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It is a cancer treatment that uses to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
1.3b Surgery is the most preferred type of treatment as each other type of treatment has its side effects.Moreover it has the least recurrence results within all of the other treatments.
A study was carried out to determine the long-term impact of medical and surgical treatment of well differentiated papillary and follicular thyroid cancer.
Patients with papillary and follicular cancer (n = 1,355) treated either in U.S. Air Force or Ohio State University hospitals over the past 40 years were prospectively followed by questionnaire or personal examination to determine treatment outcomes.
conclusion: Over the long term, for tumors ≥1.5 cm that are not initially metastatic to distant sites, near-total thyroidectomy followed by 131I plus thyroid hormone therapy confers a distinct outcome advantage. This therapy reduces tumor recurrence and mortality sufficiently to offset the augmented risks incurred by delayed therapy, age ≥40 at the time of diagnosis, and tumors that are much larger than 1.5 cm, multicentric, locally invasive, or regionally metastatic(22)
The study which was done on people surgically treated included a proper tool as it depended on the questionnaire method and also on personal examination. There was no information about the sample chosen.A proper procedure as it included an examination together with the questionnaire which involved vandetanib and placebo.It was carried on1355 patients which is a large number so the results might be reliable..There was no information about the repetition of the study by that center or any other centers.The study did not include a control.
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Figure (8) showing the loss of hair caused by chemotherapy
Figure (7) showing the side effects of chemotherapy
Table (4) showing the side effects of chemotherapy
Source: http://www.avastin.com/patient/crc/side-effects/crc/index.html
2.1)Implications:
Economical implications:
- U.S. Centers for Disease Control and Prevention, 20 percent of cancer patients younger than 65 delay or refuse treatment due to the high associated cost. However, resources are available to patients who need financial assistance.which makes a huge burden on the patient and the government especially if it was a growing country.
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The cost of eight weeks of chemotherapy can range from $100 to $30,000. Treatment with inexpensive drugs like 5-FU or leucovorin costs around $300 dollars for eight weeks. However, to improve therapeutic effect, these drugs are often used in combination with newer drugs which are typically more expensive.
Ethical implications:
An ethical implication in radioiodine therapy is that the staff may be exposed to radiations.Moreover,if certain nerves or muscles were damaged or removed during surgery,the patient may suffer from voice problems or one shoulder shorter than the other,and patients may not be aware about those side effects,thus making this an ethical and social implication.
2.2a)Advantages and disadvantages of treatment:
Advantages of surgery:Although it’s true that some of the side effects from the surgery can be difficult to handle, the prognosis and survival rate for thyroid cancer patients who have undergone the procedure is excellent. The best long-term advantage of thyroid cancer surgery is the gift of life. (21)
Disadvantages of surgery:surgery has some disadvantages as patients are often uncomfortable for the first few days after surgery.Moreover, It is common for patients to feel tired or weak.Also,after surgery to remove the thyroid and nearby tissues or organs, such as the parathyroid glands, patients may need to take medicine (thyroid hormone) or vitamin and mineral supplements (vitamin D and calcium) to replace the lost functions of these organs. In a few cases, certain nerves or muscles may be damaged or removed during surgery. If this happens, the patient may have voice problems or one shoulder may be lower than the other. In spite of the possible side effects, the most important fact to remember is that surgery represents the most effective treatment for thyroid cancer.(9)
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Disadvantagesof radioiodine therapy body will give off radiation for some time after you get RAI therapy. Depending on the dose of radioiodine used and where you are being treated, you may need to stay in a special isolation room.
Short-term side effects of RAI treatment may include:neck tenderness,
nausea and upset stomach,swelling and tenderness of the salivary glands,dry mouth,taste changes,and pain (this is rare)
Chewing gum or sucking on hard candy may help with salivary gland problems.
Radioiodine treatment also reduces tear formation in some people, leading to dry eyes.
Men who receive large total doses because of many treatments with RAI may have lower sperm counts or, rarely, become infertile. Radioactive iodine may also affect a woman's ovaries, and some women may have irregular periods for up to a year after treatment. Many doctors recommend that women avoid becoming pregnant for 6 months to a year after treatment. No ill effects have been noted in the children born of parents who received radioactive iodine in the past.
Both men and women who have had RAI therapy may have a slightly increased risk of developing leukemia in the future. Doctors disagree on exactly how much this risk is increased, but most of the largest studies have found that this is an extremely rare complication. Some research even suggests the risk of leukemia may not be significantly increased.(19)
One major advantage of chemotherapy is the widespread nature of its effectiveness. Chemotherapy drugs act as general toxic agents in the body, targeting rapidly proliferating cells, including cancer cells. Although this widespread action can lead to harmful side effects such as healthy tissue damage during chemotherapy .he general toxic nature of chemotherapy drugs means they can kill cancer cells, regardless of the cells' genetic background. This provides an advantage over more target therapies which may only target cancer cells with a specific genetic mutation; while the targeted therapy may kill only a population of cancer cells, a chemotherapy drug likely has a toxic effect on almost all cancer cells. As a result, patients may respond positively to chemotherapy even after targeted treatments have failed, and may successfully use chemotherapy to fight cancer growth. Whole-Body Treatment
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Another advantage of chemotherapy is whole-body treatment. While some other therapies, such as radiotherapy or cancer surgery, remove cancer in a specific region or tissue of the body, chemotherapy can treat cancer growth in multiple tissues at once. The Eye Cancer Network explains that systemic chemotherapy involves injecting chemotherapy drugs into a patient's veins, allowing the drug to travel throughout the body. Since the entire body becomes exposed to the chemotherapy drug, the drug can kill small colonies of tumor growth in any tissue, allowing doctors to target any cancer cell in the body. As a result, chemotherapy often proves effective in controlling the growth of metastatic cancers, or cancers in which tumors grow in multiple organs.
In some cases, chemotherapy can lend the advantage of pain relief by controlling cancer growth. Many patients with advanced cancer experience significant pain associated with cancer growth, as tumors may press on nerves and lead to chronic pain, while metastatic cancer growth in the lung can decrease lung functioning and make it painful to breathe. Chemotherapy can help doctors partially shrink cancerous growths, easing the pressure on surrounding tissues and improving organ function -- essentially increasing patient quality of life. Chemotherapy for pain relief, called palliative chemotherapy, is often given to patients with incurable cancer, according to the Colon Cancer Resource.(6)
2.3)Alternative solutions:
Chemotherapy has a limited role in the treatment in the treatment of advanced radio-iodine resistant cancers,such as PDTC,MTC,and ATC.Patients with advanced or metastatic thyroid cancer should be considered for clinical trials of new agents such as tyrosine kinase inhibitors,antiangiogenesis agents and growth modulators.(16)
TYROSINE KINASE INHIBITORS
Generally, RTKs are activated through ligand-induced oligomerisation, typically dimerisation, which juxtaposes the cytoplasmic tyrosine kinase domains (21). For most RTKs, this juxtaposition facilitates autophosphorylation in trans of tyrosine residues in the kinase activation loop or juxtamembrane region, inducing conformational changes that serve to stabilise the active state of the kinase (21). These and other phosphotyrosine residues serve as recruitment sites for a host of downstream signalling proteins. TKIs are a group of small molecules that interfere with the interaction between the kinase domain and ATP, thereby inhibiting phosphorylation of the kinase and downstream substrates (8). TKIs used in the treatment of thyroid cancers and the corresponsing
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Table(6) showing studies and their conclusions on Tyrosine kinase as a treatment
Treatment with the multitargeted agent (Caprelsa®) improved in patients with (MTC), according to findings from a . Earlier this year, the Food and Drug Administration (FDA) approved vandetanib for the treatment of patients with MTC based on initial findings from the . MTC is a rare cancer, accounting for only 5 percent of all thyroid cancer cases, and radiation and chemotherapy have limited effects once the cancer progresses to an advanced stage. The trial enrolled 331 patients with MTC who were randomly assigned to receive vandetanib or a placebo. All patients had disease or . If there was evidence that their disease was progressing, patients in the placebo arm could opt to receive vandetanib.
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In addition to the improvement in progression-free survival, the rate was higher and several other disease-related measures were better in the vandetanib arm than in the placebo arm. One of the drug's targets is RET , and the measurable response rate appeared to be higher in patients with RET mutations than in those without mutations. Because so few patients were defined as not having a RET mutation, the response rate in RET mutation-negative patients remains uncertain.(18)
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Bibliography:
- TYROSINE KINASE INHIBITORS IN THE TREATMENT OF THYROID CANCER ,Mehtap Cakir ,Division of Endocrinology and Metabolism, Meram School of Medicine, Selcuk University, Konya, Turkey Concise Review invited by Murat Erdogan; Reviewing Editor: Furio Pacini
8)thyroid.about.com/od/thyroidcancer/a/symptoms.htm
9)
10)Source: http://www.everydayhealth.com/thyroid-cancer/thyroid-cancer-statistics.aspx
11)thyroid.about.com/od/thyroidcancer/a/diagnosis.htm
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14)
15)
16)Surgical oncology,David L Bartlett,pargatheeshwar thirunavurkarasm,Mathew D Neal,2011
17)Thyroid cancer,h-j Biersack,F grUnwald,2005
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21)
22) http://www.ncbi.nlm.nih.gov/pubmed/7977430
3.3)Sources evaluation:
The source
was very credible as it had recent informationas it was last modified 12/16/2011.Morever,it is owned by the NCI(national cancer institute) which are a very good source for information about cancer.Its origin is the United States wjich is a developed country.
Also,the source is credible as it was last modified on 22/07/11.The website is specialized in cancer,so the information found on it is much more credible than the information that Wikipedia may say.The country of origin of website is the United kingdom which is a developed country and this makes that source more credential.
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