Tamoxifen was the first selective estrogen receptor modulator developed and has been used for over 20 years. Recently, several other drugs of this class have been released and more are presently undergoing development. The goal is to develop the “perfect” drug in this class that prevents breast cancer without stimulating the uterus, is beneficial to the skeletal system and is good for lipid metabolism with as minimal side effects as possible. The perfect selective estrogen receptor modulator should also be an excellent hormone replacement agent for women entering menopause.

Tamoxifen is orally administered just like other hormones. Aside from rendering breast cancer cells into apoptosis, it also acts like estrogen on other tissues and has a positive effect on bone metabolism. Tamoxifen, in comparison to estrogen, stimulates the uterine lining more and both substances are equally effective in retaining bone calcium.

Several studies have shown that Tamoxifen increases the cure rate of women with non-invasive breast cancer, but is still controversial in its clinical use. The controversy lies on a recent clinical trial, which aimed to determine if Tamoxifen was effective in primary breast cancer prophylaxis in high risk asymptomatic women. At the end of the trial, Tamoxifen was dealt with severe scrutiny and a large amount of negative press overstating its potential adverse effects for asymptomatic women. There is, indeed, no question that Tamoxifen is an extremely potent drug in the treatment of breast cancer patients. Based on the results of another clinical trial involving the use of Tamoxifen, treatment duration plays a significant role in drug treatment outcome. This clinical trial compared five years versus ten years of using Tamoxifen after the diagnosis of breast cancer. The trial showed that five years of taking Tamoxifen significantly diminished the systemic recurrence of breast cancer. On the other hand, an additional five years added only expense and potential risk of uterus cancer with no additional benefits in cure rate. Not all breast cancers, however, respond to Tamoxifen treatment. Response rate to Tamoxifen varies upon the abundance of estrogen and progesterone receptors in the primary cancer.

Since breast cancers are very heterogeneous, they do not develop in the same cellular way. About 60 percent of breast cancers contain estrogen and progesterone receptors, while others contain less. Tamoxifen appears to be more effective in women who have more of these hormone receptors in their tumors than those who do not. On the other hand, within a given breast cancer, there may be cells that have more hormone receptors than others do. Hence, the effect of Tamoxifen on these conditions varies. It is also possible that over time, breast cancer cells that are hormone receptor positive may evolve and may not contain hormone receptors anymore. This may explain why women who receive a combination treatment of Tamoxifen and chemotherapy may have a better response to treatment than with either therapy given alone. In most cases, when chemotherapy and Tamoxifen are given in a cancer patient, they are given sequentially; initially, chemotherapy is given to destroy hormone receptor negative breast cancer cells and then followed by Tamoxifen, which can then act on hormone receptor positive cells that may be less susceptible to chemotherapeutic drugs.

In a few cases, perimenopausal women seem to have a difficulty with Tamoxifen use. Most premenopausal women in their 30s and 40s almost have no adverse effects with Tamoxifen and older women who are not in hormone replacement have little problem with Tamoxifen treatment.

The major side effect of Tamoxifen is uterine toxicity. Some women taking the drug have endometrial thickening, a stimulation of the glandular lining of the uterus, which can become cancerous if left unnoticed. The chance of developing uterine cancer as a result of Tamoxifen use is quite small, only about one percent. Nevertheless, the uterus must be monitored carefully with either an ultrasound or endometrial biopsy during the patient’s annual pelvic examination if she is taking this drug.

Lymphedema can be defined as the swelling of the limbs as a result of the non-functioning of the lymphatic system. A condition which is known as primary lymphedema may be inherited due to genetic factors and lineage of the individual. The other type of lymphedema is secondary lymphedema, where the patient may acquire the ailment as a result of an injury or obstruction to the smooth functioning of the lymphatic system.

Although lymphedema symptoms are seen mainly in the arms and legs, the ailment can influence any body part. The obvious sign of the disease is a swelling present in the area. The limb may feel heavy due to fluid accumulation. Lymph fluid may build up in the region of the head and neck; there may be skin discoloration or patches appearing on the affected limb. General first impression that the patient gets is a feeling of fullness in the limb. A cut or an injury to the limb treated for cancer could be a trigger for the swelling. An airplane trip may also be the first instance to prompt a lymphedema attack. Symptoms of lymphedema that you would notice are a sudden tightness in the wrist or ankles, restricting movement. Sometimes, it could be difficult to fit into your clothes or a ring or bracelet you could wear easily is suddenly becoming tight.

Many a times, lymphedema is a side-effect of breast cancer therapy. Women who undergo lumpectomy, mastectomy or the removal of lymph nodes in the armpit are prime candidates for the condition. In such cases, there is a change in the pathway of the lymph fluid, which is the reason for the condition. The symptoms may show up at any time after the operation and the condition may aggravate if not treated in time.

Recent studies state that controlled weight lifting may reduce the incidence of lymphedema for women who have had a mastectomy. Weight lifting may provide protective benefits to the affected arm by boosting the strength in that arm and improving circulation. Generally, an exercise schedule is a part of the lymphedema treatment therapy that is recommended by doctors.

Since treatment for cancer may lead to lymphedema, persons who have been treated for cancer are at a high risk for contracting the condition. Hence, such patients must be vigilant to note any symptoms of lymphedema. Treating the problem at the initial stage arrests the progress of the condition. If the symptoms are ignored, the ramifications can be severe and the damage may be irreversible. A nutritious diet with proper exercise plays an important role in maintaining the health of the lymphedema patient. A skin care routine is also essential. Lymphedema patients should protect themselves from any injury as much as possible to avoid the complications that may arise later. Even though there may not be a cure for lymphedema, it can be controlled with proper care and treatment.