Thyroid cancer radiotherapy (Essay Sample)

Thyroid cancer radiotherapy 4/16/2021 Abstract This paper described the prognosis of thyroid cancer in a patient using radioiodine Iodine-124 and iodine-131. The patient was prepared and underwent the scans to study the existence of lesions, as well as their characteristics. Selumetinib doses were used as controls to study the uptake of radioactive iodine. Section 1: Defining the Disease The disease to be studied is thyroid cancer, which is in the advanced stage. There are four major types of thyroid cancer, which are papillary, follicular, medullary and anaplastic. The etiology of thyroids cancer is complex and yet to be fully defined, but research has established a number of risk factors. The main risk factors are classified into genetic causes (family history of the disease), exposure to high amounts of radiation over a long time, and a number of hereditary syndromes (Mallick & Harmer, 2018). A majority of patients reporting thyroid cancer are found to have experienced changes to DNA, which causes the thyroid cells to be cancerous. Studies have found that several DNA mutations are found in the papillary thyroid cancer, many of which are due to changes in specific parts of the RET gene. Follicular thyroid cancer is caused by acquired changes in the RAS oncogene, and significant changes in the PAX9-PPAR-y rearrangements (Raman & Koenig, 2014). Those who have medullary thyroid cancer have mutations in different parts of the RET gene, and is mainly hereditary. In many cases, thyroid cancer is found in a patient by a medical examiner who notes palpates in the lower front part of the neck, the location where the thyroid is found (Mallick & Harmer, 2018). Most of the palpates are painless, and many patients report to have felt them accidentally. In some cases, there may be an overgrowth of cells around the neck, resulting in bigger than normal lymph nodes. At the time of discovery of the palpates, many patients may report to having normal thyroid function, and exhibit no significant signs of hyperthyroidism. The main structural concern occurs when the tumor grows beyond the expected size, affecting nearby structures. This may cause dysphagia in cases where the tumor presses against the esophagus, but is quite rare (Price, Wong & Randolph, 2008). Another structural effect may be on the vocal cords, causing a hoarse voice. There are several treatment options for thyroid cancer, which all depend on the nature of the occurrence of the disease, as well as patient and doctor preferences. In some cases, Mallick & Harmer (2018) explain that treatment may not be needed immediately, especially in cases where there is low risk of spreading to other parts of the body. The most common treatment option is surgery. During the surgery, the thyroid is removed, either wholly or partly. The surgical options include removing all or most of the thyroid, in a procedure known as thyroidectomy, removing a portion of the thyroid (thyroid lobectomy), or lymph node dissection, whereby the lymph nodes located in the neck are removed (Jongekkasit et al., 2019; White, Gauger & Doherty, 2007). The second popular treatment options is radioactive iodine therapy. This method uses large doses of radioactive iodine to destroy remaining parts of healthy thyroid tissues after thyroidectomy. The option is mainly chosen for cases where the cancer recurs after treatment, or when the cancer spreads to other parts of the body (Mallick & Harmer, 2018). There some potential benefits, as well as risks, for the iodine therapy. The potential benefits include decrease in the frequency of recurrence and reduced mortality after treatment. The main risks include risks to the organ systems such as the eye, salivary system gastrointestinal, pulmonary and gonads, among others (van Nostrand, 2009). Regardless, experts often consider the benefits to be greater than the risks. Given the patient’s medical history and current condition, the prognosis is iodine therapy. Section 2: History History for Thyroid Uptake and Scan ○ M ○ F Date of exam _10/5/2021___________________ □ OP □ ER Room # __3_________________ Patient name __Derrick Noriega_______________________ Age __78___ DOB _7___/__6__/__1943____ MR number _____#628______ Height ______6’11’’___ Weight _____76_____ Physician: Dr. ____Abdullah Alshammari______ Radiopharmaceutical: 99mTcO4 − Dose __________________ mCi __ Injection site _____Arm____ Time ____16:45_______ Scan time ____10 minutes_______ 123I or 131I dose ____75 mg__________ µCi time _____ Standard count ___14.6 mCi___ 4- to 6-hour uptake __42%___ % Normal range __75_____ to ___77__ % 24-hour uptake _____56%_______ % Normal range ____75__ to _____80____% Diagnosis _______Positive for thyroid cancer______________ Upon arrival, the patient’s medical history was taken. The patient was a 78 year old male. No significant family history of thyroid cancer was noted, which would have influenced the diagnosis and treatment of the condition. It is important to ask patients about a possibility of family history of thyroid cancer because genetics is an important risk factor for the development of the disease. For this patient, one of the nuclear medicine tests that may be ordered is thyroid scan and uptake. This is a type of nuclear medicine procedure which is conducted to measure the thyroid function, but does not involved imaging (Mallick & Harmer, 2018). The procedure uses a small amount of radioactive material to evaluate a variety of diseases, among them thyroid disease. Specifically, the patient is given radioactive iodine, either in liquid or capsule form. The uptake takes place up to a day later, and the physician takes readings at different times, mostly at four, six and 24 hours. Because of its ability to pinpoint molecular activity, it has a great potential in identifying thyroid disease even at the earlier stage. These figures are recorded in the thyroid scan history sheet. Another option is using nuclear imaging procedure, which is non-invasive. The only procedure that is involved is an intravenous injection, whereby radioactive material is injected into the patient and studied as it flows through the target area. The material that is used is normally radiopharmaceuticals or radiotracers, which help the physician to study the medical condition, in this case, thyroid sickness. The radiotracers are linked to a small amount of radioactive material that can be detected on the PET scan (Jadver & Jadver, 2005). For patients that have the thyroid disease, the radiotracers will accumulate in the tumors, or other swollen regions. Another method of diagnoses is studying the pattern of binding to specific proteins. Studying this pattern enables the doctors to identify the disease before it can be seen in other imaging tests. Section 3: Procedure The patient was required to have differentiated thyroid carcinoma of follicular-cell region and confirmed by the physician through historical information. There were also three minimum requirements, which the patient had to satisfy at least one. the first was an index metastatic lesion not radioiodine-avid 2 years prior, a lesion that had remained stable despite treatment for at least half a year, or/and an FDG-avid lesion on PET scan, indicating resistance to radioiodine (Ho et al., 2013). The procedure used iodine-124. At the beginning of the procedure, the patient was advised to keep a low-iodine diet for at least 5 days. This was to enable the radioactive iodine therapy to be more effective, as too much iodine in the system can stop the thyroid cells from taking up the radioactive iodine (Ho et al., 2013). This was followed by a thyrotopin-alfa stimulated I-124 PET-CT study, then an oral selumetinib dose of 75 mg. After 4 weeks of the selumetinib treatment, the patient took the second iodine-124 PET-CT study. Data of the spot urinary measurements was taken. This data was needed to rule out any clinically significant iodine contamination before the scan. If the patient was to show a dosimetry threshold during the second scan, the sulumetinib would be discontinued. A therapeutic iodine-131 was given after a patient exhibited the maximum tolerable activity. The physicians monitored toxic effects for a period of 30 days. Since the patient received iodine-131, CT imaging and magnetic resonance imaging were performed 2 and 6 months after the therapy. The patient received 0.9 mg of thyrotropin alfa intramuscular for two days, followed by a 6mCi of oral iodine 124 on the third day. This was followed by a PET-CT, with the precaution of avoiding contrast material. The patient was scanned 6 times, at up to 9 different positions, from the canthmeatal line to the midthigh. Such imaging is performed using a high energy collimator with a wide field-of-view, and the images are captured using a window set at 15% centered on a 364 keV photopeak. A...