Staging and risk stratification of thyroid cancer improved with SPECT/CT

The use of single positron emission computed tomography (SPECT)/computed tomography (CT) has been reported to change clinical management in a significant number of thyroid cancer patients according to research presented in the May issue of The Journal of Nuclear Medicine. Information obtained from these scans not only helps determine the need for radioiodine therapy or alterative options, but also impacts the long-term follow-up strategy.

"In this article I aimed to highlight the role of radioiodine imaging in risk stratification of patients with thyroid cancer and to assess the contribution it brings to the completion of staging and the decision to omit or proceed with I-131 therapy," said Anca M. Avram, MD, author of "Radioiodine Scintigraphy with SPECT/CT: An Important Diagnostic Tool for Thyroid Cancer Staging and Risk Stratification." She continued, "The new technology of SPECT/CT has substantially improved the interpretation of planar studies and can be implemented in the post-operative management protocols of thyroid cancer patients."

SPECT/CT has commonly been used for imaging thyroid cancer patients after radioiodine therapy, with the advantages of substantially reducing the number of equivocal foci seen on planar imaging alone, determining lymph nodal status more accurately than planar imaging and improving anatomical localization of activity foci seen on planar imaging. Studies cited in the article report on the high diagnostic value of radioiodine SPECT/CT, resulting in changes in risk stratification and clinical management in a substantial number of patients (ranging between 25 – 47 percent of patients).

More recently, SPECT/CT has been utilized prior to radioiodine therapy to better identify and characterize focal activity seen on planar scans for differentiating between metastatic lesions and benign uptake in residual thyroid tissue or normal organs. Information acquired with pre-ablation SPECT/CT scans can be used in addition to histopathology information to complete staging and risk stratification prior to radioablation. The pre-ablation scans can reveal unsuspected regional and distant metastatic lesions, resulting in changes in the prescribed I-131 activity, either by adjusting empiric I-131 doses or performing dosimetry calculations.

The article reports that SPECT/CT changed post-surgical staging in 21 percent patients, modified the treatment approach in 36 percent patient with disease, and led to avoidance of unnecessary I-131 therapy in 20 percent patients without disease. The findings on pre-ablation scans altered the recommended I-131 therapy in 58 percent patients as compared to therapy based on histopathologic risk stratification alone, by appropriately prescribing higher activities for treatment of regional and distant metastases and minimizing the activity prescribed for thyroid remnant ablation.

SPECT/CT is also very useful for evaluating unusual radioactivity distributions in thyroid cancer patients; accurate anatomic localization of radioactivity foci permits rapid exclusion of physiologic mimics of disease, or confirmation of metastatic lesions to unexpected sites.

"Diagnostic radioiodine scintigraphy with SPECT/CT provides a clear advantage for the management of patients with thyroid cancer," said Avram. "By integrating clinical, pathology and imaging information, the nuclear medicine physicians are able to offer an individualized treatment plan, bringing the nuclear medicine community a step closer to the goal of personalized medicine."

The incidence of thyroid cancer has increased 2.4 times since 1975. The U.S. National Cancer Institute estimates that in 2012 more than 56,000 cases of thyroid cancer will be diagnosed and nearly 1,800 individuals will die from the disease.

Source: Society of Nuclear Medicine

Cancer Research Video: Using Mice Models to Fight Thyroid Cancer

Dr. Sheue-yann Cheng, Head of the Gene Regulation Section in the Laboratory of Molecular Biology, takes you into her lab where she researches the biology and molecular actions of thyroid hormone receptors in health and disease. Dr. Cheng uses mouse models to study resistance to thyroid hormone (RTH), a key step in cancer development. Watch and listen to Dr. Cheng's passion for uncovering possible molecular targets for the treatment of thyroid cancer. Learn more about Dr. Cheng's research at    http://ccr.cancer.gov/staff/staff.asp?profileid=5784

STUDY: c-KIT receptor expression is strictly associated with the biological behaviour of thyroid nodules

A large amount of information has been collected on the molecular tumorigenesis of thyroid cancer. A low expression of c-KIT gene has been reported during the transformation of normal thyroid epithelium to papillary carcinoma suggesting a possible role of the gene in the differentiation of thyroid tissue rather than in the proliferation.

The initial presentation of thyroid carcinoma is through a nodule and the best way nowadays to evaluate it is by fine-needle aspiration (FNA). However many thyroid FNAs are not definitively benign or malignant, yielding an indeterminate or suspicious diagnosis which ranges from 10 to 25% of FNAs.

BRAF mutational analysis is commonly used to assess the malignancy of thyroid nodules but unfortunately it still leaves indeterminate diagnoses. The development of molecular initial diagnostic tests for evaluating a thyroid nodule is needed in order to define optimal surgical approach for patients with uncertain diagnosis pre- and intra-operatively. 

Methods: In this study we extracted RNA from 82 FNA smears, 46 malignant and 36 benign at the histology, in order to evaluate by quantitative Real Time PCR the expression levels of c-KIT gene. 

Results: We have found a highly preferential decrease rather than increase in transcript of c-KIT in malignant thyroid lesions compared to the benign ones. To explore the diagnostic utility of c-KIT expression in thyroid nodules, its expression values were divided in four arbitrarily defined classes, with class I characterized by the complete silencing of the gene. Class I and IV represented the two most informative groups, with 100% of the samples found malignant or benign respectively.  The molecular analysis was proven by ROC (receiver operating characteristic) analysis to be highly specific and sensitive improving the cytological diagnostic accuracy of 15%. 

Conclusion: We propose the use of BRAF test (after uncertain cytological diagnosis) to assess the malignancy of thyroid nodules at first, then the use of the c-KIT expression to ultimately assess the diagnosis of the nodules that otherwise would remain suspicious. The c-KIT expression-based classification is highly accurate and may provide a tool to overcome the difficulties in today's preoperative diagnosis of thyroid suspicious malignancies.

Authors:  Sara TomeiChiara MazzantiIvo MarchettiLeonardo RossiKatia ZavagliaFrancesca LessiAlessandro ApolloPaolo AretiniGiancarlo Di CoscioGeneroso Bevilacqua

Credits/Source: Journal of Translational Medicine 2012, 10:7

Thyroid Cancer: Risk Factors and Prevention

Thyroid cancer is the fastest increasing newly diagnosed cancer worldwide regardless of age, sex, race or ethnic background. According to the Mayo Clinic the number of people diagnosed with the condition is rising is rising.  Women are three times more likely than men to be diagnosed with the condition and sadly, childhood cancer survivors are also at an increased risk. The National Cancer Instituted noted that during the year 2011, an estimated 36,550 women were diagnosed with thyroid cancer in the USA, compared to 11,470 men.

RISK FACTORS:  Columbia University Medical Center noted that 20 to 25 percent of patients with medullary thyroid cancer and 5 percent of patients with papillary thyroid cancer have a family member who had thyroid cancer.

One type of medullary thyroid cancer, MEN 2A associated medullary thyroid cancer, usually results from a mutation of the gene RET proto-oncogene. Another type of medullary thyroid cancer, familial medullary thyroid cancer, is passed down through families.

Another genetic condition that increases the risk of thyroid cancer is familial adenomatous polyposis, a condition in which the patient develops multiple benign polyps in her colon that will become malignant if not removed. Cetta et al. noted that papillary thyroid cancer is a rare manifestation of familial adenomatous polyposis.

Exposure to radiation is another risk factor of thyroid cancer, such as radiation therapy that is targeted to the neck. Before the link between radiation and thyroid cancer was known, radiation was used to treat many benign diseases.

MedlinePlus noted that people who had radiation therapy during childhood have an increased risk of thyroid cancer. People exposed to radiation through nuclear plant accidents or nuclear weapons also have a higher risk of developing thyroid cancer.

People who have either had a goiter or who have a family history of goiters also have an increased risk of developing thyroid cancer. A goiter is a noncancerous enlargement of the thyroid gland. Goiters may occur for unknown reasons.

People who do not get enough iodine in their diet may develop colloid goiters, or endemic goiters. MedlinePlus stated that on some occasions, medications such as aminoglutethimide and lithium can cause nontoxic goiters, or sporadic goiters.

PREVENTION: While there is no way to prevent thyroid cancer, people at risk can take certain precautions. For example, the MayoClinic.com noted that people with the genetic mutation that puts them at increased risk for medullary thyroid cancer may choose to have a prophylactic thyroidectomy. Prophylactic thyroidectomy is surgery on the thyroid gland done to prevent medullary thyroid cancer.

In cases of a radiation emergency, people at risk, such as people living near a nuclear power plant, may take potassium iodine to prevent the thyroid gland from taking in radioactive iodine released in the air. The Centers for Disease Control and Prevention warned that potassium iodine is only taken when advised by a physician, emergency management official or public health official.

REFERENCES:

• National Cancer Institute. Cancer of the Thyroid – Surveillance Epidemiology and End Results. Web. 10 January 2012  

• Cetta F, Curia MC, Montalto G, Gori M, Cama A, Battista P and Barbarisi A. “Thyroid Carcinoma Usually Occurs in Patients with Familial Adenomatous Polyposis in the Absence of Biallelic Inactivation of the Adenomatous Polyposis Coli Gene.” The Journal of Clinical Endocrinology and Metabolism, January 2000. Web. 10 January 2012 

• MedlinePlus Medical Encyclopedia. Goiter – Simple. Web. 10 January 2012 

• Columbia University Medical Center. Thyroid Cancer – Risk Factors. Web. 10 January 2012 

• MayoClinic.com. Thyroid Cancer. Web. 10 January 2012 

• MedlinePlus Medical Encyclopedia. Thyroid Cancer. Web. 10 January 2012 

• Centers for Disease Control and Prevention. Potassium Iodine. Web. 10 January 2012 

Reviewed January 10, 2011

by Michele Blacksberg RN

Thyroid Health Facts and Stats 2012

January is Thyroid Health Awareness Month. This blog post shares "Facts and Stats" on the disorder that is more common than diabetes or heart disease, and often goes undiagnosed because of its subtle symptoms.

THYROID HEALTH DISORDER TYPES:

There are two main types of thyroid disorders:

• Hypothyroidism is the underproduction of the thyroid hormones T3 (triiodothyronine) and T4 (thyroxine). This makes their metabolism slow down. About 80 per cent of patients with thyroid disorders suffer from hypothyroidism. 

• Hyperthyroidism is the underproduction of the thyroid hormones T3 and T4. It is less common. A hyperactive thyroid over-produces hormones and works more than it needs to, speeding up your metabolism.

THYROID DISEASE PREVENTION:

There is no known way to prevent hyperthyroidism or hypothyroidism. A healthy diet, exercise and proper nutrition are not just the keys to living a healthy life, but also key preventive measures. Reduce stress. If you are a smoker, stop smoking, as smoking can damage the thyroid. Some doctors advise avoiding soy supplements and eating no more than one small serving of soy foods daily. 

WHY YOUR THYROID IS ESSENTIAL TO OVERALL GOOD HEALTH:

The thyroid gland is a butterfly-shaped gland located in the base of the neck just below the Adam's apple. Despite being relatively small, the thyroid gland plays a major role in influencing several functions of the body's most important organs, including the heart, liver and kidneys. Therefore, ensuring the proper functioning of the thyroid is essential to the body's overall health.

Hypothyroidism is more common than hyperthyroidism. Roughly 80 per cent of total thyroid cases are categorised as hypothyroidism. 

HYPOTHYROIDISM SIGNS AND SYMPTOMS:

• depression
• moodiness
• muscular weakness and constant fatigue
• muscle aches and pains
• a weak, slow heart beat
• unexplained weight gain
• sensitivity to cold
• thick, puffy skin
• forgetfulness
• constipation
• hoarse voice
• dry skin and hair
• heavy menstrual flow

EARLY DETECTION:

One way to increase early detection of thyroid nodules is to perform a Thyroid Neck Check, a simple check you can do anytime, developed by the American Association of Clinical Endocrinologists (AACE).

HOW TO CHECK YOUR NECK AND THYROID GLAND

What you need:

1. Glass of water
2. Hand-held mirror

Hold the mirror in your hand, focusing on the lower front area of your neck, above the collar bone, and below the voice box. This is the area in which the thyroid gland is located.

While looking at this area in the mirror, tip your head back.

Take a drink of water and swallow.

As you swallow, look at your neck. Check for bulges or protrusions in the area while swallowing. Don't confuse the Adam's apple with the thyroid gland. The thyroid gland is located further down the neck, closer to the collar bone. Repeat the process as many times as you might need to.

If you do see any bulges or protrusions in this area, consult a doctor. You may have an enlarged thyroid gland or a thyroid nodule and should be checked to determine whether treatment for thyroid disease is needed.

DID YOU KNOW?

• Thyroid disease is more common than diabetes or heart disease
• More women suffer from thyroid disorders than men
• The chances of developing a thyroid problem increase with age 
• Thyroid disorders tend to be genetic
• Irritability and changes in weight gain are other signs of a thyroid disorder. 

Since the signs and  symptoms of thyroid disorder are common and can be associated with other medical conditions, thyroid disorders often go undiagnosed.

Iodine Radioisotope Effective for Bone Mets From Thyroid Cancer

NEW YORK (Reuters Health)- When differentiated thyroid cancer has spread to bone, iodine-131 can help stabilize the disease and significantly reduce pain, a Chinese team reports.

Iodine-131 has been used to treat differentiated thyroid cancer (DTC) for 70 years, the authors note, but it's been very difficult to evaluate its effect on DTC bone metastases.

"The indolent course of DTC requires very large cohorts of patients followed over several decades to confirm significant differences in prognostic factors and treatment efficacy," said Dr. Quan-Yong Luo and colleagues at Shanghai Sixth People's Hospital. "Moreover, DTC patients with bone metastasis are relatively rare."

In a report scheduled for the October print issue of the Journal of Clinical Endocrinology and Metabolism, available online now, the researchers report on 106 such patients treated at their center with oral I-131 therapy, up to 13 times at intervals of 4 to 12 months. Follow-up ranged from 1 to 17 years, with the median being 10.5 years.

Based on changes in serum thyroglobulin, I-131 significantly decreased disease activity in 37 cases (34.9%) and stabilized it in 56 patients (52.8%), the team reports.

Treatment also produced significant pain relief in 39 of 61 patients (63.9%) with painful bone metastases.

Survival rates were 86.5% at 5 years and 57.9% at 10 years, Dr. Luo and colleagues report. Factors independently associated with better prognosis were a solitary bone metastasis, the absence of non-osseous metastases, and bone surgery prior to I-131 therapy.

"In summary, I-131 therapy can significantly decrease or stabilize serum Tg (thyroglobulin) and alleviate bone pain. It can also shrink or stabilize lesions for most DTC patients with bone metastases, and therefore, it is an effective treatment modality for bone metastases from DTC," they write.

SOURCE: http://bit.ly/nup9n4

J Clin Endocrinol Metab 2011.

Is a Clinical Trial for You?

Cancer is and has been one of the most active areas in medical research worldwide for decades. At any time, hundreds of clinical trials are under way on new cancer drugs, treatments or combinations of exisiting treatments.  Many trials may be withing your geographic area. That means you may have access to the very latests treatment for your type and stage of cancer -- even if that drug or treatment option is not on the market yet.

Clinical trials (also called clinical research studies) evaluate new drugs the U.S. Food and Drug Administration (FDA) hasn't yet approved or test new uses for already approved drugs. They also evaluate new combinations of existing drugs and treatments, different dosages of approved drugs, or find the best time to begin using a particular drug or treatment.

How Do Clinical Trials Start?

Every new medication begins in the laboratory. Pharmaceutical company researchers test hundreds of thousands of compounds every year, searching for the few that may prove beneficial. From the time they identify such a compound until it reaches the market (if it does) it could take 10 years or more and cost hundreds of millions of dollars.

Once compounds show promise in laboratory and animal studies, companies apply to the FDA for permission to conduct human clinical trials. These trials occur in four phases designed to determine specific information, such as risks, safety, and effectiveness compared with a standard drug or therapy.

Each phase is strictly regulated and evaluated, and the safety of the participating is always the top priority. If there are any safety concerns, officials will halt the trial. Only after a cancer drug has been shown to be safe and effective -- or more effective, or otherwise better than existing ones -- does the FDA approve it for sale in the United States of America.

Why Participate in Clinical Trials?

When you volunteer for a cancer clinical trial, you are guaranteed to receive either the treatment under investigation or the best available standard of care treatment. Unlike clinical studies in other therapeutic areas, patients in cancer clinical trials receive a "sugar pill" placebo ONLY if no standard treatment exists, therefore make sure you know if this is the case before signing up for a cancer clinical trial.

Patients in cancer clinical trials also receive increased monitoring and attention from nurses and  doctors due to being in the trial. Other benefits in a cancer clinical trial include:

• You may receive access to innovative new treatments that aren't available anywhere else.
• It offers another option if your cancer has become resistant to treatment or has re-ocurred.
• You can help further medical research not only for yourself but for other cancer patients as well.

Are Clinical Trials Safe?

All cancer or medical treatments carry risks, even those that have been used by thousands of patients. Not all treatments prove to be better that the standard of care and may produce additional side effects. Yet all clinical trials must meet rigourous guidelines designed to protect you. You will be monitored very closely during the trial  for any potential side effects or problems. Also, healthcare professionals involved in the study will explain any known or anticipated risks to you before you commit to the trial. This is part of the informed consent process.

What is Informed Consent?

Informed consent is your right as a clinical trial participant. A document will outline the purpose of the study (clinical trial), the exact treatments you will receive, all possible side effects (known or anticipated) and your right to withdraw at any point. Signing the informed consent form acknowledges that the trial was explained to you and you understand it. However, you can withdraw from a clinical trial at any time , even after signing the form.

Phases of a Clinical Trial:

A clinical trial typically includes four phases of testing and information collection as follows:

Phase 1  This stage tests the safety of a potential new drug or therapy on a small number of humans to find the best dosage and potential side effects.

Phase 2   Using the dose and schedules determined in Phase 1, this stage discovers more about how effective the treatment is for patients.

Phase 3   This stage compares the new drug or therapy with a standard therapy in a randomised study involving hundreds of participants.

Phase 4   After the drug is approved for marketing this stage lets pharmaceutical companies gather more information as the drug is used in thousands of patients and conduct additional trials investigating other uses for it.  

How Do I Participate in a Clinical Trial?

If you are interested in participating in a clinical trial, talk to your doctor. Cancer doctors are usually aware of ongoing studies. Very often, they are helping to conduct a trial by having some of their patients participate. Clinical trials are conducted in hospitals, universities, cancer centers, clinics, and even doctor's offices.

Get Help With Decision Making:

Ask questions before signing up for a clinical trial.   Choosing to be in a clinical trial is an important personal decision. Discuss the following questions with your healthcare team to make an informed choice and decision about which clinical trial you participate in.

• What is the purpose of this trial?
• How ill I benefit?
• What are the potential risks?
• What will be required of me and my family?
• What kinds of test and procedures are involved?
• Do I have to change doctors to be in the trial, or can I stay with my own doctor?
• How will I learn the final result of the study?
• Will I be paid or do I have to pay to participate in the study?
• What follow-up is involved once my treatment in the trial ends?
• What treatment will I receive if I do not participate in this clinical trial?

Please remember your healthcare team and family doctor are the best sources of information for your individual care. If you have any questions about this article or you are interested in clinical trials talk to your doctor.

***********************************

Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

The Thyroid and Thyroid Disease Risks

The thyroid is a small gland, shaped like a butterfly, located in the lower part of your neck. The function of a gland is to secrete hormones. The main hormones released by the thyroid are triiodothyronine, abbreviated as T3, and thyroxine, abbreviated as T4. These thyroid hormones deliver energy to cells of the body. The most common problems that develop in the thyroid include: hypothyroidism (an underactive thyroid), hyperthyroidism (an overactive thyroid), goiter (an enlarged thyroid), thyroid nodules (lumps in the thyroid gland), thyroid cancer (malignant thyroid nodules or tissue), and thyroiditis.

You have a higher risk of developing thyroid disease if, among a variety of factors:

…You have a family member with a thyroid problem

…You have another pituitary or endocrine disease

…You or a family member have another autoimmune disease

…You've been diagnosed with Chronic Fatigue Syndrome

…You've been diagnosed with Fibromyalgia

…You're female

…You're over 60

…You've just had a baby

…You're near menopause or menopausal

…You're a smoker

…You've been exposed to radiation

…You've been treated with lithium

…You've been exposed to certain chemicals (i.e., perchlorate, fluoride)

Radioactive Idoine 131: What is it and Why Should You Care?

Iodine-131 is a radioactive particle that is produced by the fission of uranium atoms within nuclear reactors. It can also be produced by plutonium and/or uranium in the detonation of nuclear weapons. Iodine-131 takes the solid form of a purplish-blackish crystal. It can undergo sublimation, which means it can go from a solid to a gas without first becoming a liquid. Iodine-131 dissolves in water.

Occurrence: 

• Iodine-131 can get into the environment through air or water.
• Being that Iodine-131 is created through fission, the substance matures within rods, but if the rods are not carefully monitored then pressure within the rod can increase, leading to corrosion and eventually leakage.
• Iodine-131 can get into water by a similar process; however it leaks into the liquid surrounding the cracked rod that is typically used to cool it. This liquid then circulates throughout the facility.
• While Iodine-131 has the tendency to attach to organic particles, such as soil, it can be spread fairly quickly through water.
• Iodine-131 can be ingested within water; since it dissolves in water it can easily move from the atmosphere to humans.
• Some doctors actually use small amounts of ingested Iodine-131 to detect thyroid problems.

Health Effects:

• Long term exposure to radioactive Idodine-131 can cause thyroid cancer.
• Low doses of Iodine-131 can also lower the activity of the thyroid gland by lowering the production of hormones.
• Doctors sometimes use small doses of Iodine-131 to treat an overactive thyroid, however the equilibrium must be perfect or the treatment will cause cancer in the area.
• If large quantities of Iodine-131 are released via some sort of nuclear accident, government agencies can use stable, non radioactive iodine to ensure that people do not absorb too much Iodine-131.

In The News:

Following the collapse of the Fukushima nuclear plant in Japan due to the earthquakes that took place in early March 2011, Iodine-131 has been a large concern of the world media.

• On March 23, 2011, the Los Angeles Times reported that tap water should not be consumed by infants in Japan due to the presence of Iodine-131 in the water.
• In March 2011, the Philadelphia Inquirer reported that officials had discovered Iodine-131 in rain water wells in Philadelphia, which were inspected to ensure that the collapse of the plant in Japan didn’t affect water in the U.S. However, the amount found was not lethal, and officials declared the water safe to drink.

Regulation:

The U.S. Environmental Protection Agency (EPA) has applied both water-based and airborne regulations to Iodine-131.

The regulations limit the amount of Iodine-131 that can legally be released by nuclear plants and various industrial facilities.

Water Treatment:

• EPA recommends that reverse osmosis be used to treat water containing Iodine-131.
• EPA also recommends the use of ion exchange to remove Iodine-131.

 --------------------------------------------------------------------------------

  

Sources:

Forbes, Los Angeles Times, Philadelphia Inquirer, U.S. Environmental Protection Agency.

Suicide Risk Higher in Cancer Patients than General Population

The incidence of suicide among U.S. cancer patients is nearly twice that of the general population, and suicide rates vary among patients with cancers of different anatomic sites, according to a study published online August 11 in the Journal of Clinical Oncology (JCO). The risk remained elevated for as long as 15 years after diagnosis.

Researchers from the University of Washington analyzed Surveillance, Epidemiology, and End Results (SEER) data from nearly 3.6 million patients diagnosed with cancer from 1973 to 2002. They compared those data, which included 5,838 suicides, with data from the U.S. general population collected by the National Center for Health Statistics. The cancer patients had an adjusted rate of 31.4 suicides per 100,000 person-years, compared with 16.7 suicides in the general population. Suicide rates were particularly high for cancers of the lung/bronchus (81.7), stomach (71.7), oral cavity/pharynx/thyroid (53.1), and thyroid/larynx (46.8).

Two other studies that examined the association between cancer and suicide appear in the same issue of JCO. The second study, using data from Medicare patients in New Jersey, found that the "risk of suicide in older adults is higher among patients with cancer than among patients with other medical illnesses, even after psychiatric illness and the risk of dying within a year were accounted for." A third study of cancer center patients in Edinburgh, United Kingdom, found, "A substantial number of cancer outpatients report thoughts that they would be better off dead or had thoughts of hurting themselves."

In an editorial, Dr. Timothy Quill of the University of Rochester Medical Center, noted, "What is interesting and potentially important about the studies is that these thoughts about suicide and the associated risk factors that are relatively well known for terminally ill patients may be just as important for those patients with cancer who are survivors or are living with the disease, the constant threat of recurrence real or perceived being equal in relevance to the patients involved."

***********************************

Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

Scientists Explore How Thyroid Cancer Metastasizes

Distant metastases of thyroid cancer can dramatically reduce a patient's likelihood of survival, which is one reason why a scientist at the Ohio State University College of Medicine recently reviewed the current clinical understanding of how thyroid carcinoma cells migrate.

Dr. Matthew Ringel, who also hails from the Arthur G. James Comprehensive Cancer Center, stated that a number of factors can influence the metastasis of thyroid cancer, but that the disease appears to be able to spread at nearly any stage. Ringel's review, which appeared in the journal Thyroid, traced the study of metastasis back to 1889, when English pathologist Stephen Paget described cancer migration using a "seed and soil" model.

Today, this analogy is still widely used, according to a review published in the journal Clinical and Experimental Medicine. That said, in the past century, researchers have added significantly to the collective knowledge about how thyroid cancer spreads. Ringel noted that the migration of thyroid tumor cells to other parts of the body can be thought of in terms of short dormancy or long dormancy.

Short-dormant metastases involve the mutation of thyroid cancer epithelial cells into those that can grow into a number of different cell types. These cells escape into the bloodstream, stick in different organ systems and begin growing almost immediately.  The study's author noted that short-dormant metastatic cells tend to be organ-specific. For instance, while medullary thyroid cancer often metastasizes in the liver and bones, papillary thyroid cancer usually migrates to the lungs or brain, he wrote.

By contrast, long dormancy is a more recently observed phenomenon. Ringel stated that once embedded in a distant organ system, long-dormant thyroid cancer cells may wait for months or years before rapidly multiplying, due to either genetic variations, immune activity or the cellular micro environment.  The endocrinologist added that different varieties of the disease tend to be short- or long-dormant.

He specified that anaplastic, invasive papillary and invasive follicular thyroid cancers often spread quickly, while metastases of well-differentiated forms of the condition may experience long periods of dormancy.

SOURCE: endocrineweb

Last updated on 05/24/2011

First published on 05/23/2011

New Treatments and Shifting Paradigms in Differentiated Thyroid Cancer Management

Abstract

Background: Although most thyroid cancer patients have an excellent prognosis, 10% of low-risk cancers and 25% of high-risk cancers recur, with mortality rates in excess of 50% at 3 years for aggressive thyroid cancer. Traditional paradigms including surgery, I¹³¹ ablation, and TSH suppression do not offer additional therapeutic options for cancers that fail these interventions. Risk stratification and outcomes data are shifting the treatment paradigms to favor more individualized therapies based on risk, and new treatment targets have been identified with promise to treat more aggressive thyroid cancer.

Methods: The authors review the recent literature and published guidelines on thyroid cancer and summarize changing management paradigms and treatments of thyroid cancer.

Results: Outcomes data and risk stratification have promoted changes to traditional paradigms. Total/near-total thyroidectomy improves outcomes in both recurrence and mortality. Central compartment lymph node dissection facilitates nodal status determination and likely improves outcomes, while low-risk patients with small tumors are not likely to benefit from I¹³¹ remnant ablation. Early-phase studies have demonstrated significant improvement in progression-free survival with multikinase inhibitors targeting MAPK and angiogenic pathways.

Conclusions: Risk stratification and outcomes data have modified treatment paradigms in thyroid cancer. Patients with progressive thyroid cancer that is no longer surgically resectable or iodine avid should be considered for treatment with multikinase inhibitors, preferably by enrollment in a therapeutic treatment trial

SOURCE:  Medscape Today News

Authors and Disclosures: W. Bradford Carter, MD; John B.Tourtelot, MD; Jason G. Savell, MD; Howard Lilienfeld MD

Posted: 05/10/2011; Cancer Control. 2011;18(2):96-103. © 2011 H. Lee Moffitt Cancer Center and Research Institute, Inc.,

New radiation treatment practice recommendations for thyroid disease

New recommendations from the American Thyroid Association (ATA) on outpatient radioiodine (131I) treatment aim to minimize unintended radiation exposure and maximize the safety of patients, their families, and the public. The new ATA recommendations are presented in the April issue of Thyroid, a peer-reviewed journal published by Mary Ann Liebert, Inc

The ATA convened a task force to update radiation safety information related to outpatient 131I therapy to treat hyperthyroidism and thyroid cancer. The new ATA practice recommendations cover a broad range of topics including travel; safety precautions at home, work, and school; personal hygiene; and pregnancy and breastfeeding. 

These recommendations comply with the most up-to-date U.S. Nuclear Regulatory Commission (NRC) regulations, including a recent guidance statement that advises medical professionals administering 131I therapy to ask patients about their intended destination after the treatment and to discourage them from staying at hotels to limit public radiation exposure.

In a Commentary in the February issue of Thyroid, Richard T. Kloos, MD, Professor, The Ohio State University and Secretary/Chief Operating Officer of the ATA, states that the new ATA document "aims to provide simplified, consistent, and safe instructions for care providers and patients."

"The strength of these practice recommendations is that the task force included representatives across the range of disciplines that use radiation to treat thyroid patients. It is essential that our patients receive clear and consistent information from those ordering, administering, and monitoring these treatments," states Gregory A. Brent, MD, Professor of Medicine and Physiology, David Geffen School of Medicine at the University of California Los Angeles and President of the ATA.

More information: The ATA recommendations are available free online at  www.liebertpub.com/thy

Provided by Mary Ann Liebert, Inc

Increasing Incidence of Thyroid Cancer: The Facts

The thyroid, a butterfly-shaped gland beneath the Adam's apple in the neck, is responsible for producing and regulating some of the hormones that control metabolism. The incidence of cancer in it has more than doubled over the last three decades, increasing to almost 12 cases per 100,000 in 2007 from 4.85 cases per 100,000 in 1975.

Much of this rise can be attributed to the increased detection of small tumors. There is increased utilization of imaging technology such as neck ultrasounds, CT scans, MRIs and PET scans that has resulted in the discovery of incidental thyroid nodules. Studies have shown that when doctors feel the neck during a physical examination, about 5 percent of patients will be found to have thyroid nodules.

When the thyroid is studied by an ultrasound examination, it turns out that half of all adults actually have thyroid nodules and 5 percent or so of these represent low-grade cancers. When doctors detect these "incidental" thyroid nodules, they will subject some of them to a fine needle aspiration biopsy to determine if they are cancerous. Many, but not all of the increased number of thyroid cancers that are found are small (called microcarcinomas), measuring less than 1 centimeter (less than ½ inch).

The increase of observed thyroid cancer, however, is not fully explained just by the disease's improved detection through greater use of imaging procedures. There also has been a real increase in the incidence of these tumors.

There are two known causes of well-differentiated thyroid cancer, the most common variety. The first is exposure to therapeutic x-rays. Indeed, x-ray therapy once was used to treat children with enlarged tonsils and adenoids, birth marks and even ringworm, as well as for teens with acne. This led to an increase in the development of both benign and malignant thyroid growths.

Well-differentiated thyroid cancer is the type that was caused by the Chernobyl nuclear disaster. The second known risk factor is a genetic predisposition, with 5 percent or so of the occurrences of this most common form of thyroid cancer running in families.

However, these two risk factors alone also do not account for the rising incidence of thyroid cancer. It is likely that some of the thyroid cancer increase can be attributed to other environmental factors, such as the amount of iodine people ingest; environmental toxins, such as materials used to make plastics, fire retardants and pesticides; or other unknown causes.

Thyroid Cancer Treatment

Close to 90 percent of these thyroid cancers fall into the group of well-differentiated tumors; women are three times more likely than men to develop these cancers. More than 95 percent of patients younger than 45 who develop one of these tumors will survive, even if there is evidence of spread to the lymph nodes in the neck, which is found at the time of diagnosis in many patients. Those older than 60, especially men with large tumors, do not fare as well, but their overall prognosis is still good.

Most patients with differentiated thyroid cancer undergo surgery to remove their thyroid. Depending on their age and the degree of involvement of surrounding tissues and lymph nodes, or if there is evidence of the disease's spread to distant tissues such as lung or bone, radioactive iodine may be used for treatment. It is a paradox that relatively low levels of radioactive iodine can cause thyroid cancer by injuring DNA in thyroid cells, while large doses of radioactive iodine can kill both normal and cancer cells in the thyroid.

All patients with thyroid cancer are placed on thyroid hormone. Doctors very rarely treat these patients with external beam radiation therapy and even less frequently use some new medications that target the molecular abnormalities found in thyroid cancer. After a patient's initial treatment, the standard follow-up includes periodic ultrasound exams of the neck as well as blood tests to measure thyroglobulin, a protein that is an excellent tumor marker for differentiated thyroid cancer.

Other Forms of Thyroid Cancer

Medullary thyroid cancer is a less common form of the disease, accounting for 5 to 10 percent of patients. This tumor is more aggressive than the more common form and has a higher tendency to run in families. It can be detected through a fine needle aspiration biopsy of the suspicious thyroid nodule or through the measurement of calcitonin, a blood protein that is produced by the cells that form the tumor.

Fortunately, the least common form of thyroid cancer is anaplastic cancer, which progresses rapidly and almost always is a fatal form of the disease. Less than 1 percent of patients with thyroid cancer have this form.

The management of thyroid cancer has evolved greatly over the last several decades and a number of centers have been developed with multidisciplinary teams to treat the disease. Further information about thyroid cancer can be obtained online from the Cedars-Sinai Thyroid Cancer Center,  The American Thyroid Association and The Endocrine Society's Hormone Foundation.

SOURCE: The Huffington Post

About The Author: Dr. Glenn Braunstein is professor and chairman of the Department of Medicine at Cedars-Sinai Medical Center where he holds the James R. Klinenberg Chair in Medicine. Board certified in Internal Medicine and Endocrinology, Diabetes and Metabolism, Dr. Braunstein also serves as the Director of the Thyroid Cancer Center at Cedars-Sinai. 

Follow Glenn D. Braunstein, M.D. on Twitter:  http://www.twitter.com/CedarsSinai