Comprehensive, easy to understand, up to date information.

1. Presented by:
Ms. Elizabeth M.Sc (N)
Asst. Professor,
Dept of MSN
NNC, GNSU.
Presented by:
Ms. Elizabeth M.Sc (N)
Asst. Professor,
Dept of MSN
NNC, GNSU.

2. Hormone Therapy - Outline
1. What is Hormone?
2. What is Hormone therapy?
3. Hormone therapy is used to...??
4. Hormone therapy is used as...??
5. How hormone therapy works?
6. Hormone therapy - Indication
7. Hormone therapy for various cancer
8. Side - effects
9. Monitoring
10. Hormonal immunotherapy

3. Hormones are natural substances made by glands in our
bodies. They are carried around our body in our
bloodstream and act as messengers between one part of
our body and another.
Hormones are responsible for many functions in our body,
including the growth and activity of certain cells and
organs. The endocrine system is the network of glands
that make hormones.

4. Hormones are known as the body’s
chemical messengers and are produced in
the endocrine glands, which include glands
such as the thyroid, pancreas, ovaries in
women and testes in men.
Some hormones encourage the growth of
some cancers, such as breast and prostate.
But, in some cases, they may kill, slow or
stop cancer cells from growing.

5. Hormone therapy is a cancer treatment that slows or
stops the growth of cancer that uses hormones to grow.
Hormone therapy is also called hormonal therapy,
hormone treatment, or endocrine therapy.

6. Hormone therapy is a form of systemic therapy—a way of administering drugs
so they travel throughout the body, rather than being delivered directly to the
cancer—that works to add, block or remove hormones from the body to slow or
stop the growth of cancer cells.

7. • Treat cancer by stop or slow its growth.
• Ease cancer symptoms - reduce or prevent
symptoms in men with prostate cancer who are not
able to have surgery or radiation therapy.
Hormone therapy is used to......

8. How hormone therapy works....
• Block the hormones from acting
• Prevent hormone production
• Eliminate the hormone receptors on cells or
change their shape

9. 1. Neo-adjuvant therapy.
2. Adjuvant therapy.
3. To reduce metastasis.
Hormone therapy is used as.....

10. • Prostate Cancer
• Breast cancers
• Ovarian Cancer
• Uterine cancer
- Indication

11. Prostate cancer
Abiraterone,
Leuprolide
Breast cancer
Anastrozole,Exemestane,
Fulvestrant, Letrozole ,
Tamoxifen, Leuprolide
Uterine Cancer
Leuprolide

12. Breast Cancer Hormone therapy
Oestrogen and progesterone affect some breast cancers. Breast cancers can be
oestrogen receptor positive (ER+) or progesterone receptor positive (PR+) or both.
Hormone treatment for breast cancer works by stopping these hormones getting to
the breast cancer cells
• Selective estrogen receptor modulators (SERMs)
• Aromatase inhibitor
• Estrogen receptor antagonists
• Luteinising hormone (LH) blockers
• Oophorectomy

13. Selective estrogen receptor modulators (SERMs)
It acts by blocking the oestrogen receptors. It stops oestrogen from telling the cancer
cells to grow.
Suitable for pre menopausal and post menopausal women
E.g. tamoxifen and raloxifene

14. Aromatase Inhibitors
After menopause, ovaries stop producing oestrogen. But body still makes a small
amount by changing androgens into oestrogen. Aromatase is the enzyme that makes
this change happen. Aromatase inhibitors block aromatase so that it can’t change
androgens into oestrogen.
E.g. anastrozole, exemestane and letrozole
Side - effects: hot flashes, night sweats, headache, nausea, hair thinning, vaginal dryness, muscle
aches, and joint pain.

15. Estrogen receptor antagonists
It works by blocking estrogen receptors in breast tissue. While estrogen may not
actually cause breast cancer, it is necessary for the cancer to grow in some breast
cancers. With estrogen blocked, the cancer cells that feed off estrogen may not be
able to survive.
E.g. fulvestrant and toremifene
Side effect: hot flashes, night sweats, weight gain, vaginal dryness and nausea. Blood clots and
endometrial cancers are rare

16. Luteinising hormone (LH) blockers
Pituitary gland produces luteinising hormone (LH) which controls the amount of
hormones made by the ovaries. LH blockers are drugs that stop the production of
luteinising hormone. This blocks the signal from the pituitary gland to the ovaries.
So, the ovaries stop making oestrogen or progesterone.
Suitable for Pre - menopausal women.
E.g. Goserelin
Side - effects: tiredness, breast tenderness, nausea, loss of sex drive, and impotence.

17. Oophorectomy
Surgery to remove the ovaries

18. Prostate Cancer Hormone therapy
Prostate cancer depends on testosterone to grow. Hormone therapy blocks or lowers
the amount of testosterone in the body.This can lower the risk of an early prostate
cancer or, it can shrink an advanced prostate cancer or slow its growth.
• Luteinising hormone (LH) blockers
• Anti androgens
• Gonadotrophin releasing hormone (GnRH) blocker
• Other therapies
• Orchiectomy

19. Luteinising hormone (LH) blockers
Pituitary gland produces luteinising hormone (LH). This controls the amount of
testosterone made by the testicles.LH blockers are drugs that stop the production of
luteinising hormone. They do this by blocking the signal from the pituitary gland to
the testicles. So the testicles stop making testosterone.

20. Anti androgens
Prostate cancer cells have areas called receptors. Testosterone attaches to these
receptors and that can encourage the cells to divide so that the cancer grows. Anti
androgen drugs work by attaching themselves to these receptors. This stops
testosterone from reaching the prostate cancer cells.
E.g. bicalutamide, cyproterone acetate and flutamide
Side - effects: hot flashes, breast tenderness, nausea, loss of libido and impotence.

21. Gonadotrophin releasing hormone (GnRH) blocker
It stop messages from hypothalamus to pituitary gland to stop produce luteinising
hormone. Luteinising hormone signals testicles to produce testosterone. So,
blocking GnRH stops the testicles producing testosterone.

22. Other hormone therapy
• enzalutamide
• abiraterone

23. Orchiectomy
• Surgery to remove the testicles
• Also known as surgical castration

24. Endometial Cancer Hormone therapy
Oestrogen and progesterone affect the growth and activity of the cells that line the
uterus. Progesterone treatment to help shrink larger cancers.
i. Progestins - medroxyprogesterone acetate or megestrol acetate
ii. Selective estrogen receptor modulators (SERMs) - tamoxifen and raloxifene
iii. Luteinizing hormone (LH) - goserelin, and leuprolide
iv. Aromatase inhibitors (AIs) - letrozole, anastrozole, and exemestane

25. Adrenal cancer
• Adrenolytics - mitotane
• Estrogen receptor antagonists - fulvestrant and toremifene
• Selective estrogen receptor modulators (SERMs) - tamoxifen and raloxifene

26. Side - effects
Prostate cancer
• Hot flashes
• Weakened bones
• Diarrhea
• Nausea
• Enlarged and tender breasts
• Fatigue
• Loss of libido
Breast cancer
• Hot flashes
• Vaginal dryness
• Menstrual irregularities
• Loss of libido
• Nausea
• Mood changes
• Fatigue

27. Other Side effects
• Thrombosis
• Stroke
• Cataracts
• Liver toxicities

28. Route
IM - arm, thigh, or hip
SC - Abdomen
• Surgery - to remove organs that produce hormones.
- it doesn’t require long-term treatment with medicines.
- it can’t be reversed.

29. Monitoring
• PSA • BSE
• Mammogram
• Imaging
• Lab test

30. Hormonal immunotherapy
Hormonal stimulation of the immune
system with interferons and
cytokines has been used to treat
specific cancers, including renal cell
carcinoma and melanoma.