After breast cancer surgery, why did she have hot flashes, sweating, body aches and restlessness?

*Only for medical professionals to read and refer to the 31st article related to the prevention and treatment of osteoporosis published by Professor Bian Pingda of Zhejiang Provincial People's Hospital in the medical field.

In recent osteoporosis clinics, breast cancer patients are often seen, and 64-year-old Sister Wang is one of them.

 Case introduction Four years ago, Sister Wang found a lump in her left breast during a physical examination, which has never attracted attention.

One year ago, a breast magnetic resonance examination in the outside hospital showed: irregular enhancement of the upper left outer quadrant, multiple small lymph nodes in the left axillary, BI-RADS 4c category, under general anesthesia "modified radical mastectomy + fascial tissue flapplasty" ".

The postoperative pathological section showed: (left breast) solid papillary carcinoma (mainly intraductal), estrogen receptor (ER, +++ 90%), progesterone receptor (PR, ++ 90%), Human epidermal growth factor receptor 2 (HER2, 1+), no cancer tissue was found in the nipple, skin and basal margins, and no cancer metastasis was found in the axillary lymph nodes.

After taking the drug letrozole after surgery, Sister Wang had obvious hot flashes and sweating.
When she got up in the morning, her underwear was often soaked, and she showed obvious fatigue and decreased appetite.

In addition, Sister Wang has body bone soreness.
The waist and ischium are the most obvious ones.
As long as she sits down or stands still, her waist and ischium are so sore that she can't stand it, so she has to walk back and forth.
.
.
Cause analysis Breast cancer is one of the most common malignant tumors in elderly women in my country.
About 80% of breast cancer patients have single or double positive estrogen receptors and progesterone receptors.

In order to reduce the recurrence rate of breast cancer and improve the survival rate, adjuvant endocrine therapy is often implemented for breast cancer patients with estrogen receptor and/or progesterone receptor positive to reduce the adverse effects of endogenous estrogen on breast tissue [1].

Aromatase inhibitors, including non-steroids (letrozole, anastrozole) and steroids (exemestane), are commonly used drugs for adjuvant endocrine therapy for breast cancer patients.
These drugs mainly inhibit the body The activity of aromatase reduces the conversion of androgens into estrogen in the body.

Due to the decreased synthesis of endogenous estrogen, patients are not only prone to symptoms such as hot flashes and sweating, but also due to accelerated bone loss, it is easy to induce or aggravate osteoporosis and increase the risk of fracture [2].

Sister Wang’s dual-energy X-ray absorptiometry showed that her lumbar spine and hip were both osteoporotic (T-value <-2.
5) (Figure 1).

 Figure 1 Sister Wang's dual-energy X-ray absorption method bone mineral density test report.
Serum bone turnover markers test showed that the specific sequence of type I collagen carboxyl terminal peptide β was significantly increased (1391.
0pg/ml) (Figure 2), suggesting increased osteoclast activity , Bone is losing rapidly [3].

Elderly osteoporosis patients with rapid bone loss are prone to symptoms such as systemic bone soreness.

 Figure 2 Sister Wang’s serum bone turnover marker report treatment plan.
After taking the aromatase inhibitor letrozole, she experienced obvious hot flashes, sweating, and body aches.
Sister Wang refused to continue taking the drug and switched to selective estrogen.
Body regulator tamoxifen.

Tamoxifen is another type of drug for adjuvant endocrine therapy for breast cancer patients.
On the one hand, it can bind to the estrogen receptor in breast tissue to inhibit breast hyperplasia and reduce the risk of breast cancer recurrence.
On the other hand, it can interact with the skeletal system.
Binding of the estrogen receptor to delay bone loss.

However, patients receiving tamoxifen treatment need to undergo B-ultrasound examinations regularly (every 6-12 months) to understand the thickness of the endometrium [4].

Because Sister Wang suffers from osteoporosis, and her bone is rapidly losing, and there is no abnormal renal function (glomerular filtration rate 95ml/min), so on the basis of supplementing calcium and vitamin D, intravenous infusion of anti-skeletal Absorb the drug zoledronic acid injection.

The main pharmacological effect of zoledronic acid is to inhibit bone resorption by inhibiting the activity of osteoclasts and inducing osteoclast apoptosis.

It can not only quickly reduce the level of bone turnover in breast cancer patients and delay bone loss, but also help prevent and treat bone metastases in breast cancer patients [4].

Three days after receiving the above treatment measures, Sister Wang felt that the hot flashes were significantly relieved, sweating at night was reduced, and soreness in the waist and ischium was relieved, and she could sit or stand quietly to work! References: [1] Chinese Anti-Cancer Association Breast Cancer Professional Committee.
Chinese Anti-Cancer Association Breast Cancer Diagnosis and Treatment Guidelines and Standards (2019 Edition) [J].
Chinese Journal of Cancer, 2019, 29 (8): 609-679.
[2 ] Huang Shunfa, Cai Siqing, Sun Xiaoqi, et al.
Analysis of related factors of osteoporotic vertebral fractures in breast cancer patients[J].
Chinese Journal of Osteoporosis, 2021, 27(3): 396-400.
[3] Bian Pingda, Shou Zhangxuan, Li Xiuyang, et al.
The predictive value of bone turnover markers in the changes of bone mineral density in elderly men[J].
Chinese Journal of Osteoporosis and Bone Mineral Diseases, 2018, 11(2): 155-159.
[ 4] Sheng Xiao, Shi Xiaoqi, Cheng Jinluo.
Early breast cancer bone protection treatment[J].
Chinese Journal of Osteoporosis and Bone Mineral Diseases, 2020, 13(3): 280-284.