I. Q: What is differentiated nail cancer?
A: Differentiated nail cancer refers to the pathological type of papillary carcinoma, follicular carcinoma and mixed carcinoma of the two.
Q: Under what circumstances does differentiated nail cancer need radioactive iodine treatment?
A: In principle, patients with lesions larger than 4 cm in diameter or those with cancer cells invading the envelope or blood vessels or with lymph node metastasis or distant metastasis in the neck are in need of radioactive iodine treatment.
Q: What are the benefits of postoperative radioactive iodine therapy for differentiated nail cancer?
A: The recurrence rate of surgery alone is about 33%, and the recurrence rate of surgery plus thyroxine replacement therapy is also about 15%, while the recurrence rate of surgery plus radioiodine therapy is less than 3%. Therefore, postoperative radioactive iodine therapy can significantly reduce the recurrence rate of differentiated nail cancer.
Q: Can differentiated nail cancer without surgery be treated with radioactive iodine directly?
A: No, it cannot. Because the primary foci of nail cancer itself do not take iodine, radioactive iodine can only work if the primary foci are completely removed and the normal thyroid tissue and metastases visible to the naked eye are removed as much as possible.
V. Q: What is the mechanism of radioactive iodine treatment for metastases of differentiated nail cancer?
A: Since more than 90% of metastases of differentiated nail cancer ingest iodine, radioactive iodine can be like a refined missile, which can find cancer cells very accurately and kill them, and can achieve the effect of carpet removal.
Q: After my surgery, the doctor said my lesion has been cut very cleanly, do I still need to do radioactive iodine treatment?
A: It should be said that it is impossible for a highly skilled surgeon to cut out all the lesions because some of them are so small that they cannot be seen by the naked eye, not even by CT. These invisible lesions are the source of future recurrence. Therefore, treatment with radioactive iodine is very necessary.
Q: A friend of mine has had surgery for differentiated nail cancer for 20 years and is still doing well, so it seems that it does not matter even without radioactive iodine treatment? A: Differentiated nail cancer is a kind of low-grade malignant cancer, which is one of the few malignant tumors that can be cured by human beings. However, 33% of patients can still recur after surgery, and the recurrence time is mostly 5-10 years or even 15 years after surgery. At this time, both patients and doctors lose their alertness, and once the recurrence is often in advanced stage, it is more difficult to treat. If we use radioactive iodine treatment to reduce the recurrence rate to less than 3%, won’t there be more people like your friend who will not recur for a long time!
Q: I heard that after treatment with radioactive iodine, the thyroid gland is gone and I need to take thyroxine tablets for life, is that right? A: Yes. But I have to say, in view of the consequences of recurrence of thyroid cancer, taking thyroxine tablets for the rest of your life is really a trivial matter.
Q: After my surgery, my doctor said that I should take thyroxine tablets for a while, and then I don’t need to take them after my thyroid gland grows up after surgery?
A: On the surface, this can kill three birds with one stone, and the patient is very happy after hearing this, but in fact this is irresponsible and wishful thinking. Because nail cancer is multicentric, that is to say, multiple lesions can exist on one lobe of thyroid gland and they can be in different periods. Just like people, there are old and young. In other words, there are large and small lesions, and small lesions may not be visible to the naked eye. If the thyroid gland is not completely removed during surgery, small lesions may be left behind and become a source of recurrence in the future. Since the thyroid gland is completely removed, can it still grow up?
Q: Some doctors say that my thyroid cancer has metastasized to the lymph nodes in the neck and is at an advanced stage, so it is quite good to live for 5-10 years.
A: If liver cancer or lung cancer has distant metastasis, it is not easy to live beyond 5-10 years. However, even if nail cancer has distant metastasis, if treated properly, there are many people who can survive for life, not to mention 10 years. It must be remembered that differentiated nail cancer is a completely curable malignant tumor. The key is to add radioactive iodine treatment after surgery.
Q: My papillary nail cancer has recurred five years after surgery, and I have lymph nodes in the neck and lung metastasis. Can I still be cured?
A: The regular treatment should be surgery to remove the residual thyroid gland and neck metastases as much as possible, followed by radiation iodine treatment. Never use local radiotherapy and chemotherapy first, which will delay your treatment. This is because local radiotherapy and chemotherapy are not sensitive to differentiated type of nail cancer. If the lesions in the lung are not too big or too small, it is possible to be cured. At present, the only effective way to treat differentiated nail cancer with systemic metastases is surgery plus radioiodine therapy.
Q: My daughter is 12 years old and has papillary nail cancer with lung and neck lymph node metastases. She has already undergone radical nail cancer surgery.
A: There is no evidence that the therapeutic amount of radioactive iodine will affect the growth and future fertility of the child. However, for your daughter, the more important issue should not be fertility, but survival. Surgery plus radioactive iodine treatment is likely to cure her disease and is her only treatment.