131I (131 iodine) is used to treat thyroid cancer, which is a malignant tumor of the thyroid gland. The main clinical manifestation is the growth of thyroid lump in the neck, and sometimes the lump may cause difficulty in breathing and hoarseness due to the pressure of the lump. Except for 15-20% of undifferentiated carcinoma and medullary carcinoma which have higher malignancy, more than 80% of nail cancer is differentiated nail cancer, including papillary carcinoma, follicular carcinoma and mixed papillary-follicular carcinoma, which have lower malignancy, slower development and relatively benign nature.
As long as these patients are detected early and treated regularly, they can achieve good treatment effect and even rarely cause death. Therefore, timely formal treatment in qualified hospitals is the key to overcome the disease.
1.What is the formal treatment of nail cancer?
The formal treatment of differentiated nail cancer consists of three parts, one of which is indispensable.
(1) Surgery to remove the primary lesion and the metastatic lesion that can be removed.
(2) Destruction of residual thyroid tissue and occult metastatic lesions after surgery with radioactive 131 iodine.
(3) Lifelong thyroid hormone replacement therapy to correct hypothyroidism and inhibit the recurrence and growth of tumor.
The necessity of surgical treatment for nail cancer is easily accepted and understood by everyone. However, many patients with nail cancer think that everything is fine once they have undergone surgery, especially when they feel good about their physical condition, which is a very harmful concept. Modern medical science believes that the second step, i.e. radioactive 131 iodine treatment, must be carried out after nail cancer surgery, and surgery alone is not enough because
First: many metastases of nail cancer, especially distant extensive metastases, such as lung and bone, are very difficult to be removed by surgery.
Secondly, in order to avoid damaging the parathyroid glands and the laryngeal nerve, it is impossible to remove all thyroid tissues during surgery, and there are always residual thyroid tissues. In other words, each cell group in the thyroid gland may conceal cancer. According to our experience and overseas data, 62.5~87.0% of postoperative residual thyroid tissues can be seen as cancerous lesions under microscope, and they are the root cause of recurrence and metastasis in the future.
Thirdly, the residual thyroid tissues after surgery often make many proven methods of modern medicine to detect recurrence and metastasis of nail cancer much less sensitive, making it impossible to make early diagnosis and delaying treatment.
Therefore, it is of great clinical significance to remove residual thyroid gland and destroy the metastases that cannot be removed surgically after nail cancer surgery. To achieve this purpose, modern medicine has developed the easiest and most effective method, which is oral radioactive iodine 131. After the residual thyroid tissue is removed after surgery, most of the metastases have the ability to take in radioactive 131 iodine, so after giving oral radioactive 131 iodine to the patient, it reaches the lesion like a biological missile and uses the radioactivity released to destroy the lesion. The radioactive rays are used to destroy the lesion and achieve the treatment purpose.
2. How is 131 iodine treatment performed?
The method is very simple, only one oral dose (or one mouthful of medicine) is needed, and the whole treatment will be finished after a few days of hospitalization and observation.
3.What is the efficacy of 131 iodine treatment after nail cancer surgery?
According to the experience of our hospital, the recurrence rate of nail cancer is as high as 32.0% for surgery alone; 11.0% for surgery + oral thyroid hormone; and only 2.7% for surgery + 131 iodine therapy + oral thyroid hormone. According to overseas data, the mortality rate of patients treated with 131 iodine after surgery is 3.8~5.2 times lower than that of patients treated with surgery alone, and the recurrence rate is 4 times lower. 131 iodine is 75% effective in the treatment of metastatic foci of differentiated nail cancer. So, can the same purpose be achieved with other methods besides 131 iodine? Studies have shown that external irradiation and chemotherapy are not suitable as routine adjuvant treatment after surgery for differentiated nail cancer, but only for patients whose disease progresses rapidly after surgery and cannot be effectively controlled by surgery and 131 iodine.
Therefore, 131 iodine therapy is an essential and important part of the treatment plan for differentiated nail cancer. All patients with differentiated nail cancer, such as papillary carcinoma, follicular carcinoma or mixed carcinoma, should be routinely treated with 131 iodine to remove residual thyroid tissue after surgery, regardless of whether they have conscious symptoms or not, for the long-term benefit; if the metastases have the function of 131 iodine uptake, 131 iodine should also be applied to destroy the metastases.
4.Is there any adverse reaction and complication in 131 iodine treatment for nail cancer?
We say that 131 iodine treatment for thyroid cancer is a kind of biological missile treatment, and the drug only reaches the diseased tissues and has less impact on other organs and tissues of the whole body, so it is a treatment method with less side effects and complications.
In terms of immediate reactions, generally speaking, in the first few days after taking the drug, there may be loss of appetite, poor mental health, dizziness, neck swelling and pain, etc. Most of them are not very serious and will disappear on their own after a few days without special treatment. In terms of long-term reactions, most scholars have not found complications such as leukemia and permanent bone marrow suppression, nor does it affect fertility. Of course, hypothyroidism is bound to occur after treatment, which is the goal of our treatment, and it is not a negative consequence for patients with thyroid cancer. Besides, hypothyroidism can be quickly corrected with thyroid hormone replacement therapy.
5.Why do we need to take thyroid hormone for life, or why must we do the third step of treatment?
As already discussed, after surgery and 131 iodine treatment, patients with nail cancer are bound to have hypothyroidism, which must be corrected by taking thyroid hormone for life; in addition, thyroid hormone can inhibit the recurrence and growth of nail cancer lesions, so even without 131 iodine treatment, taking thyroid hormone is still necessary. Therefore, this is naturally an essential step in the treatment plan.
Finally, it is important to point out that nail cancer is a general term for malignant tumors of the thyroid gland, which includes many categories and their treatment measures vary. Then again, the presence of a mass in the neck may not always be nail cancer. Therefore, it is necessary to make a clear diagnosis first, and then it is necessary to formulate an appropriate treatment plan and choose the right treatment method. All patients with lumps in the neck should go to qualified hospitals in time for early diagnosis and early treatment. 131 iodine treatment for nail cancer is an emerging advanced technology, which generally requires hospitals with advanced equipment and experience to carry out.
6.Cautions for 131 iodine treatment of nail cancer.
(1) 131 iodine treatment is not suitable for breastfeeding and pregnant women.
(2) Iodine-containing drugs, food and thyroid hormone should not be used for 3~4 weeks before treatment.
(3) After discharge from 131 iodine treatment, rest for 2-4 weeks, during which time iodine, iodine-containing foods (mainly seafood) and medications should continue to be prohibited.
(4) Female patients should not be pregnant for 6 months (subsequent pregnancies have no effect).
(5) Review the hospital after 3-6 months of 131 iodine treatment to evaluate the effect of treatment or to decide further treatment measures.
(6) Take thyroid hormone as prescribed by the doctor.