Why steroids are crucial in cancer management

Steroids or corticosteroids are potent chemical substances that can reduce swelling and inflammation in various parts of the body and quickly. They are closely related to natural body hormone cortisol, produced on the cortex of the adrenal glands.

Steroids or corticosteroids are potent chemical substances that can reduce swelling and inflammation in various parts of the body and quickly. They are closely related to natural body hormone cortisol, produced on the cortex of the adrenal glands.

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Dr Joseph Kamugisha

Corticosteroids can be prescribed widely in varying doses depending on the condition and goal of treatment. Most importantly help to control inflammation brought about by infections, trauma and most importantly inflammation implicated in auto-immune illnesses.

Commonly used steroids in cancer management include dexamethasone, prednisolone and hydrocortisone.

Few people tend to have allergy or adverse side effects to these medications as they are also potential anti-allergic medications and used to control inflammation caused by allergy.

Side effects usually occur when these drugs are used at high doses or used for long term. This is why doctors prescribe short-term, high-dose intravenous steroids in some situations, and can sometimes give local shots of injections as seen in some inflammatory sites in joints.

In daily clinical practice, doses of steroids should never be stopped suddenly. They should be decreased gradually so as to permit the adrenal glands to resume natural cortisol production. Abrupt or quick elimination of steroids can lead to adrenal crisis, which is a life threatening condition.

Corticosteroids are highly implicated in management of cancer because of the inflammatory characteristic of neoplasm and some cytotoxic drugs or chemotherapy. Corticosteroids are particularly useful if the neoplasm is associated with autoimmune hemolytic anemia, neutropenia, and thrombocytopenia with hemorrhagic complications.

Glucocorticoids alleviate the lymphadenopathy and hepatosplenomegaly that are often associated with this condition.

Steroids are sometimes used in therapeutic regimens for other endocrine-responsive cancers. They form an efficient treatment in various side effects caused by malignancies and are widely used as palliative care therapy.

Corticosteroids are highly implicated in the management of non-Hodgkin lymphoma. Corticosteroids are implicated in almost every complex regimen used for the treatment of non-Hodgkin lymphoma.

These drugs can also be used as single-agent therapy in patients with non-Hodgkin lymphoma but produce temporary responses.

For tumors within the central nervous system, dexamethasone is preferred instead of prednisone to decrease swelling.

Steroids are also highly implicated in the management of multiple myeloma, a bone marrow neoplasm. For example, one clinical trial done by scientists showed that high-dose melphalan plus methylprednisolone with bone marrow transplantation as consolidation therapy after conventional chemotherapy resulted in a 75 per cent complete remission rate and an estimated 54-month survival rate of 63 per cent.

The highly malignant nature of some breast cancers dictates aggressive therapeutic regimens that often include multiple drug chemotherapy.

For example, in some metastatic breast cancers that does not respond to aggressive cytotoxic chemotherapy. Oncologists usually combine drugs such as mitoxantrone, leucovorin, 5-fluorouracil and prednisone to induce tumor regression in over 60 per cent of patients and sometimes there is even a complete response though considered to be less than 30 per cent.

Hydrocortisone replacement is highly indicated in adrenalectomy. Adrenalectomy is the surgical removal of the adrenals and usually eliminates circulating steroids in cases of breast cancer, prostate cancer, some cases of ectopic Adrenal Cortico thyroid hormones.

Some hemangiomas that occur in infants can be treated with corticosteroid injections. Thymomas are often treated with steroids either alone or in combination with cytotoxic drugs. Other tumors that have been treated with combination chemotherapy and steroids include medulloblastoma, primitive neuroectodermal tumors and ependymomas.

Steroids are highly implicated in the symptomatic treatment of brain lesions. Steroids tend to overcome neurologic symptoms from primary, metastatic brain tumors, spinal cord tumors that are partially caused by peritumoral edema. 

Steroids improve quality of life or alleviate these symptoms by inducing both decreased edema production and increased edema reabsorption. Dexamethasone is the recommended steroid for this treatment because it contains no mineral corticoid activity and is highly potent.

However, steroids action on the brain and spinal cord lesions is short-lived, can only increase survival unless radiotherapy or surgery is taken.

Dr Joseph Kamugisha is a resident oncologist at Jerusalem Hospital, Israel

 

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