Methods of treatment of carcinoid syndrome

It is often a symptom of carcinoid treatment involves removing or reducing the size of carcinoid tumors, and relief of symptoms. As used method of treatment depends on the size, location of tumor, and the extent of its spread. In general, treatment methods are divided into the following categories:

• Surgical treatment

The operation - the first paragraph of treatment carcinoids, especially in the early stages of the disease and tumors of small size. Type of surgery depends on the location and size of tumors. Many small tumors during surgery removed completely. Even in cases where the tumor has time to go to some of the lymph nodes located near Lymph nodes - what keeps our immune system Cancer can often be cured by removing the primary tumor and lymph nodes next few.

With significant amounts of tumor or if there are multiple tumors in one area, conducted a more extensive operation. In some cases, the removed part of the body affected by the tumor. If the tumor is very large or went far beyond their initial location, then surgery is not possible.

• Medication

If it is impossible to remove the tumor surgically, the symptoms of carcinoid syndrome can be relieved by drugs. Most often used for this drug octreotide (Sandostatin). Octreotide is used to eliminate the redness of the skin, and diarrhea caused by carcinoid syndrome, relieves symptoms of the condition in 75-80% of patients. Furthermore, Octreotide inhibits the growth of these tumors.

Also alleviate the symptoms of carcinoid syndrome helps alpha interferon. It can be used in combination with octreotide to reduce tumor size. Symptoms of the disease are also able to take drugs that lower the level of serotonin or histamine in the body. Currently, several drugs in clinical trials or are waiting for approval of the Office of the United States to monitor the quality of food and medicines. Some of these new drugs are already used in Europe.

• Ablation

The method involves the use of liquid nitrogen of high radio wave or concentrated alcohol solution, which are administered by injection into the affected tissue and kill tumor cells. Ablation is often used in cases where the tumor has spread to the liver and can not be removed surgically.

• Chemotherapy

This method is also used to destroy tumors that can not be surgically removed. Drugs for chemotherapy Chemotherapy - it always falls the hair?   taken orally or administered by injection into a vein. They have a devastating effect on the cancer cells. Although the treatment of many kinds of carcinoid tumors, this method is not very efficient, it is suitable for the treatment of certain forms of the disease, especially in cases where carcinoids are thyroid The thyroid gland - is responsible for your hormones .

Chemotherapy can be effective if the tumor has spread to the liver. Sometimes chemicals are introduced by injection directly into an artery carrying blood to the liver, which is subjected to powerful chemical influence. At the same time the remaining bodies not impeded.

• Radiation

This is a method in which to destroy cancer cells using high-energy radiation. Radiotherapy is not very effective when it comes to carcinoids. But in combination with other kinds of treatment method can be very useful for the treatment. Also, radio frequency radiation helps relieve pain in cases where the cancer Malignant tumor: cells are mad   proceeds to bone.

The prognosis for the detection of carcinoid syndrome

The presence of carcinoid syndrome usually means that the tumor has spread to other organs. However, since such tumors grow very slowly, treatment can be effective at this stage of the disease. Often people with carcinoid syndrome live another 10-15 years.

Treatment of bone metastases in differentiated thyroid carcinoma

Radioiodine

Efficacy radioiodine therapy depends on the number of metastases and patient age. In a study in 2001 was attended by 107 patients were divided into two groups: the first group included those who are less than 45 years, the second - patients older than 45 years. Complete or partial remission occurs in most of the subjects in the first group (62.5% of cases in the second group - 49.5%). In the first group, three of the four patients, three had less bone metastasis, complete remission. Long-term and partial remission was achieved in 24% and 27% of patients, respectively. The scientists who conducted the study, concluded that the differentiated thyroid cancer is the most favorable prognosis for patients younger than 45 years, the number of metastases which does not exceed 3.

Surgery

The main indications for surgery in metastatic thyroid cancer Metastatic thyroid cancer: clinical trials   are constant pain, is not amenable to drug therapy, the tumor does not absorb radioactive iodine, the instability of the spine with compression of nerves or lack thereof.

There are few studies in which analyzed the impact of surgery on patients with differentiated thyroid cancer and bone metastases. According to reports, the removal of up to five metastases associated with improved quality of life and survival.

If single, isolated metastases, distinguishable on x-ray, many experts recommend surgical removal and, as adjunctive therapy, radioactive iodine treatment before and after surgery. In patients without metastases ekstraskeletnyh radical extirpation of bone metastases can significantly increase the survival rate.

Some groups of patients are suitable modern minimally invasive techniques. Percutaneous vertebroplasty and kyphoplasty - a good alternative to traditional surgery for patients with metastatic vertebral fractures, and without damage to the nerves or spinal instability. Both procedures include injections of PMMA - bone cement - into the damaged vertebra.

During kyphoplasty first uses a special balloon by which restores vertebral height and kyphosis is corrected. Then a low pressure is injected bone cement. Kyphoplasty is an outpatient surgery, rarely causes complications and is effective in reducing back pain. Various orthopedic devices can also be used to relieve the pain and restore function.

Embolization can be used for the palliative treatment of pain and to prevent further spread of metastases Metastasis - danger everywhere . We investigated the use of embolization in conjunction with radioactive iodine therapy in the treatment of patients with differentiated thyroid cancer and high bone metastasis, not amenable to resection. The results of treatment were compared with a control group in which only used radioactive iodine therapy. In the first group after embolization and two sessions of radioiodine was a sharp decline in Tg compared with the control group. In addition, the CT scan showed that the subjects of the first group the size of metastases decreased by 52.5%. The results of the two treatment strategies was a rapid relief of pain and neurological symptoms.

Radiofrequency ablation and ethanol injection - two minimally invasive procedure that can be used in the treatment of bone metastases of thyroid cancer. However, their use requires special training to staff; moreover, their effect on patients with metastatic disease is not well understood.

External radiotherapy

Bone metastases of differentiated thyroid cancer does not respond to treatment with radioactive iodine, may respond positively to external radiotherapy Radiotherapy in cancer treatment: irradiation aid . It is a palliative treatment which is appointed only when severe pain, risk of pathological fractures, and neurological complications associated with spinal cord compression.

In 80% of individuals undergoing radiotherapy outer, full or partial relief of pain persists for at least six months. Chance of pathological fractures and spinal cord compression after treatment is reduced.

When differentiated thyroid cancer is sometimes used a combination of radiotherapy and outdoor treatment with radioactive iodine. After surgery this combined treatment significantly reduces the risk of further deterioration of bone tissue.

Chemotherapy

In the treatment of metastatic differentiated thyroid cancer may use different chemotherapy drugs, but the scientific evidence regarding their effectiveness yet.

Bisphosphonates

Bisphosphonates - an effective means of prevention of complications of bone metastases in cancer of the thyroid gland The thyroid gland - is responsible for your hormones . They bind to cells of bone tissue in areas where cellular metabolism is particularly active, are released from the cellular matrix during bone resorption and inhibit activity of osteoclasts, thereby reducing osteoclast-mediated bone resorption. Scientists have repeatedly pointed sclerosis lytic bone metastases after administration of bisphosphonates - in other words, substances to some extent destroyed metastases.

Nitrogen-containing bisphosphonates, such as zoledronic acid, pamidronate and ibandronate, has a unique mechanism of action and clinical activity greater than the first generation bisphosphonates; the number of skeletal complications of bone metastases is reduced when administered up to 50%. However, exposure to drugs of this type on malignant cells requires further study.

Antiresorptive effect. One recent study showed that zoledronic acid reduces the risk of skeletal complications in bone metastases of thyroid cancer, but it does not slow the progression of the disease, it does not increase survival and improve quality of life.

Patients who were given pamidronate significantly weakened the pain caused by bone metastases, the patient began to cope better with everyday activities and quality of life is improved. At the same time, the patients did not reduce the dose of analgesics. Side effects of pamidronate were mild and passes quickly.

Antitumor effect. Preliminary studies have shown that bisphosphonates have an antitumor effect both in vitro and in vivo. Bisphosphonates containing nitrogen inhibit processes which induce apoptosis in osteoclasts and cancerous cells.

They also violate the adhesion of cancer cells and prevent their spread, enhancing the effect of cytotoxic agents. However, the concentration necessary to achieve such results during in vitro experiments was much higher than that used in clinical practice today. Exposure to high doses per person is not known. However, experts point out that the use of bisphosphonates (standard doses) in the treatment of bone metastases of thyroid cancer is already justified, and gives very good results.

Developments and Prospects

• Inhibitors of bone resorption

Who is developing new approaches to prevention and treatment of bone metastases. One example of such approach is the treatment of inhibitors of bone resorption which are now in clinical trials around the world. Their impact on the metastases of differentiated thyroid cancer is not known.

Especially for the treatment of metastatic cancer that is resistant to the effects of radioactive iodine, have developed drugs such as bevacizumab (Avastin) and Sutent (sunitinib malate). It is necessary to point out that their study is still ongoing and it is not clear whether these medications effective standard for the treatment of bone metastases.

• Gene therapy of cancer

Currently the following types of developing gene therapy for metastatic thyroid cancer: inhibition of functioning of oncogenes, replacement of tumor suppressor genes, pro-drug therapy, immunotherapy, genetic vaccination, antisense therapy, therapy with ribozymes neutralizing antibodies.