There are two general types of steroids. The anabolic steroids are abused by some professional athletes; they have little medical use, especially in cancer patients. The glucocorticoids or corticosteroids, however, are used for many medical conditions, including problems related to breathing, arthritis, pain, and infection. Administered over a period of years, they often cause a multitude of side effects, some of which are serious, such as weight gain, diabetes, skin problems, osteoporosis, and fractures. Used for short periods of time, their benefits may strongly outweigh their risks. They are commonly used in patients with cancer, both as a part of chemotherapy and to control symptoms, especially with brain tumors and advancing disease.
Steroids are one of the body's fundamental hormones, and prescribed hormones are not foreign substances but serve to boost the effects of steroids produced constantly by the adrenal glands. Steroid therapy has many potentially useful roles in the treatment of patients with cancer, such as being very potent in reducing inflammation and its related swelling, and is used in some chemotherapy treatments to shrink tumors, to reduce excessive levels of calcium that are sometimes caused by tumors, and to forestall nausea. They may improve mood and appetite, thus helping to promote weight gain.
One of their most important roles is as a painkiller, traditionally used to relieve pain and other symptoms when a tumor is growing in a small enclosed space, like a brain tumor within the skull, or a spinal cord tumor within the spinal column. By reducing swelling (edema) and inflammation around the tumor and nerves, they may not only dramatically relieve headache and backache but can reverse evolving neurological changes (such as paralysis), although these effects often only last a few weeks. In addition, they may help relieve pain anytime it originates with pressure from a bulky or strategically located tumor, such as that caused by a swollen liver, a tumor near the nerves to the arm or leg (brachial or lumbosacral plexopathy), or cancer of the esophagus, rectum, or female pelvic organs (cervical, ovarian, or uterine cancer).
Steroids are also used to reduce breathlessness and swelling in the upper body (superior vena cava syndrome) and lower body swelling (inferior vena cava syndrome) when tumors or lymph nodes press on the large veins responsible for draining circulating blood. They may also reduce breathing difficulties when cancer has spread diffusely around the lungs' lymphatic drainage system (lymphangitic spread).
Until other, more specific treatments can be found, high doses of corticosteroids can sometimes provide quick, dramatic short-term relief when severe pain is caused by bone tumors or tumors that have spread near nerves. These drugs may also help by boosting a patient's mood, stimulating appetite, reducing nausea, increasing strength, and by just giving the patient an overall improved sense of well-being. If a patient has a serious illness with a short expected survival time, these drugs may be used more freely because the side effects from long-term use are less important. Yet even with short-term use side effects still occasionally occur, such as increased susceptibility to infection, diabetes, fluid retention, acne, depression, psychotic episodes, and delirium.
Unfortunately, the benefits of the corticosteroids often only last several weeks, either because effectiveness diminishes with time or because progression of the disease overrides the drug's benefits. Nevertheless, the use of corticosteroids is becoming more and more widespread. Studies have shown that half of all patients in some special cancer units are given corticosteroids for symptom control. Another benefit is that these drugs may allow opioid doses to be reduced, thereby alleviating opioid-induced side effects. And finally, as noted, depression, nausea, and breathlessness may be relieved in certain circumstances.
Thus steroids can improve the quality of life in some cancer patients. At least one study, conducted in Britain, has shown that selected patients on corticosteroids live longer as well. However, caution must be exercised with these medications. In particular, patients with peptic ulcers or poorly controlled high blood pressure are not good candidates for treatment with steroids.
The steroid of choice is usually dexamethasone.
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