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Hormone Therapy for Breast Cancer

© David Olle

What is hormone therapy?

Cancers that depend upon hormones for growth stimulation are suitable candidates for hormone therapy. The basic objective of hormone therapy is to block the action of the hormone so that cancer growth is inhibited. 5Currently, physicians practice hormone therapy for cancers of the breast, endometrium (lining of the uterus), and ovary, with therapy for other cancer conditions under consideration. This article focuses on the use of hormone therapy for breast cancer.

Hormone interactions important in the breast cancer process

Estrogens are the primary stimulus for growth of breast tissue (whether normal or cancerous). The synthesis of estrogens begins in the adrenal gland, with the conversion of cholesterol into many adrenocortical hormones. These hormones are also known also as steroids since their core structure is similar to that of cholesterol. Estrogens are derived from androgens (male hormones) in the biosynthetic pathway. The androgens are secreted into the blood and taken up by the ovary. In the premenopausal woman, testosterone is converted into estradiol, the most potent of the estrogens. The ovary then secretes estrogen, which makes its way to the breast. Estrogen will only be able to stimulate breast cells if the cells have estrogen receptors. Estrogen binds to the receptor because the shape of the receptor and the estrogen molecule are complimentary and allow them to fit into each other. The binding initiates a series of steps that lead to cell division.

The ovaries of postmenopausal women no longer secrete estrogen, but they receive estrogen by another synthetic pathway. Aromatase enzyme, which is present in breast, muscle, fat and other tissues, converts androgen hormones into estrogens. The conversion of androstenedione to estrone is particularly important for this group of women.

Another pathway to estrogen production is important to breast cancer growth. The pituitary gland secretes lutenizing hormone that stimulates the ovary to synthesize estrogen. The pituitary will only secrete lutenizing hormone if it receives a signal from the hypothalamus to do so. The signal is a type of hormone known as lutenizing hormone releasing hormone.

Surgery as a means of hormone therapy

Based on an understanding of the role of the pituitary in estrogen synthesis, early attempts at hormone therapy involved either surgical removal of the gland or its destruction by irradiation. 8However, when you realize that the pituitary is a “master gland” that secretes many hormones essential for body functions, it is obvious that this approach is not satisfactory. Currently, surgical removal of the ovary is an option for premenopausal women who still have functional ovaries. Physicians consider this approach (in conjunction with chemotherapy) for women with breast cancer that has spread (metastasized).

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