benign or malignant tumors. As a result of the studies, evidence was also obtained that excludes the very possibility of fibroids developing into the category of malignant neoplasms.

Uterine fibroids on ultrasound

Judging by the obtained characteristics of this disease, fibroids are more like a keloid scar (and/or an ordinary wen). This fact is intended to completely refute any suspicions that arise in patients with fibroids about possible oncological complications.

Since uterine fibroids do not have a bright severe symptoms, it is not always easy to detect during its development.

Causes of fibroids

On this moment The following main causes of this disease have been identified:

Damage and wear to the uterus

One of the main (if not the most main) reason for the appearance of this disease in patients is damage to the uterus, which is often accompanied by heavy and prolonged menstruation. Women by nature need motherhood (preferably repeatedly), and this reduces the number of menstruation. Moreover, the fewer there are, the stronger and much healthier the uterus becomes. The process of menstruation itself greatly wears out the uterus, which can provoke a large number of gynecological diseases.

The cause of damage to the uterus can be the labor of the woman’s body, as well as diagnostic curettage, unprofessional insertion of intrauterine contraceptive devices, as well as a grossly incompetent gynecological examination.

In most cases, the occurrence of uterine fibroids was provoked by multiple abortions, since any abortion is a colossal hormonal surge for everything female body. Another possible reason The appearance and development of this disease may be inflammation of the genital organs or a hormonal imbalance, which results in an increase in the amount of female hormones (another name is estrogens) and a decrease in the level of progesterones.

Almost always, such negative changes are the result of impaired functioning of the ovaries.

Currently, experts are still divided into two camps. Some argue that fibroids are not a tumor, while others believe the opposite - that they are.

However, no matter what size the fibroid is, it is an estrogen-dependent tumor.

If women consume refined carbohydrates, saturated fatty acids, and, at the same time, reducing the amount of fiber consumed increases the content of estrogen in the body. Finding out whether a woman’s level of this hormone is elevated is quite simple.

Such a woman usually has a blooming appearance, is very active, very energetic and looks much younger than her peers, whose amount of estrogen is within the normal range or reduced.

Heredity

Heredity has a serious influence on the possibility of developing a disease such as fibroids.

If a mother had this disease, then most likely her daughter will have it too.

Those women who, for some reason, are unable to experience orgasm during sexual intercourse are at increased risk of developing uterine fibroids. In such women, blood stagnates in the pelvic area, and blood vessels wherein long time remain in a tense state. All this ultimately leads to hormonal imbalance in a woman’s body.

Until ultrasound became widely available, the diagnosis of fibroids was made on the basis of heavy and prolonged menstruation, since the relatively small size of this tumor made it difficult to detect by other means.

However, the level modern medicine makes it possible not only to determine the size of fibroid nodes, but also allows you to accurately determine their location, determine their exact number, and also give a complete and specific picture of the disease itself.

Symptoms of uterine fibroids manifest differently and individually for each woman.

The only one general point, uniting these various symptoms in different patients, are nagging pain(which periodically occurs in the lower abdomen in all sick women) and heavy bleeding from the uterus.

As secondary manifestations, there is also an increased frequency of urination and, conversely, infrequent bowel movements. In some cases, such formations can cause infertility.

What types of fibroids are there?

Uterine fibroids happen:

submucosal;
interstitial;
intramural.

Among other types of neoplasms, submucosal is the most serious illness. Its development occurs in the uterus itself, very deep. This type of disease can only be diagnosed through careful ultrasound examination. Neoplasms appear both on the outer part of the uterus and on the outer pelvic cavity.

Main features interstitial fibroids are heavy menstruation, as well as impaired urination and bowel movements. During the development of this type of disease, a uniform increase in the size of the uterus is observed. In case of rapid development of this disease, a nagging pain appears in the lower abdomen. With this type of fibroid, the fibroid nodes are usually located on the inside of the uterine muscles.

The intramural type of the disease is characterized by disruptions in monthly cycle, constant painful sensations in the pelvic area and a significant increase in the size of the uterus itself.

For effective treatment All three types of uterine fibroids require, first of all, a responsible attitude of the patient towards herself. Only a qualified, licensed physician should treat this condition.

And, of course, the key to a successful recovery is a timely visit to a specialist!