Breast cancer is the most common type of cancer seen in women all over the world and in our country, and it is thought that one in every 8 women will develop breast cancer in their lifetime. During the examination after breast cancer, they go through a process where surgery, chemotherapy, radiotherapy and then drugs such as tamoxifen are used for many years.
Since the breast is an organ sensitive to hormones, breast-related conditions and the female reproductive system, especially between the uterus and ovaries, There is a very close relationship.
Similarly, in the examination after breast cancer, conditions such as obesity, late menopause or BRCA familial breast-ovarian cancer syndrome that lead to breast cancer also affect the female reproductive system. It can be understood that gynecologists and, if necessary, gynecological oncology surgeons have an important place in the follow-up of women with breast cancer, as it causes some changes in their organs.
Menopause and related complaints that develop after breast cancer treatment:
Chemotherapy drugs used after surgical treatment for breast cancer may reduce or completely eliminate ovarian functions in these women. This condition is seen in approximately 50-80% of patients. If patients have not entered menopause before, these patients will experience complaints such as menstrual cessation, hot flushes, mood disorders, and vaginal dryness due to early menopause. They may start menstruating. Even in patients whose ovarian functions return, there will be a risk of re-menopause due to chemotherapy.
Post-breast cancer examination should be evaluated by a gynecologist and appropriate treatment should be initiated in order to eliminate menopause-related complaints in women and reduce the risk of osteoporosis.
>Ovarian suppression in breast cancer treatment:
During the examination after breast cancer, since breast cancer is sensitive to estrogen, the female hormone, sometimes medical oncologists want to suppress ovarian functions and for this, monthly or They resort to injections every 6 months.
In some patients, ovarian function is impaired. Their pain may not be suppressed despite these injections, or patients may become bored with monthly injections and want to plan a more permanent solution. In this case, medical oncologists and gynecological surgeons can jointly decide to remove the ovaries and tubes.
After this surgery, the patient's estrogen hormone production will completely disappear. It is necessary to inform patients about the surgical menopause that will occur after the removal of the ovaries.
Follow-up during the use of Tamoxifen Derivatives and Aromatase Inhibitors:
Completing the surgical treatment and subsequent chemotherapy and radiotherapy process. Some drugs that have hormonal effects have been shown to be useful in preventing the recurrence of breast cancer in women. There are two types of drugs used for this:
Aromatase inhibitors:A group of drugs called aromatase inhibitors, which are three different drugs called anastrazole, eczemastan and letrozole. It is a group of drugs used after the first treatment of hormone-sensitive breast cancer.
These drugs reduce the rate of estrogen (female hormone) in the body by inhibiting the production of femininity in the surrounding tissue. Aromatase inhibitors are used in post-menopausal women because they have the opposite effect on pre-menopausal women and use the ovaries.
Points to consider in gynecological follow-up in patients receiving aromatase treatment are hot flashes and osteoporosis caused by these drugs. It's about probability. Unlike drugs in the tamoxifen group, aramotase inhibitors do not have the risk of causing thickening of the uterine wall.
Drugs in the tamoxifen group:They consist of a group of drugs called tamoxifen, raloxifene and toromifene. The mechanism of action of these drugs is to bind to the receptors in the tissues to which the female hormone binds, sometimes reducing and sometimes increasing the effect on these receptors.
Drugs in the tamoxifen group reduce the effect of female hormone on the breast, while increasing the effect of female hormone on the uterine wall.
Drugs in the tamoxifen group reduce the effect of female hormone on the breast. strong> While this effect leads to a protective effect on breast cancer, it can lead to thickening of the uterine wall and sometimes an increase in the risk of uterine cancer.
However, thickening of the uterine wall It can be monitored and if the patients do not complain of abnormal bleeding, there is no need for any intervention (taking a sample from the uterine wall, etc.). However, if patients have complaints such as increased bleeding, breakthrough spotting, and endless discharge, a piece of the uterine wall (biopsy) will be required.
Evaluation for Familial Breast-Over Cancer Syndrome (BRCA) Risk:
strong>Information that cancers are caused by genetic causes is increasing day by day. Some of these genetic changes occur due to various reasons throughout human life (smoking, radiation, sunlight, various chemicals), and some come from genes in the family before life begins. One of the most common of these familial genetically inherited cancer syndromes is Familial Breast-Over Cancer Syndrome.
In this syndrome, which occurs as a result of mutations in the genes called BRCA1 and BRCA2, breast and ovarian cancer, pancreatic and prostate cancer and melanoma are seen. The risk increases. Although this unfortunate situation increases the risk of cancer in patients, if this situation can be detected by professionals dealing with cancer, it makes it possible to provide treatment opportunities and preventive procedures for both the patient and his close relatives.
Evaluation of familial cancer risk in the presence of the conditions listed below. It will be appropriate:
In the presence of breast, colon and ovarian cancer seen at a very early age or under the age of 50.
In case cancer is observed in more than one organ (such as breast and ovary) in the same patient
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In case the same patient has cancer in both breasts or in two different points of the large intestine.
In case of the same type of cancer in close relatives, especially on one side of the family (mother's or father's side).
In case of rare types of cancer, such as breast cancer in men.
Your gynecologist, together with a medical geneticist, will interpret your results and help determine the most appropriate strategy for you.
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