What's New With Thyroid Cancer
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[edit] What's New With Thyroid Cancer
Here are a few recent papers that might give a sense, in which direction things are moving.
1. Fine needle aspirates are the way most thyroid cancers are diagnosed. In Ref. 3 the authors describe how they used an oncogene tumor marker for papillary thyroid carcinoma, which is the most common thyroid cancer, to diagnose the thyroid cancer on miniscule sample sizes with 100% accuracy.
It seems that gene derived technology is yet another means to improve diagnostic accuracy.
2. The PET scanner can be a valuable tool to diagnose metastatic thyroid cancer, where the primary tumor is unknown. Using a fluoridized glucose compound all the thyroid cancer cells including the primary tumor light up on this PET scan test. Treatment can then be directed at the cancer site wherever it was located.
3. Many thyroid cancers were found in Ref. 5 to have a dysregulation of the "wild-type" P53 gene. This is associated with an increase in two proteins that are transcribed by the p53 gene, "BAX" protein and "p21" protein.
These proteins can be investigated by immunohistochemistry, which is what these authors did. To their surprise they found that many benign thyroid tumors (goiters and adenomas) had a high value of these proteins, but also many thyroid cancers with a good prognosis (follicular and papillary thryoid cancers). In an earlier paper the same group had shown that patients with liver metastases from colon cancer had a poor survival, if the BAX protein, investigated with immunohistochemistry, was low or absent (Ref. 6). The authors think that tests of these proteins with immunochemistry methods might be able to predict, which patients have a better long-term survival.
4. The anaplastic thyroid cancer, which has a 10-year survival of 0% , has been shown in tissue cultures to respond to two new metabolic inhibitors (Ref. 7).They belong into the group of "histone deacetylase inhibitors" (never mind the name, if this sounds foreign to you). The two agents that tested well in this category were: sodium butyrate and trichostatin A. The authors of this study describe how these agents stop the cell division of this very malignant thryoid cancer cell line in tissue culture. We likely will see several clinical trials soon to check out how these medications can help patients with this type of cancer survive much longer.
5. Another cell growth inhibitor, which works on another enzyme, was shown to have a powerful effect on stunting growth of human papillary thyroid cancer in tissue culture and in mice (Ref. 8). One of the medications is the existing troglitazone (brand name: Prelay), which is already used for other cancers. There will be several other medications that are being tested already now, which will be added to the treatment list of the clinician.
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References:
1. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Thyroid tumors.
2. Cancer: Principles &Practice of Oncology, 4th edition, by V.T. De Vita,Jr., et. al J.B. Lippincott Co.,Philadelphia, 1993. Thyroid tumors.
3. CC Cheung et al. J Clin Endocrinol Metab 2001 May;86(5):2187-2190.
4. F Dede et al. Clin Nucl Med 2001 May;26(5):396-399.
5. S Hermann et al. Int J Cancer 2001 Jun 15;92(6):805-811.
6. I Sturm et al. J Clin Oncol 1999 May;17(5):1364-1374.
7. VL Greenberg et al. Thyroid 2001 Apr;11(4):315-325.
8. K Ohta et al. J Clin Endocrinol Metab 2001May;86(5):2170-2177.
9. Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
10. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc
