A - Z Of Breast Cancer: HORMONAL THERAPY

Some cancers thrive on hormones. If for example, they tell you your cancer is PR positive it means that the cancer cells thrive on the hormone progesterone. ER positive means that cancer cell growth is stimulated by the oestrogen produced in your body. The solution seems obvious: Stop the oestrogen supply. Tamoxifen does just this by stopping the oestrogen reaching the cancer cells and apparently it is very successful in reducing breast cancer recurrence.

A star is born

Of course any drug that interferes with your hormones will not be without drawbacks. I was wary. I immediately asked the nurse about side effects and she explained that Tamoxifen is taken for a five year period during which time I could expect to experience an array of symptoms from hot flushes to cataracts. The list of side effects is so impressive that it really is not a good idea to read them all. Just wait and see what happens to you. And be prepared for a delayed reaction, one woman I know didn’t start getting hot flushes until she had been on the drug for a year. The breast care nurse gave me a leaflet on Tamoxifen and said I might experience menopause like symptoms and that there were other, rarer side effects that I should be aware of. Such as? Such as failing vision, hirsutism (hair growth), and a deepening of the singing voice. I pictured myself a blind and bearded baritone. Move over Andrea Bocelli – a star is born. We had a laugh and moved on to the next symptom, uterine cancer. I stopped laughing. That’s the problem with cancer treatments from chemo to hormonal to radiation therapy, they can all potentially cause new cancers to develop. Add double edged sword to you list clichés.

Bad blood

I was very worried about uterine cancer and wanted to know what screening is offered. The answer is none. Screening is not routinely offered to women taking Tamoxifen. You have to present with symptoms. Symptoms like irregular bleeding. Well guess what? Tamoxifen causes irregularities in your menstrual cycle. The Tamoxifen leaflet I was given lists as a lesser side effect periods becoming irregular. It then lists as a more serious side effect endometrial cancer, a symptom of which is irregular bleeding. How on earth are you to tell the difference between one type of irregular bleeding and another? My periods have gone haywire, is this good or bad irregular bleeding? God, I wish I’d married a doctor.

The first thing to do here is to keep a strict record of the bleeding in your diary. If after a while you are convinced that your cycle is well and truly ‘up the left’ go and see your GP and ask to see a specialist. I waited five months because I felt the doctors wouldn’t take me seriously until I’d given the drug a chance. But I don’t think you should leave it so long if you are having really major irregularities. Remember the main person looking out for you at this point is you.

Preparing the little ones

This is a lot to worry about. You will have to establish a hierarchy of worries. Presumably you are not going to get uterine cancer after swallowing one or two pills, so push it down the list. That will give you time to focus on the more imminent problems of nausea (I felt sea sick for about six weeks) and fatigue and the dreaded menopausal symptoms. What larks, a chemically induced false menopause. Daft word menopause, isn’t a pause meant to be a temporary cessation? Anyway, I saw myself tired, crabby, flushed and sweating, plagued by near psychotic mood swings. I reckoned I needed to prepare the ten year old. I told him that I would be taking some tablets for a while that might make me a bit tired and crabby. After a marked pause he looked up at me and smiled, I smiled back, and we said in unison, “No change there then.”

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