The incidence of tamoxifen side effects is quite small compared to most other chemotherapeutic agents used in the treatment of breast cancer. It is a comparison of apples and oranges, however. Most patients who receive chemotherapy have active or advanced disease, whereas tamoxifen is usually given to patients who are judged free of disease. Therefore, any adverse effects of tamoxifen would be considered to significantly affect the quality of a patient’s life. Most of the side effects are related to tamoxifen’s antiestrogenic activity, although the drug is known to have some estrogenic effects as well. For the most part, tamoxifen has been particularly well tolerated in clinical trials, with only a handful of patients (3 to 4 percent) having to withdraw because of acute adverse effects. Overall, the incidence of hormone-related side effects is much lower in postmenopausal patients. In premenopausal patients, tamoxifen may produce symptoms similar to menopause, with menstrual irregularities occurring in as many as 20 to 35 percent of patients.
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First of all, there are some types of cancer for which complete surgical removal is never feasible. Cancers which start in many different parts of the body at the same time can never be cured surgically. Examples include leukaemias and myeloma (cancers of the bone marrow) and most lymphomas (cancers of the lymph nodes). The other group of cancers which cannot be cured surgically are those starting in a part of the body which is essential to life and the function of which cannot be naturally or artificially replaced. Examples include cancers of most parts of the brain, spinal cord, heart, and cancers which extensively involve the liver.

Then there are some types of cancer which can rarely be cured by surgery on its own because they almost always release cells into the bloodstream very early, before the primary cancer is big enough to be detected. Examples include some primary bone cancers (Ewing’s sarcoma, osteogenic sarcoma), small cell anaplastic (oat cell) cancer of the lung, cancer of muscle (rhabdomyosarcoma), a type of kidney cancer (Wilm’s tumour) and others. With these types of cancer you will make the best decisions if you simply take it for granted that tiny blood-borne seedlings are present, even when no actual secondary growths can be detected. Obviously these types of cancer are rarely cured simply by removal of the primary growth. Usually the best chance of cure is provided by chemotherapy combined with either surgery and/or radiotheraphy treatment.

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