Endocrine and associated consequences of conservative and chemo- and hormonal therapy in cancer treatment: opportunities and extent of the feasibility of correction.

Abstract

Treatment of patients with malignant tumors, largely involves the use of chemotherapy, targeted therapy and endocrine therapy (anti-hormonal and hormonal drugs). Depending on the location and nature of the tumor, surgical interventions aiming to remove some endocrine organs (in particular, ovarian, testicular, thyroid and endocrine portion of the pancreas, etc.) can lead to disruption of their function. The objective of presented study is to focus our attention mainly on the effects (including the steroid and non-steroidal components) of anticancer treatment in the endocrine system and in the outcomes associated with hormonal and metabolic changes, clinical and phenotypic features. These effects are manifested not only by changes of laboratory and instrumental parameters, but also accompanied by changes in the clinical manifestations of the disease and the patient's subjective feelings. The therapy often has adverse effects, as the anticipated final results of influence of such processes as weight gain, dyslipidemia, impaired glucose tolerance, lack of ovarian, adrenal, growth hormone and testicular function, osteopenia, hot flushes, chronic fatigue e.t.c., which often limits the success of treatment. Passive registration of such violations, and the silent watching them – is only one side of the problem rather frequent enough, the other side - are the questions about modern approaches of their correction and its feasibility. In part, this problem has a genetic basis, which, along with other indicators, can determine not only the response to anti-tumor therapy, but the severity of endocrine changes, their potential prognostic role, as well as the indications for their prevention and elimination. There are many clinically significant situations that are need to be analysed and discussed, such as: complete androgen blockade in prostate cancer patients, endocrine effects of adjuvant chemotherapy and hormonal therapy in breast cancer patients of reproductive and postmenopausal age, the expected increase of the frequency of performing of preventive salpingoovariectomies in carriers of mutations in BRCA1 and BRCA2 genes, thyroid (in particular) and adrenocortical tropism of targeted therapy, consequences of high doses of corticosteroid support therapy, etc., that demonstrate the importance of this problem, considering these facts in clinical practice and the establishment of standards for the management of patients with these problems.