Medullary thyroid cancers

Fluorinated dihydroxyphenylalanine p F]DOPA is a precursor for the neurotransmitter dopamine and is commonly used in the imaging of Parkinson s disease. In oncological imaging [ F]DOPA has been assessed for imaging of brain tumors, advanced neuroendocrine tumors and medullary thyroid cancer [215],... 

Depsipeptide I Radioiodine-refractory non-medullary thyroid cancer NCI... 

Peltier, P. Curtet, C. Chatal, J.-F. Radioimmunodetection of medullary thyroid cancer using a bispecific anti-CEA/ Anti-insium-DTPA antibody and an indium-111 labeled DTPA-dimer. J. Nucl. Med. 1993, 34, 161- 113. 

BEHR, T.M., BEHE, M., Cholecystokinin-B/gastrin receptor-targeting peptides for staging and therapy of medullary thyroid cancer and other cholecystokinin-B receptor-expressing malignancies, Semin. Nucl. Med. 32 (2002) 97-109. 

NCI (2008d). Genetics of Medullary Thyroid Cancer. National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD. Available at http //www.cancer. gov/cancertopics/pdq/genetics/medullarythyroid/healthprofessional/. Accessed January 19, 2009. 

Kambouris M, Jackson CE, Eeldman GL. Diagnosis of multiple endocrine neoplasia [MEN] 2A, 2B and familial medullary thyroid cancer [FMTG] by multiplex PCR and heteroduplex analyses of RET proto-oncogene mutations. Hum Mutat. 1996 8 64-70. 

SCLC small cell limg carcinoma, MTC medullary thyroid cancer... 

REGULATION OF SECRETION Calcitonin secretion increases with hypercalcemia and decreases when plasma Ca " is low the hormone in circulation has a t of 10 minutes. Circulating concentrations are normally low (<15 pg/mL in males and 10 pg/mL in females) but can be markedly elevated with C cell hyperplasia or medullary thyroid cancer. 

Serum thyroid-stimulating hormone (TSH) and thyroid hormone levels should be measured in any patient with a goiter to determine the hormonal status. TSH concentrations increase with age, but the levels remain within the normal range in the healthy population throughout life up to 100 years of age (Canaris et al., 2000 Mariotti et al, 1995). See Chapter 106 by Diez and Iglesias on Hypothyroidism in the Middle Aged and Elderly Clinical Aspects for details of thyroid hormone changes in the elderly. Serum calcitonin levels are not needed unless there is a family history of medullary thyroid cancer or multiple endocrine neoplasia (MEN) type 2. 

Diehl M, Risse JH, Brandt-Mainz K etal. (2001) Fluorine-18 fluorodeoxyglucose positron emission tomography in medullary thyroid cancer results of a multicentre study. Eur J Nucl Med 28 1671-1676... 

Neuroendocrine tumors are metastatic and treatable with RFA. Liver metastases from neuroendocrine tumors often produce severe clinical symptoms caused by excessive hormone production and release. Only a minority of these patients with neuroendocrine liver metastases are curable by surgical resection. However, a significant relief of symptoms can be obtained by "debulking, which includes resection, resection combined with RFA or RFA alone. There is one publication reporting on 18 patients with more than 100 neuroendocrine tumors (carcinoid, islet cell, or medullary thyroid cancers) treated with RFA (Siperstein and Berber 2001). Unfortunately, the exact number of patients was not indicated. However, the authors reported that most patients had significant improvement in symptoms related to reduced hormone release after RFA (Siperstein and Berber 2001). However, the major drawback is that there are no prospective randomized trials so far, comparing local ablation with hepatic resection or with chemotherapy alone and there are no randomized studies comparing the outcome of patients after different ablative methods. 

Monitoring Therapy A high-dose calcium test may be used as a potent biomarker for the diagnosis and follow-up of medullary thyroid cancer (MTC), since it is well tolerated and is cost effective compared to the pentagastrin test. A recent study identified that the best levels of basal calcitonin (bCT) to distinguish normal and C-cell hyperplasia (CCH) cases, from MTC patients were above 18.7pg/ml in females and above 68pg/ml in males while calcium-stimulated calcitonin levels above 184 pg/ml in females and above 1620pg/ml in males were most accurate to separate normal and CCH cases from patients with MTC [74 ]. 

Colombo C, Verga U, Mian C, Ferrero S, Perrino M, Vicentini L, et al. Comparison of calcium and p>entagastrin tests for the diagnosis and foUow-up of medullary thyroid cancer. J Clin Endocrinol Metab 2012 97(3) 905-13. 

Soler, M.N., Bobe, R, Benflioud, K., Lemaire, G., Roos, B.A., and Lausson, S. (2000). Gene therapy of rat medullary thyroid cancer by naked nitric oxide synthase II DNA injection. J. Gene Med. 2(5), 344-352. 

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