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Hormone Replacement Therapy After Gynaecological Cancers
Vulvar Cancer the most frequently reported complaints, while osteoporosis and
Carcinoma of the vulva is an infrequent tumour, typical of advanced cardiovascular risk increase are long-term consequences.
age; its aetiology is not yet fully known. Normal and neoplastic vulva
tissue have oestrogen, progesterone and androgen receptors, but Recent data are encouraging in terms of the use of HRT in EC
epidemiological studies have not shown any association between the survivors, but as no randomised controlled studies are available,
patient’s reproductive history or taking oestrogen in menopause and decision-making should be shared with symptomatic patients after
in situ or invasive vulva carcinoma. In a case-control study, the RR of adequate discussion about the risks and benefits of therapy.
developing vulva carcinoma in women who had taken oestrogen was Furthermore, no evidence exists to show that HRT negatively
1.2 (95% CI 0.7–2.1) for in situ and 1.2 (95% CI 0.6–2.3) for invasive influences survival after treatment for ovarian cancer. Squamous cell
cancers; the data are not sufficient in terms of the effect of combining carcinoma and vulvar neoplasms do not appear to be influenced by
progesterone and oestrogens.
40
HRT use after cancer diagnosis, and the use of oestrogens for this
group of patients is generally allowed.
Similar results were reported in a recent Swedish study that
considered carcinoma of the vulva and vagina together, with an RR Fears and uncertainties persist for breast cancer survivors. Recent
of 1.2 for women on HRT (95% CI 0.7–1.8).
41
Therefore, it is data from an extended follow-up in the HABITS trial suggested that
hypothesised that there is no contraindication to the use of HRT in HRT induces and promotes breast cancer and may also stimulate the
women treated for vulvar neoplasms. growth of tumour microdeposits in breast cancer survivors. Moreover,
preliminary results from the LIBERATE study are not reassuring about
Conclusion the possibility of treating menopausal breast cancer patients with
Induced menopause after surgical or medical treatment for tibolone. Further studies are required in order to define the precise
gynaecological cancers deeply affects the quality of life of patients. indications for HRT; in the meantime, non-hormonal treatment is
Vasomotor symptoms, vaginal dryness and sexual dysfunctions are suggested to relieve oestrogen-deficiency-derived symptoms. ■
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