Radio-nuclide


Radio-Iodine

What is Radioiodine and how does it work

The thyroid gland absorbs nearly all of the iodine in your blood. When a large enough dose of radioactive iodine is taken into the body, it can destroy the thyroid gland and any other thyroid cells (including cancer cells) that take up iodine, with little effect on the rest of your body.

[Source: American Cancer Society]

Precautions for Radioiodine Treatments

Some precautions are necessary because of the small amount of radiation that emanates from the neck where the radioiodine therapy is stored for a few days after treatment. While this radiation is beneficial for the person being treated, precautions are needed to reduce the radiation families and friends are exposed to.

  1. Avoid prolonged contact with others, especially children and pregnant women. In general, a distance of one arm's length should be maintained between the person treated and others who spend more than two hours next to the patient in any 24 hour period. This applies especially to children and pregnant women. While brief contact with a person after treatment is acceptable, sleeping together, watching television, going to movies, long care or plane trips should be avoided for approximately 11 days after the treatment. Sharing food and utensils, including glasses, bottles, cans of soda, water, beer, etc., should also be avoided. For example, when the treated person is eating an ice cream cone, it should not be licked by anyone else. Dishes and eating utensils should be rinsed before being put with those of the rest of the family. Paper plates and plastic utensils should only be used if they are immediately disposed of outside the home. Cooking is fine, as long as the utensil used to taste the food while cooking is not re-used before rinsing.
  2. Drink lots of liquids, void often, and flush twice. The treated person should drinks lots of liquids, especially water, to help remove the radioiodine therapy from the system, flush the toilet twice after using it, and be sure to thoroughly clean up any spilled urine. Laundry need not be washed separately unless the treated person has sweated heavily, such as after exercise.
  3. No pregnancy or breast-feeding. It is extremely important that women who are breast-feeding stop before the radioiodine therapy is given, since iodine is concentrated and excreted in breast milk. Pregnant women should not be treated with radioiodine therapy, and pregnancy should be avoided for six months following treatment.

[Source: Diabetes and Hormone Center of the Pacific, Hawaii]

 

TACE (Transarterial Chemoembolisation)

What is TACE and how does it work

TACE refers to TransArterial ChemoEmbolization where a chemotherapeutic agent is injected directly into the arteries that supply blood to the liver's tumor. According to American Association for the Study of Liver Disease (AASLD), TACE is recommended as first line non-curative therapy for non-surgical patients with large and multifocal hepatocellular carcinoma who do not have vascular invasion or extra hepatic spread.

The normal liver gets its blood supply from two sources; the portal vein (about 70%) & hepatic artery (30%). Primary liver cancer, also known as hepatoma or hepatocellular carcinoma (HCC) gets its blood exclusively from the hepatic artery.

By applying the knowledge of the blood supply of liver cancer, TACE's procedure involves intra-arterial infusion of chemotherapy, with an additional step of blocking (embolizing) the small blood vessels with different types of compounds, such as, gelfoam.

TACE has the advantage of exposing the tumor to higher concentrations of chemotherapy and confining the agents locally so that they are not carried away to other parts of the body through the blood stream. Hence, patient can avoids side effect of usual chemotherapy treatment like reduce blood count, depress immune system, nausea, vomiting and hair drop. The creative procedure kill cancer cell optimally and minimize the side effects of the chemotherapy treatment.

On the other hand, the procedure also associated with mild local regional side effects in more than 50% of the patients as it obstructs the hepatic artery. The side effects include fever, mild abdominal pain and distension because of extensive tumor cell necrosis.

Indications of TACE

[Source: Al. D. Rodriguez Liver Foundation, http://www.aldrodriguezliverfoundation.com/transarterial-chemoembolization-tace-for-liver-cancer/ ]

  • Recommended by According to American Association for the Study of Liver Disease (AASLD) as first line non-curative therapy for non-surgical patients with large and multifocal hepatocellular carcinoma who do not have vascular invasion or extra-hepatic spread.
  • Used in conjunction with other cancer treatments including tumor ablation. This treatment strategy works when TACE reduce the size of tumor and facilitate the killing of tumor cell more effectively using targeted ablative measure in order to reduce the damage of surrounding tissue.
  • As bridging and down staging procedure before liver transplantation for localized liver cancer.
  • Liver dominant metastatic disease from colon, breast, carcinoid, islet cell tumours of the pancreases, ocular melanoma and sarcoma.