Hormonal therapy

hormones are normally involved in the differentiation , stimulation , and control of certain tissues, including but not limited to lymphoid tissue, the uterus, the prostate, and the mammary glands.
The administration of estrogen to a man ultimately suppresses the production of testosterone which is useful in the treatment of prostate cancer. Corticosteroids have a powerful suppressive effect on lymphoid cells, making them useful in the treatment of acute leukemias, lymphomas, myeloma, and other myeloproliferative disorders.

Estrogen and androgen inhibitors
SERMs can have different tissues, sometimes inhibiting the action of estrogen while sometimes behaving like estrogen . Tamoxifen, which is used not only to treat estrogen-sensitive breast cancer but also to prevent breast cancer in high-risk individuals. Raloxifen is a newer SERM that has been approved for prevention and treatment of postmenopausal osteoporosis and is presently being studied in the chemoprevention of breast cancer. Flutamide is a testosterone antagonist used in the treatment of prostate cancer. It works by blocking translation of the androgen receptor to the nucleus. Flutamide is most effective when used in combination with surgical or pharmacologic castration.

Gonadotropin-releasing hormone analogue
The pharmacologic equivalent of castration can be accomplished with leuprolide, an analogue of GnRH. Leuprolide is commonly used to decrease testosterone levels in the treatment of unresectable prostate cancer.

Aromatase inhibitors
Aromatase inhibitors can eliminate functional estrogen in this population of women and may be an effective hormonal treatment of breast cancer. Anastrozole is approved for the treatment of metastatic breast cancer and appears promissing as adjuvant therapy for postmenopausal women whose tumors posses estrogen or Progesterone receptors.

Gynecologic cancer

Types of radiation
* radiation oncology-be defined as therapeutic manipulation of radiation delivered to a target for cure or for palliation.
*electromagnetic radiation is energy that is transmitted at the speed of light through oscillating electric and magnetic fields.
*particulate radiation uses subatomic particles, instead of photons, to deliver the dose of radiation.
Dosage theory
Normal tissue as well as malignant cells are susceptible to toxicity induced by radiation therapy, the extent of which depends on total dose, fractionization, and tumor volume.
A. Repair of sublethal injury
When a specified radiation dose is divided into two doses given at separate times, the number of cells surviving is higher than that seen when the same total dose is given at one time.
B. Repopulation
The reactivation of stem cells that occurs when radiation is stopped is necessary for further tissue growth
C. Reoxygenation: hypoxic cells are known to be relatively resistant to radiation. Cells located farther than 100mm from capillary flow are at risk for hypoxia and may not be killed by radiation therapy.
D. Radiation-induced synchrony
Malignant cells are most sensitive to radiation while in the mitotic phase of the cell cycle.

Classes of chemotherapeutic agents

All forms of curative chemotherapy, the goal is elimination of all tumor stem cells. The method of combining agents help to combat tumor cell resistance and increase the tumor cell killing while avoiding the compounding of toxic effects.
A. Alkylating agents
B. Platinum analogues
C. Antimetabolites
D. Antimicrotubule agents
E. Topoisomerase inhibitors
F. Antibiotics