Uterine Sarcoma: Hormone Therapy
What is hormone therapy?
Hormone therapy is a type of cancer treatment that works to change the levels of some hormones in your body. It may be used to treat some types of uterine sarcoma. It's not the same as the hormone therapy that can be used to help manage the symptoms of menopause. The treatment is usually done by a gynecologic oncologist. This is a specialist who diagnoses and treats female cancer. It may also be done by a medical oncologist, a specialist in the treatment of cancer using medicines (chemotherapy). You may have hormone therapy along with radiation or chemotherapy.
How hormone therapy works
Hormones are chemicals in your blood. They control how cells grow. Hormones such as estrogen and progesterone can cause cancer cells in the uterus to grow. The goal of hormone therapy for cancer is to stop the cancer cells from getting the hormones they need to grow. The cancer cells may then shrink and die.
Estrogen and progesterone are the 2 main types of female hormones that affect uterine cancer. Different types of cancer cells respond differently to them. Your healthcare provider may test samples of the cancer cells from your biopsy or surgery to see how they respond. Certain types of uterine sarcoma, such as endometrial stromal sarcoma (ESS), respond better to hormone therapy. ESS is cancer that starts in the stromal tissue. This tissue connects the lining of the uterus (endometrium) to the wall of the uterus. Hormone therapy can help shrink or kill the cancer.
You may have hormone therapy:
After you've had surgery. In this case, the goal is to help ensure that all the cancer cells have been killed. Treatment after surgery is called adjuvant hormone therapy.
If your cancer has spread or cannot be removed with surgery. Hormone therapy may be used to control or shrink the cancer.
If your cancer has come back. Hormone therapy may be used if you have already been treated for uterine sarcoma, and it has come back.
If surgery and radiation are not good choices for you. This may be the case if your health is not good.
Hormone therapy medicines for uterine sarcoma
You may take a progesterone-like medicine to help work against the effects of estrogen. Or you may take a medicine with anti-estrogen effects. These are some of the hormone-influencing medicines used to treat uterine sarcoma. Your gynecologic oncologist will talk with you about the kind of hormone therapy that would be best for you:
Progestins. These include megestrol acetate and medroxyprogesterone. These progesterone-like medicines may be used to treat ESS.
Aromatase Inhibitors. These include letrozole, anastrozole, and exemestane. These medicines prevent estrogen from forming in the body's fatty tissue. They may be used to treat ESS in women who have had their ovaries removed. They may be used to treat ESS in women who have been through menopause.
Gonadotropin-releasing hormone agonists. These include goserelin and leuprolide. These medicines are used to lower estrogen levels in women who have not gone through menopause.
How is hormone therapy given?
Most hormone therapy medicines are pills that you simply take at home. A few are shots (injections).
Common side effects of hormone therapy
If you are taking medicines for hormone therapy, you will need to know what they are and the common side effects you should watch for. The kind you have depends on which medicines are used and how the medicine is given. Your healthcare team will give you the details on your treatment.
Side effects most often seen are a lot like symptoms of menopause and may include:
Joint or muscle pain
Menstrual blood clots
Weakened bones (osteoporosis), if certain types of hormone therapy are used for years
Coping with side effects
Talk with your healthcare provider about what to expect from your type of hormone treatment. Some side effects can be prevented or treated. For example:
Weight-bearing exercise and medicine can help decrease bone loss.
Vaginal moisturizers and lubricants can help overall vaginal health and comfort during sex.
Regular exercise can help prevent weight gain and muscle loss.
Ease hot flashes by wearing layers of clothing that you can easily take off, taking care not to overheat yourself, and staying away from your hot flash triggers.
Working with your healthcare team
It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have. Make sure you know what number to call with questions. Is there a different number for evenings and weekends? Tell your healthcare team about any side effects, even those that seem minor. Your treatment may be changed to reduce these effects.
It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.
Also talk with your healthcare provider about any other therapies you may want to try. Some alternative therapies can affect hormone therapy, so talk with your healthcare provider first.
June 15, 2018
NCCN Clinical Practice Guidelines in Oncology: Uterine Neoplasms Ver 2.2017. National Comprehensive Cancer Network
Goodman, Howard, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS