Thyroid cancer:
Gespeichert in:
| Weitere Verfasser: | |
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| Format: | Elektronisch E-Book |
| Sprache: | English |
| Veröffentlicht: |
Berlin [u.a.]
Springer
2005
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| Ausgabe: | 2. ed. |
| Schlagworte: | |
| Online-Zugang: | Volltext Inhaltsverzeichnis |
| Beschreibung: | 1 Online-Ressource (XX, 361 S.) Ill., graph. Darst. |
| ISBN: | 9783540278450 |
| DOI: | 10.1007/3-540-27845-1 |
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| 250 | |a 2. ed. | ||
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| 300 | |a 1 Online-Ressource (XX, 361 S.) |b Ill., graph. Darst. | ||
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Datensatz im Suchindex
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| adam_text | Contents
Part I Basics 1 The Changing Epidemiology of Thyroid Cancer 3
R. Gorges
1.1 Basic Epidemiological Problems in Thyroid Cancer .. 3
1.2 General Epidemiological Data for Thyroid Cancer ... 6
1.3 Prognosis 9
1.4 Thyroid Malignancy Entities with Special Features .. 11
1.4.1 Papillary Microcarcinoma 11
1.4.2 Hurthle Cell Carcinoma 12
1.4.3 Histological Variants of Papillary Thyroid Cancer ... 13
1.4.4 Poorly Differentiated (Insular) Thyroid Carcinoma .. 14
1.4.5 Anaplastic Carcinoma 14
1.4.6 Medullary Thyroid Carcinoma 15
1.4.7 Thyroid Lymphoma 15
1.4.8 Secondary Tumors 16
1.5 Changes in Epidemiology 16
1.6 Summary 20
References 21
2 Histopathology, Immunohistochemistry,
and Molecular Biology 29
F. HOFSTA.DTER
2.1 Introduction 29
2.2 Principles of Histopathological Diagnosis
and Classification 29
2.2.1 The Rules and Their Problems 29
2.2.2 Papillary Carcinoma 30
2.2.3 Follicular Carcinoma 31
2.2.4 Anaplastic (Undifferentiated) Carcinoma 33
2.2.5 Medullary (C cell) Carcinoma 33
2.3 Histopathology and Prognosis 34
2.3.1 Histopathology and Prognostic Scores 34
2.3.2 Histological Subtypes Influencing Prognosis 36
[ Contents 2.4 Histo/Cytopathology in Preoperative
and Intraoperative Diagnosis
(Problem of Frozen Section) 39
2.5 Auxiliary Techniques (Cytometry,
Immunohistochemistry, Molecular Pathology) 39
2.6 Preoperative Diagnosis
(Fine Needle Aspiration Biopsy) 40
2.7 Prognosis 41
2.8 Pathogenesis 42
2.8.1 Anatomical Histogenesis 43
2.8.2 Molecular Pathogenesis 43
2.8.2.1 Genetics 43
2.8.2.2 Malignant Transformation 44
2.8.2.3 Mechanisms of Invasion and Metastasis 46
2.8.2.4 Cell Cycle Regulation 46
2.8.2.5 Cytogenetics and Clonality 47
2.8.2.6 Receptor Activation 48
2.8.2.7 Telomerase 48
References 48
3 Familial Differentiated Carcinoma of the Thyroid 57
M.R. Carlisle and I.R. McDougall
3.1 Introduction 57
3.2 Etiology of Non Medullary Thyroid Cancers 57
3.3 Could Familial Thyroid Cancers
Be a Chance Finding? 59
3.4 Genetics and Associated Syndromes 60
3.4.1 Molecular Genetics of Familial Thyroid Cancer 62
3.4.2 Natural History of Familial Thyroid Cancer 64
3.5 Clinical Implications
of Familial Nonmedullary Thyroid Cancer 65
3.5.1 Primary Treatment 65
3.5.2 Screening of Families 65
References 66
4 The Diagnosis of Thyroid Cancer 71
C. Reiners
4.1 Prevalence/Risk Assessment 71
4.2 Findings/Symptoms 71
4.3 Ultrasonography 72
4.4 Scintigraphy 73
4.5 Fine Needle Aspiration Biopsy 76
4.6 Additional Diagnostic Procedures 79
References 80
Contents XI
5 The Current Surgical Approach
to Non Medullary Thyroid Cancer 83
O. Gimm and H. Dralle
5.1 Introduction 83
5.2 Prognostic Factors 84
5.3 Surgical Treatment 85
5.3.1 Technique 85
5.3.2 Primary Therapy 85
5.3.2.1 Thyroid Gland 85
5.3.2.1.1 Differentiated Thyroid Carcinoma 85
5.3.2.1.2 Undifferentiated Thyroid Carcinoma 86
5.3.2.1.3 Rare Types of Thyroid Cancer 87
5.3.2.2 Extrathyroidal Tumor Extension 87
5.3.2.3 Lymph Nodes 88
5.3.2.4 Distant Metastases 88
5.3.3 Completion Thyroidectomy 89
5.3.4 Recurrent Disease 89
References 89
Part II Differentiated Thyroid Cancer 6 Radioiodine Therapy for Thyroid Cancer 95
M. Dietlein, D. Moka, and H. Schicha
6.1 Introduction 95
6.2 Radioiodine Ablation and Radioiodine Therapy 96
6.2.1 Ablation of Residual Thyroid Tissue 96
6.2.2 Ablative Dose 97
6.2.3 In Which Patients Is Ablation Unnecessary? 100
6.2.4 Radioiodine Therapy for Thyroid Cancer 101
6.2.5 Radioiodine Therapy with Negative
Radioiodine Scan 101
6.2.6 Radioiodine Therapy in Patients
on Maintenance Hemodialysis 102
6.3 Prognostic Factors and Therapeutic Strategies
in Metastatic Thyroid Cancer 103
6.3.1 Lymph Node Metastases 103
6.3.2 Pulmonary Metastases 104
6.3.3 Bone Metastases 106
6.3.4 Brain Metastases 108
6.3.5 Locally Invasive Thyroid Cancer 109
6.4 Optimizing the Therapeutic and Diagnostic
Capabilities of 131I 110
6.4.1 Thyroid Stimulating Hormone Stimulation 110
[I Contents ___
6.4.2 Administration of Recombinant
Human Thyrotropin 110
6.4.3 Low Iodine Diet 112
6.4.4 Optimal Diagnostic Scan Dose 113
6.4.5 Redifferentiation Therapy and Future
Therapeutic Options 114
6.4.6 Lithium 115
6.4.7 Further Optimization of mI Imaging 115
6.4.8 Diuretic Enhanced 131I Clearance 116
6.5 Side Effects of 131I Therapy 116
6.5.1 Radiation Thyroiditis 116
6.5.2 Painless Neck Edema 116
6.5.3 Sialadenitis 116
6.5.4 Taste Dysfunction 117
6.5.5 Gastrointestinal Symptoms 117
6.5.6 Testicular Function and Male Fertility 118
6.5.7 Ovarian Function and Female Fertility 118
6.5.8 Pregnancy Outcome 118
6.5.9 Bone Marrow Suppression 119
6.5.10 Leukemia 119
6.5.11 Solid Tumors 120
6.5.12 Pulmonary Fibrosis 120
6.5.13 Neurologic Complications 121
6.5.14 Parathyroid Dysfunction 121
6.5.15 Lacrimal Gland Dysfunction 121
6.6 Radiation Considerations in the Treatment
of Thyroid Cancer 122
References 122
7 124I Positron Emission Tomographic Dosimetry
and Positron Emission Tomography/
Computed Tomography Imaging
in Differentiated Thyroid Cancer 127
L.S. Freudenberg, A. Bockisch, and W. Jentzen
7.1 Introduction 127
7.2 124I Characteristics 128
7.3 Metastases Dosimetry Using 124I PET 128
7.4 PET/CT Imaging with 124I 132
7.5 Conclusions 136
References 137
8 External Beam Radiotherapy 139
M. BlERMANN, M.K. PlXBERG, A. SCHUCK,
N. Willich, A. Heinecke, and O. Schober
8.1 Introduction 139
8.2 Methods 139
Contents XIII
8.2.1 Literature Search 139
8.2.2 Statistical Analysis 140
8.3 Results 140
8.3.1 Literature Search 140
8.3.2 Methodological Quality of the Studies 148
8.3.3 Rationale of RTx 149
8.3.4 RTx Protocol 151
8.3.5 Retrospective Studies 151
8.3.6 Prospective Studies 152
8.3.7 Toxicity 153
8.3.8 Guidelines 153
8.4 Discussion 155
References 156
9 Thyroid Cancer: Treatment with Thyroid Hormone 163
P. M. Schumm Draeger
9.1 Introduction 163
9.2 Rationale of Thyroid Hormone Therapy 163
9.3 Effects on Thyroid Growth 164
9.4 Effects on Differentiation of Thyroid Cells 164
9.5 Optimal Level of TSH Suppression in Patients
with Differentiated Thyroid Cancer 164
9.6 Treatment with Thyroid Hormones 165
9.7 Pharmacology of Thyroid Hormones
(Levothyroxine, L T4) 165
9.8 Optimal Dosage and Adjustment of L T4 in Thyroid
Cancer Patients According to Disease Status 166
9.9 Important Side Effects
of L T4 Suppressive Therapy 167
9.9.1 Side Effects of L T4 Therapy: Bone 167
9.9.2 Side Effects of L T4 Therapy: Heart 168
9.10 Conclusion 168
References 168
10 Treatment with Cytotoxic Drugs 171
B. Saller
10.1 Introduction 171
10.2 Results of Chemotherapy in Differentiated
Thyroid Carcinoma 171
10.2.1 Monotherapy 171
10.2.2 Combination Chemotherapy 172
10.2.2.1 Doxorubicin and Cisplatin 172
10.2.2.2 Doxorubicin and Bleomicin 173
10.2.2.3 Doxorubicin and other Cytotoxic Drugs 174
IV Contents 10.3 Results of Chemotherapy in Poorly Differentiated
and Anaplastic Thyroid Carcinoma 174
10.3.1 Chemotherapy 174
10.3.2 Combined Modality Treatment 176
10.3.2.1 Treatment Protocols Including Chemotherapy
with Single Cytotoxic Drugs 176
10.3.2.2 Treatment Protocols Including Combination
Chemotherapy 176
10.4 Drugs with In Vitro Anti Tumor Effects 177
10.5 Mechanisms of Resistance Against Cytotoxic Drugs .. 178
10.5.1 Overexpression of P glycoprotein
and Multidrug Resistance Associated Protein 179
10.5.2 Alterations of DNA Topoisomerases 179
10.5.3 Alterations of Glutathione
and Glutathione S transferases 180
10.5.4 Control of Apoptosis 180
10.6 Future Directions in Chemotherapy
of Thyroid Cancer 180
10.7 Current Suggestions for Management 181
10.7.1 Differentiated Thyroid Cancer 181
10.7.2 Poorly Differentiated
and Anaplastic Thyroid Carcinoma 183
References 183
11 Redifferentiation Therapy of Thyroid Carcinomas
with Retinoic Acid 187
D. Simon
11.1 Introduction 187
11.2 Biological Effects of Retinoic Acids 188
11.3 Retinoids in Cancer Treatment 188
11.4 Thyroid Specific Effects of Retinoids 189
11.4.1 Thyroid Specific Functions 189
11.4.2 Differentiation 190
11.4.3 Proliferation 190
11.5 Basis for Therapeutic Approach 190
11.6 Results of a Clinical Pilot Study 191
11.7 Conclusion and Perspectives 193
References 194
12 Follow up of Patients with Well Differentiated
Thyroid Cancer 199
B. Shapiro, J. Freitas, and M. Gross
12.1 Introduction 199
12.2 The Follow up of Patients with Thyroid Cancer 199
12.2.1 Assessing the Risk of Morbidity and Mortality 199
12.2.2 Postoperative Evaluation of Thyroid Cancer 202
Contents
12.2.3 Postoperative Laboratory Evaluation and Imaging ... 203
12.2.3.1 Radioiodine 203
12.2.3.2 Other Agents Used to Image Thyroid Cancer 206
12.2.3.3 Thyroglobulin 208
12.2.4 Follow up Therapy After Thyroidectomy 209
12.2.4.1 Ablation of Thyroid Remnants 209
12.2.4.2 Follow up Intervals After Successful Ablation 211
12.2.4.3 Thyroid Hormone Replacement
in the Thyroid Cancer Patient 212
12.2.4.4 Radioiodine Therapy for Recurrent/
Metastatic Thyroid Cancer 212
12.2.4.5 Radioiodine Negative Thyroid Cancer 213
12.3 Summary 215
References 216
13 Thyroglobulin as Specific Tumor Marker
in Differentiated Thyroid Cancer 221
R. Gorges and A. Bockisch
i
13.1 Introduction 221
13.2 Thyroglobulin Measurement:
Methodology and Problems 223
13.3 Diagnostic Value of Thyroglobulin
in the Spectrum of Follow Up Methods 226
13.4 Tg Measurement
Under Exogenous TSH Stimulation 227
13.5 Ultrasensitive Thyroglobulin Measurement 230
13.6 Thyroglobulin Messenger RNA
as Alternative Tumor Marker 232
References 232
14 Functional Imaging of Thyroid Cancer 239
F. Grunwald
14.1 Introduction 239
14.2 Tracers 239
14.2.1 Thallium Chloride 239
14.2.2 MIBI and Other 99mTc Labeled Tracers 240
14.2.3 18F Fluorodeoxyglucose 240
14.2.4 nlIn Octreotide 242
14.3 Clinical Use of Functional Imaging 243
14.3.1 Presurgical Evaluation 243
14.3.2 Postsurgical Treatment and Follow up 244
References 247
XVI Contents ___
15 Magnetic Resonance Imaging 251
J.H. Risse
15.1 Introduction 251
15.2 Principles of MRI 252
15.2.1 Physical and Technical Basis of MRI 252
15.2.1.1 The Magnetic Signal 252
15.2.1.2 Image Generation: What Are TR and TE?
What are Tl and T2? 253
15.2.1.3 Further Contrast Modifications:
Fat Saturation and Contrast Media 255
15.2.1.3.1 Fat Saturation 255
15.2.1.3.2 Contrast Media 256
15.2.2 Safety 257
15.2.2.1 Safety in the Magnetic Field 257
15.2.2.2 Safety of Contrast Media 258
15.2.2.3 Contraindications 258
15.2.3 Protocol Recommendations
for Thyroid Cancer Follow up 259
15.2.3.1 Hardware 259
15.2.3.2 Sequences 259
15.2.3.3 Planes 260
15.2.3.4 Covered Anatomic Regions 260
15.2.3.5 Our Protocol 260
15.3 Normal MR Anatomy of the Neck, Thyroid,
and Upper Mediastinum 261
15.3.1 Normal Anatomy 261
/ 15.3.1.1 Neck Compartments 261
15.3.1.2 Thyroid and Parathyroid Glands 264
15.3.1.3 Salivary Glands 265
15.3.1.4 Lymphatic Drainage 266
15.3.1.5 Upper Anterior Mediastinum 267
15.3.2 Inconspicuous Anatomy After Thyroidectomy 267
15.4 Pathologic Changes 267
15.4.1 Primary Thyroid Cancer 270
15.4.2 Thyroid Remnants 271
15.4.3 Recurrent Thyroid Cancer 272
15.4.4 Pathologic Lymph Nodes 272
15.4.5 Distant Metastases 277
15.4.6 Accidental Pathologic Findings 277
References 280
16 Thyroid Cancer in Chernobyl Children 283
C. Reiners, J. Biko, E.P. Demidchik,
and V. Drozd
16.1 Experiences from the Past 283
16.2 The Chernobyl Accident 284
16.3 Thyroid Cancer in Belarus After Chernobyl 284
Contents X
16.4 Treatment of Thyroid Cancer
in Children from Belarus 286
16.4.1 Patients 287
16.4.2 Protocol 288
16.4.3 Results of Treatment 288
16.5 Discussion and Conclusions 289
References 291
Part HI Medullary Thyroid Cancer 17 Diagnosis of Medullary Thyroid Cancer 297
F. Raue and K. Frank Raue
17.1 Introduction 297
17.2 Classification and Epidemiology 297
17.3 Pathology and Biochemical Markers 298
17.4 Genetic Abnormalities 299
17.5 Clinical Syndrome and Diagnostic Procedure 302
17.5.1 Sporadic Medullary Thyroid Carcinoma 302
17.5.2 Hereditary Medullary Thyroid Carcinoma 303
17.5.2.1 Pheochromocytoma 305
17.5.2.2 Primary Hyperparathyroidism 305
17.5.2.3 Multiple Endocrine Neoplasia Type 2B 306
17.6 Natural History and Prognostic Factors 306
References 306
18 Imaging in Medullary Thyroid Cancer 311
T.M. Behr and W. Becker
18.1 Introduction 311
18.2 Diagnosis and Localization of the Medullary
Thyroid Primary Tumor; Presurgical Staging 312
18.3 Imaging and Disease Localization
in the Follow up of Patients with MTC 316
18.3.1 Conventional Radiological Techniques
(Ultrasonography, X ray, Computed Tomography,
Magnetic Resonance Imaging, Bone Scanning) 316
18.3.2 Traditional Scintigraphic Techniques [201Tl Chloride,
99mTc_(v) DMSA, i»/i3ii MIBG, etc.] 318
18.3.3 Modern Nuclear Medical Techniques (Anti CEA
Immunoscintigraphy, Somatostatin Receptor
Scintigraphy, Positron Emission Tomography) 321
18.4 Future Developments: Will Cholecystokinin B/
Gastrin Receptor Scintigraphy Allow
for More Sensitive Staging of MTC? 326
18.5 Conclusion 331
References 331
XVIII Contents 19 Therapy for Medullary Thyroid Cancer 335
O. Gimm and H. Dralle
19.1 Introduction 335
19.2 Sporadic Versus Familial Medullary
Thyroid Carcinoma 335
19.3 Therapy 336
19.3.1 Surgical Treatment 337
19.3.1.1 Thyroid Gland 337
19.3.1.2 Lymph Node Metastases 337
19.3.1.2.1 Inclusion of the Cervicolateral Compartments 338
19.3.1.2.2 Inclusion of the Mediastinal Compartment 338
19.3.1.3 Distant Metastases 339
19.3.1.4 Reoperation 339
19.3.2 Special Therapeutic Considerations
in Familial MTC 340
19.3.2.1 Thyroid Gland 340
19.3.2.2 Lymph Node Metastases 340
19.3.3 Nonsurgical Treatment Modalities 341
19.3.3.1 Octreotide 341
19.3.3.2 Radioactive Iodine 341
19.3.3.3 External Radiation 342
19.3.3.4 Chemotherapy 342
19.3.3.5 Psychological Support 342
References 343
20 Follow up of Medullary Thyroid Cancer 347
T. Schilling and R. Ziegler
20.1 Distinction Between Sporadic and Familial Form
of Medullary Thyroid Cancer 347
20.2 Survival in Patients Suffering from MTC 347
20.3 Sporadic Form of MTC 349
20.3.1 Calcitonin as a Tumor Marker During Follow up 349
20.3.2 Testing the Result of the Primary Operation 349
20.3.3 Follow up in General 351
20.3.4 Follow up in Patients with No Detectable
Calcitonin Postoperatively 351
20.3.5 Follow up in Patients with Detectable
Calcitonin Postoperatively 351
20.3.6 Adjuvant Therapy 352
20.4 Familial Form of MTC (MEN 2) 353
20.4.1 Screening for Pheochromocytoma
and Timing of Surgery 353
20.4.2 Screening for Primary Hyperparathyroidism 354
References 355
Subject Index 357
|
| adam_txt |
Contents
Part I Basics 1 The Changing Epidemiology of Thyroid Cancer 3
R. Gorges
1.1 Basic Epidemiological Problems in Thyroid Cancer . 3
1.2 General Epidemiological Data for Thyroid Cancer . 6
1.3 Prognosis 9
1.4 Thyroid Malignancy Entities with Special Features . 11
1.4.1 Papillary Microcarcinoma 11
1.4.2 Hurthle Cell Carcinoma 12
1.4.3 Histological Variants of Papillary Thyroid Cancer . 13
1.4.4 Poorly Differentiated (Insular) Thyroid Carcinoma . 14
1.4.5 Anaplastic Carcinoma 14
1.4.6 Medullary Thyroid Carcinoma 15
1.4.7 Thyroid Lymphoma 15
1.4.8 Secondary Tumors 16
1.5 Changes in Epidemiology 16
1.6 Summary 20
References 21
2 Histopathology, Immunohistochemistry,
and Molecular Biology 29
F. HOFSTA.DTER
2.1 Introduction 29
2.2 Principles of Histopathological Diagnosis
and Classification 29
2.2.1 The Rules and Their Problems 29
2.2.2 Papillary Carcinoma 30
2.2.3 Follicular Carcinoma 31
2.2.4 Anaplastic (Undifferentiated) Carcinoma 33
2.2.5 Medullary (C cell) Carcinoma 33
2.3 Histopathology and Prognosis 34
2.3.1 Histopathology and Prognostic Scores 34
2.3.2 Histological Subtypes Influencing Prognosis 36
[ Contents 2.4 Histo/Cytopathology in Preoperative
and Intraoperative Diagnosis
(Problem of Frozen Section) 39
2.5 Auxiliary Techniques (Cytometry,
Immunohistochemistry, Molecular Pathology) 39
2.6 Preoperative Diagnosis
(Fine Needle Aspiration Biopsy) 40
2.7 Prognosis 41
2.8 Pathogenesis 42
2.8.1 Anatomical Histogenesis 43
2.8.2 Molecular Pathogenesis 43
2.8.2.1 Genetics 43
2.8.2.2 Malignant Transformation 44
2.8.2.3 Mechanisms of Invasion and Metastasis 46
2.8.2.4 Cell Cycle Regulation 46
2.8.2.5 Cytogenetics and Clonality 47
2.8.2.6 Receptor Activation 48
2.8.2.7 Telomerase 48
References 48
3 Familial Differentiated Carcinoma of the Thyroid 57
M.R. Carlisle and I.R. McDougall
3.1 Introduction 57
3.2 Etiology of Non Medullary Thyroid Cancers 57
3.3 Could "Familial" Thyroid Cancers
Be a Chance Finding? 59
3.4 Genetics and Associated Syndromes 60
3.4.1 Molecular Genetics of Familial Thyroid Cancer 62
3.4.2 Natural History of Familial Thyroid Cancer 64
3.5 Clinical Implications
of Familial Nonmedullary Thyroid Cancer 65
3.5.1 Primary Treatment 65
3.5.2 Screening of Families 65
References 66
4 The Diagnosis of Thyroid Cancer 71
C. Reiners
4.1 Prevalence/Risk Assessment 71
4.2 Findings/Symptoms 71
4.3 Ultrasonography 72
4.4 Scintigraphy 73
4.5 Fine Needle Aspiration Biopsy 76
4.6 Additional Diagnostic Procedures 79
References 80
Contents XI
5 The Current Surgical Approach
to Non Medullary Thyroid Cancer 83
O. Gimm and H. Dralle
5.1 Introduction 83
5.2 Prognostic Factors 84
5.3 Surgical Treatment 85
5.3.1 Technique 85
5.3.2 Primary Therapy 85
5.3.2.1 Thyroid Gland 85
5.3.2.1.1 Differentiated Thyroid Carcinoma 85
5.3.2.1.2 Undifferentiated Thyroid Carcinoma 86
5.3.2.1.3 Rare Types of Thyroid Cancer 87
5.3.2.2 Extrathyroidal Tumor Extension 87
5.3.2.3 Lymph Nodes 88
5.3.2.4 Distant Metastases 88
5.3.3 Completion Thyroidectomy 89
5.3.4 Recurrent Disease 89
References 89
Part II Differentiated Thyroid Cancer 6 Radioiodine Therapy for Thyroid Cancer 95
M. Dietlein, D. Moka, and H. Schicha
6.1 Introduction 95
6.2 Radioiodine Ablation and Radioiodine Therapy 96
6.2.1 Ablation of Residual Thyroid Tissue 96
6.2.2 Ablative Dose 97
6.2.3 In Which Patients Is Ablation Unnecessary? 100
6.2.4 Radioiodine Therapy for Thyroid Cancer 101
6.2.5 Radioiodine Therapy with Negative
Radioiodine Scan 101
6.2.6 Radioiodine Therapy in Patients
on Maintenance Hemodialysis 102
6.3 Prognostic Factors and Therapeutic Strategies
in Metastatic Thyroid Cancer 103
6.3.1 Lymph Node Metastases 103
6.3.2 Pulmonary Metastases 104
6.3.3 Bone Metastases 106
6.3.4 Brain Metastases 108
6.3.5 Locally Invasive Thyroid Cancer 109
6.4 Optimizing the Therapeutic and Diagnostic
Capabilities of 131I 110
6.4.1 Thyroid Stimulating Hormone Stimulation 110
[I Contents _
6.4.2 Administration of Recombinant
Human Thyrotropin 110
6.4.3 Low Iodine Diet 112
6.4.4 Optimal Diagnostic Scan Dose 113
6.4.5 Redifferentiation Therapy and Future
Therapeutic Options 114
6.4.6 Lithium 115
6.4.7 Further Optimization of mI Imaging 115
6.4.8 Diuretic Enhanced 131I Clearance 116
6.5 Side Effects of 131I Therapy 116
6.5.1 Radiation Thyroiditis 116
6.5.2 Painless Neck Edema 116
6.5.3 Sialadenitis 116
6.5.4 Taste Dysfunction 117
6.5.5 Gastrointestinal Symptoms 117
6.5.6 Testicular Function and Male Fertility 118
6.5.7 Ovarian Function and Female Fertility 118
6.5.8 Pregnancy Outcome 118
6.5.9 Bone Marrow Suppression 119
6.5.10 Leukemia 119
6.5.11 Solid Tumors 120
6.5.12 Pulmonary Fibrosis 120
6.5.13 Neurologic Complications 121
6.5.14 Parathyroid Dysfunction 121
6.5.15 Lacrimal Gland Dysfunction 121
6.6 Radiation Considerations in the Treatment
of Thyroid Cancer 122
References 122
7 124I Positron Emission Tomographic Dosimetry
and Positron Emission Tomography/
Computed Tomography Imaging
in Differentiated Thyroid Cancer 127
L.S. Freudenberg, A. Bockisch, and W. Jentzen
7.1 Introduction 127
7.2 124I Characteristics 128
7.3 Metastases Dosimetry Using 124I PET 128
7.4 PET/CT Imaging with 124I 132
7.5 Conclusions 136
References 137
8 External Beam Radiotherapy 139
M. BlERMANN, M.K. PlXBERG, A. SCHUCK,
N. Willich, A. Heinecke, and O. Schober
8.1 Introduction 139
8.2 Methods 139
Contents XIII
8.2.1 Literature Search 139
8.2.2 Statistical Analysis 140
8.3 Results 140
8.3.1 Literature Search 140
8.3.2 Methodological Quality of the Studies 148
8.3.3 Rationale of RTx 149
8.3.4 RTx Protocol 151
8.3.5 Retrospective Studies 151
8.3.6 Prospective Studies 152
8.3.7 Toxicity 153
8.3.8 Guidelines 153
8.4 Discussion 155
References 156
9 Thyroid Cancer: Treatment with Thyroid Hormone 163
P. M. Schumm Draeger
9.1 Introduction 163
9.2 Rationale of Thyroid Hormone Therapy 163
9.3 Effects on Thyroid Growth 164
9.4 Effects on Differentiation of Thyroid Cells 164
9.5 Optimal Level of TSH Suppression in Patients
with Differentiated Thyroid Cancer 164
9.6 Treatment with Thyroid Hormones 165
9.7 Pharmacology of Thyroid Hormones
(Levothyroxine, L T4) 165
9.8 Optimal Dosage and Adjustment of L T4 in Thyroid
Cancer Patients According to Disease Status 166
9.9 Important Side Effects
of L T4 Suppressive Therapy 167
9.9.1 Side Effects of L T4 Therapy: Bone 167
9.9.2 Side Effects of L T4 Therapy: Heart 168
9.10 Conclusion 168
References 168
10 Treatment with Cytotoxic Drugs 171
B. Saller
10.1 Introduction 171
10.2 Results of Chemotherapy in Differentiated
Thyroid Carcinoma 171
10.2.1 Monotherapy 171
10.2.2 Combination Chemotherapy 172
10.2.2.1 Doxorubicin and Cisplatin 172
10.2.2.2 Doxorubicin and Bleomicin 173
10.2.2.3 Doxorubicin and other Cytotoxic Drugs 174
IV Contents 10.3 Results of Chemotherapy in Poorly Differentiated
and Anaplastic Thyroid Carcinoma 174
10.3.1 Chemotherapy 174
10.3.2 Combined Modality Treatment 176
10.3.2.1 Treatment Protocols Including Chemotherapy
with Single Cytotoxic Drugs 176
10.3.2.2 Treatment Protocols Including Combination
Chemotherapy 176
10.4 Drugs with In Vitro Anti Tumor Effects 177
10.5 Mechanisms of Resistance Against Cytotoxic Drugs . 178
10.5.1 Overexpression of P glycoprotein
and Multidrug Resistance Associated Protein 179
10.5.2 Alterations of DNA Topoisomerases 179
10.5.3 Alterations of Glutathione
and Glutathione S transferases 180
10.5.4 Control of Apoptosis 180
10.6 Future Directions in Chemotherapy
of Thyroid Cancer 180
10.7 Current Suggestions for Management 181
10.7.1 Differentiated Thyroid Cancer 181
10.7.2 Poorly Differentiated
and Anaplastic Thyroid Carcinoma 183
References 183
11 Redifferentiation Therapy of Thyroid Carcinomas
with Retinoic Acid 187
D. Simon
11.1 Introduction 187
11.2 Biological Effects of Retinoic Acids 188
11.3 Retinoids in Cancer Treatment 188
11.4 Thyroid Specific Effects of Retinoids 189
11.4.1 Thyroid Specific Functions 189
11.4.2 Differentiation 190
11.4.3 Proliferation 190
11.5 Basis for Therapeutic Approach 190
11.6 Results of a Clinical Pilot Study 191
11.7 Conclusion and Perspectives 193
References 194
12 Follow up of Patients with Well Differentiated
Thyroid Cancer 199
B. Shapiro, J. Freitas, and M. Gross
12.1 Introduction 199
12.2 The Follow up of Patients with Thyroid Cancer 199
12.2.1 Assessing the Risk of Morbidity and Mortality 199
12.2.2 Postoperative Evaluation of Thyroid Cancer 202
Contents
12.2.3 Postoperative Laboratory Evaluation and Imaging . 203
12.2.3.1 Radioiodine 203
12.2.3.2 Other Agents Used to Image Thyroid Cancer 206
12.2.3.3 Thyroglobulin 208
12.2.4 Follow up Therapy After Thyroidectomy 209
12.2.4.1 Ablation of Thyroid Remnants 209
12.2.4.2 Follow up Intervals After Successful Ablation 211
12.2.4.3 Thyroid Hormone Replacement
in the Thyroid Cancer Patient 212
12.2.4.4 Radioiodine Therapy for Recurrent/
Metastatic Thyroid Cancer 212
12.2.4.5 Radioiodine Negative Thyroid Cancer 213
12.3 Summary 215
References 216
13 Thyroglobulin as Specific Tumor Marker
in Differentiated Thyroid Cancer 221
R. Gorges and A. Bockisch
i
13.1 Introduction 221
13.2 Thyroglobulin Measurement:
Methodology and Problems 223
13.3 Diagnostic Value of Thyroglobulin
in the Spectrum of Follow Up Methods 226
13.4 Tg Measurement
Under Exogenous TSH Stimulation 227
13.5 Ultrasensitive Thyroglobulin Measurement 230
13.6 Thyroglobulin Messenger RNA
as Alternative Tumor Marker 232
References 232
14 Functional Imaging of Thyroid Cancer 239
F. Grunwald
14.1 Introduction 239
14.2 Tracers 239
14.2.1 Thallium Chloride 239
14.2.2 MIBI and Other 99mTc Labeled Tracers 240
14.2.3 18F Fluorodeoxyglucose 240
14.2.4 nlIn Octreotide 242
14.3 Clinical Use of Functional Imaging 243
14.3.1 Presurgical Evaluation 243
14.3.2 Postsurgical Treatment and Follow up 244
References 247
XVI Contents _
15 Magnetic Resonance Imaging 251
J.H. Risse
15.1 Introduction 251
15.2 Principles of MRI 252
15.2.1 Physical and Technical Basis of MRI 252
15.2.1.1 The Magnetic Signal 252
15.2.1.2 Image Generation: What Are TR and TE?
What are Tl and T2? 253
15.2.1.3 Further Contrast Modifications:
Fat Saturation and Contrast Media 255
15.2.1.3.1 Fat Saturation 255
15.2.1.3.2 Contrast Media 256
15.2.2 Safety 257
15.2.2.1 Safety in the Magnetic Field 257
15.2.2.2 Safety of Contrast Media 258
15.2.2.3 Contraindications 258
15.2.3 Protocol Recommendations
for Thyroid Cancer Follow up 259
15.2.3.1 Hardware 259
15.2.3.2 Sequences 259
15.2.3.3 Planes 260
15.2.3.4 Covered Anatomic Regions 260
15.2.3.5 Our Protocol 260
15.3 Normal MR Anatomy of the Neck, Thyroid,
and Upper Mediastinum 261
15.3.1 Normal Anatomy 261
/ 15.3.1.1 Neck Compartments 261
15.3.1.2 Thyroid and Parathyroid Glands 264
15.3.1.3 Salivary Glands 265
15.3.1.4 Lymphatic Drainage 266
15.3.1.5 Upper Anterior Mediastinum 267
15.3.2 Inconspicuous Anatomy After Thyroidectomy 267
15.4 Pathologic Changes 267
15.4.1 Primary Thyroid Cancer 270
15.4.2 Thyroid Remnants 271
15.4.3 Recurrent Thyroid Cancer 272
15.4.4 Pathologic Lymph Nodes 272
15.4.5 Distant Metastases 277
15.4.6 Accidental Pathologic Findings 277
References 280
16 Thyroid Cancer in Chernobyl Children 283
C. Reiners, J. Biko, E.P. Demidchik,
and V. Drozd
16.1 Experiences from the Past 283
16.2 The Chernobyl Accident 284
16.3 Thyroid Cancer in Belarus After Chernobyl 284
Contents X\
16.4 Treatment of Thyroid Cancer
in Children from Belarus 286
16.4.1 Patients 287
16.4.2 Protocol 288
16.4.3 Results of Treatment 288
16.5 Discussion and Conclusions 289
References 291
Part HI Medullary Thyroid Cancer 17 Diagnosis of Medullary Thyroid Cancer 297
F. Raue and K. Frank Raue
17.1 Introduction 297
17.2 Classification and Epidemiology 297
17.3 Pathology and Biochemical Markers 298
17.4 Genetic Abnormalities 299
17.5 Clinical Syndrome and Diagnostic Procedure 302
17.5.1 Sporadic Medullary Thyroid Carcinoma 302
17.5.2 Hereditary Medullary Thyroid Carcinoma 303
17.5.2.1 Pheochromocytoma 305
17.5.2.2 Primary Hyperparathyroidism 305
17.5.2.3 Multiple Endocrine Neoplasia Type 2B 306
17.6 Natural History and Prognostic Factors 306
References 306
18 Imaging in Medullary Thyroid Cancer 311
T.M. Behr and W. Becker
18.1 Introduction 311
18.2 Diagnosis and Localization of the Medullary
Thyroid Primary Tumor; Presurgical Staging 312
18.3 Imaging and Disease Localization
in the Follow up of Patients with MTC 316
18.3.1 Conventional Radiological Techniques
(Ultrasonography, X ray, Computed Tomography,
Magnetic Resonance Imaging, Bone Scanning) 316
18.3.2 Traditional Scintigraphic Techniques [201Tl Chloride,
99mTc_(v) DMSA, i»/i3ii MIBG, etc.] 318
18.3.3 Modern Nuclear Medical Techniques (Anti CEA
Immunoscintigraphy, Somatostatin Receptor
Scintigraphy, Positron Emission Tomography) 321
18.4 Future Developments: Will Cholecystokinin B/
Gastrin Receptor Scintigraphy Allow
for More Sensitive Staging of MTC? 326
18.5 Conclusion 331
References 331
XVIII Contents 19 Therapy for Medullary Thyroid Cancer 335
O. Gimm and H. Dralle
19.1 Introduction 335
19.2 Sporadic Versus Familial Medullary
Thyroid Carcinoma 335
19.3 Therapy 336
19.3.1 Surgical Treatment 337
19.3.1.1 Thyroid Gland 337
19.3.1.2 Lymph Node Metastases 337
19.3.1.2.1 Inclusion of the Cervicolateral Compartments 338
19.3.1.2.2 Inclusion of the Mediastinal Compartment 338
19.3.1.3 Distant Metastases 339
19.3.1.4 Reoperation 339
19.3.2 Special Therapeutic Considerations
in Familial MTC 340
19.3.2.1 Thyroid Gland 340
19.3.2.2 Lymph Node Metastases 340
19.3.3 Nonsurgical Treatment Modalities 341
19.3.3.1 Octreotide 341
19.3.3.2 Radioactive Iodine 341
19.3.3.3 External Radiation 342
19.3.3.4 Chemotherapy 342
19.3.3.5 Psychological Support 342
References 343
20 Follow up of Medullary Thyroid Cancer 347
T. Schilling and R. Ziegler
20.1 Distinction Between Sporadic and Familial Form
of Medullary Thyroid Cancer 347
20.2 Survival in Patients Suffering from MTC 347
20.3 Sporadic Form of MTC 349
20.3.1 Calcitonin as a Tumor Marker During Follow up 349
20.3.2 Testing the Result of the Primary Operation 349
20.3.3 Follow up in General 351
20.3.4 Follow up in Patients with No Detectable
Calcitonin Postoperatively 351
20.3.5 Follow up in Patients with Detectable
Calcitonin Postoperatively 351
20.3.6 Adjuvant Therapy 352
20.4 Familial Form of MTC (MEN 2) 353
20.4.1 Screening for Pheochromocytoma
and Timing of Surgery 353
20.4.2 Screening for Primary Hyperparathyroidism 354
References 355
Subject Index 357 |
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| index_date | 2024-07-02T17:16:12Z |
| indexdate | 2024-08-01T10:50:21Z |
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| isbn | 9783540278450 |
| language | English |
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| spellingShingle | Thyroid cancer Schilddrüsenkrebs (DE-588)4140890-1 gnd |
| subject_GND | (DE-588)4140890-1 (DE-588)4143413-4 |
| title | Thyroid cancer |
| title_auth | Thyroid cancer |
| title_exact_search | Thyroid cancer |
| title_exact_search_txtP | Thyroid cancer |
| title_full | Thyroid cancer H.-J. Biersack ... (eds.) |
| title_fullStr | Thyroid cancer H.-J. Biersack ... (eds.) |
| title_full_unstemmed | Thyroid cancer H.-J. Biersack ... (eds.) |
| title_short | Thyroid cancer |
| title_sort | thyroid cancer |
| topic | Schilddrüsenkrebs (DE-588)4140890-1 gnd |
| topic_facet | Schilddrüsenkrebs Aufsatzsammlung |
| url | https://doi.org/10.1007/3-540-27845-1 http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=015603684&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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