Does thyroid cancer affect immigrants?

A 'e, a 68-year-old mother-in-law, is a stage IV lung cancer patient. She has received targeted drug therapy from Aretha before and has been following up the medication in Dr. Huang's clinic. Her condition remains stable.

But in recent weeks, A E's mother-in-law has always complained to her daughter that her waist hurts more and more, and sometimes she wakes up in the middle of the night. Aunt's mother-in-law said that most of them are dull pain, and occasionally they hurt.

It hurts more at night than during the day. When you lie down and rest, it seems that your back will be more comfortable, but changing your posture will be particularly painful.

After hearing this, Dr. Huang quickly arranged a "nuclear medicine whole body bone scan" for her mother-in-law.

"Mother-in-law, the bones on this side of the waist look a bit strange in the photo. I'll transfer you to the radiation oncology department, and ask the doctor to evaluate you. Do you need some treatment? " Dr. Liu pointed to the black spots on the film and whispered to her mother-in-law.

"Oh ... good." Mother-in-law A E answered and took her daughter "Sunny" to my clinic.

"Hello, Dr. Chen, we meet again." Sunny said softly.

I just looked up at the medical record and exchanged eyes with the truth. She gently sipped the sadness at the corners of her mouth.

I turned to look at Aoe's mother-in-law, and the mouse clicked on the bone scan image. The screen shows that there are two obvious black spots on the left side of the third and fourth lumbar vertebrae.

"Good mother-in-law, what's wrong with you recently? Aunt's mother-in-law once came to Cory for radiotherapy because of lung tumor, and she is familiar with the environment here.

"Here ... here will hurt! It hurts especially at night! Also, the left foot will be slightly numb, and sometimes it hurts all the time from the waist down ... "AOE's mother-in-law said holding her left lower back.

"Can you lift your left foot? 」

Aoe's mother-in-law quickly moved her feet. "It should be ok, just a little tight ... but I think my left foot is weak, and sometimes it will be a little soft when I stand for a long time. 」

Aoe's mother-in-law can bend and straighten her feet smoothly. I asked Aoe's mother-in-law to bend her feet and try to straighten her feet to push my palm against her soles.

"Is that right? Although my mother-in-law is not as strong as ordinary adults, she can still push my hand away, but at a slower speed.

"Mother-in-law, we will arrange a physical examination for you. After the examination, I'll do some X-ray treatment for you to relieve your pain, okay? 」

"It's okay, doctor, just help me arrange it, as long as it's painless, it's okay ...! 」

I blinked at Zhenqing. She squatted down slowly and said softly to Aoe's mother-in-law, "Mom, sit outside first, and the doctor will tell me what to do. 」

A E's mother-in-law always listens to "nothing", squinting and holding her hand, nodding. "Good good, I went to rest. 」

Wait until moths mother-in-law out of the clinic, by fine light with a sigh, turned and pulled open a chair and sat down.

"At present, the preliminary examination shows that the nerves should not be too seriously oppressed. If the MRI examination shows that there is no obvious nerve compression, we will help my mother to do treatment as soon as possible. 」

"Now, radiation therapy is not my mother's main treatment. When the tumor has progressed to metastasis, it usually means that the cancer cells have not stayed in place and will spread outward along the blood circulation; Therefore, the main axis of bone metastasis treatment will be systemic treatment. The main purpose of radiotherapy is to help mother relieve local pain. If the pain can be relieved, in addition to improving the quality of life, the dosage of mother's painkillers can also be reduced, which can alleviate the discomfort caused by some drugs. I went on to say.

"Well ... all right." The answer was short, and the delicate face was full of worries.

"Don't worry, when the test results come out, we'll discuss the follow-up countermeasures with you. Generally, radiotherapy has a good analgesic effect, and my mother's pain should have a chance to get better. I will talk to you later about what problems may be encountered in radiotherapy for bone metastases. 」

Bone metastasis is a common problem for patients with advanced cancer. Although bone metastasis itself is rarely fatal, the pain, compression fracture and hypercalcemia associated with bone metastasis will obviously affect the quality of life and activity of patients.

When the mobility is affected, the patient's physical strength will deteriorate, and even stay in bed for a long time, unable to walk. It also increases the difficulty of follow-up treatment. Therefore, if bone metastasis can be properly treated, related complications can be reduced and the quality of life of patients can be improved.

Next, let's take a look at ten things you should know about bone metastasis radiotherapy.

Q 1: What exactly is bone metastasis?

When cancer cells enter the advanced stage of the disease, many mutations will occur in the genes in the cells. After mutation, some cancer cells will "migrate" from their original positions to the bones of the whole body, and then grow into another tumor in the bones, thus destroying the condition of the bones. We call it "bone metastasis".

Bone is the "third" common site of distant metastasis of cancer, and the first two are lung and liver respectively.

Bone metastasis may occur in all cancers, but breast cancer, prostate cancer and lung cancer account for about 70-80% of all patients with bone metastasis. ?

Bone metastasis can also occur in all bones of the whole body, but most of the metastatic sites are concentrated in the spine (cervical vertebrae, thoracic vertebrae, lumbar vertebrae), ribs and pelvis. Femoral and upper arm bones are also prone to bone metastasis.

Generally speaking, bone metastasis rarely occurs below the elbow joint and knee joint.

Q2: Why does bone metastasis occur?

Rich blood flow: the metastasis of cancer cells often occurs in places with "rich and slow blood flow", such as brain, lung, liver and bone. If you have ever handled chicken bones or pig bones in the kitchen, you should find that there is often a lot of blood among the broken bones. Bone marrow in bone is responsible for hematopoietic function in vivo, especially "red bone marrow", so the blood flow in bone is amazing.

Cancer cells like bones: This concept can be understood by the concept of "immigration". For example, the United States is so big, but the immigrant population in Asia is mostly concentrated in the big cities on the east and west coasts. Why? Because for Asians, living in the "environment" of big cities on both sides of the east and west can make them enjoy a more comfortable life.

For cancer cells, rich blood flow and vigorous growth factors in bones will also make cancer cells feel more comfortable. Therefore, when cancer cells flow through bone marrow with blood, they may combine with cells in bone and stay in bone.

Vicious cycle: bones are rich in growth factors. When the tumor activates osteoclasts and decomposes bones, it will activate these growth factors that originally existed in bones, further making the tumor bigger and destroying bones.

Q3: Which tumors are prone to bone metastasis?

Breast cancer, prostate cancer, thyroid cancer, lung cancer and renal cell cancer. Patients with these cancers are more likely to metastasize to bones.

Head and neck cancer, as well as gastrointestinal malignant tumors, such as gastric cancer, colorectal cancer, rectal cancer and so on. With relatively few bone metastases.

Q4: Does bone metastasis mean that my condition is serious?

Usually, if bone metastasis or other distant metastasis occurs, it means that tumor cells have spread outward along the blood route, and it is really not easy to cure in theory.

However, the survival time of different cancers varies greatly. It depends on what cancer the patient has and whether there is distant metastasis in other parts of the body, such as lung, brain and liver. Even if it is the same cancer, the survival time of each patient is very different. For example:

Lung cancer: After metastasis to bone, the median survival time is about 6-8 months.

Breast cancer: The median survival time after bone metastasis is 20 months.

Prostate cancer: The median survival time after bone metastasis is 53 months.

Q5: Why do bone metastases eat bones?

In fact, what really erodes bones is often not cancer cells themselves. In human bones, there are two kinds of special cells: one is called osteoclast and the other is called osteoblast.

From the name of a cell, we can know its function. The function of osteoclasts is to decompose bones, while the function of osteoblasts is to form bones.

In normal human bones, the activities of these two kinds of cells are in a state of balance. Therefore, although our bones have no obvious changes in appearance, they are actually in "dynamic balance".

In other words, the bones decomposed every day are almost the same as the newly generated bones, so the bones remain in balance.

However, when the tumor migrates to the bone, it will act as a cheerleader for osteoclasts, which will lead to the destruction of this ingenious balance, and the activity of osteoclasts will become stronger, while the activity of osteoblasts will be relatively weak, and bones will become less and less.

When the tumor grows, it will also destroy the structure of bones, thus reducing normal bones and causing the consequences of bone erosion. However, the main effect of bone metastasis is that the tumor makes the activity of "bone-eating cells" stronger, not the tumor itself.

Q6: What happened to me when I had bone metastasis?

Local pain: The most common symptoms of bone metastasis are pain near the "metastatic site" and pain, numbness or limb weakness caused by tumor compression or nerve invasion.

In any cancer patient, if there is "new" pain, or "persistent" or "enhanced" pain, we should be highly vigilant.

Because the structure of the bone is destroyed, the proliferating tumor will cause local inflammatory reaction and periosteum, thus causing pain. Metastatic tumors are mostly located in the "axial bone" of the body, that is, the long bones of the spine, coccyx, pelvis, thighs and arms.

Because the axial bone needs to bear the weight of the body, when the structure is damaged, the spine will become unstable, and the spine will collapse or the long bone will break because it cannot bear the weight of the body. This kind of fracture caused by tumor bone metastasis is called pathological fracture.

When the spine collapses, the nerves passing between the two vertebrae are compressed, which will also cause pain. These pains may be aggravated by activities; And it usually hurts more at night than during the day.

If the structural integrity of bone has been destroyed by bone metastasis, the damaged structure must be reset by surgery to effectively relieve pain.

Therefore, in addition to radiotherapy, the treatment of bone metastasis also needs specialists in orthopedics and neurosurgery to do better treatment.

Spinal cord compression or nerve compression: Spinal cord nerves extend down from cerebellum to waist, and there are countless nerve cells inside, which are wrapped in the bones of the spine.

If the metastatic tumor of spinal bone grows late and invades and further compresses the spinal nerve, the patient may have symptoms such as limb weakness, paralysis, paresthesia, numbness, abnormal defecation or incontinence, and may need emergency surgery.

Affect the hematopoietic function of bone marrow: Because tumors occupy part of the space of bone marrow, when the number of bone metastases is large, especially when the bone metastases are located in the lumbar spine or pelvis, it may affect the hematopoietic function of patients, leading to anemia, leukopenia or thrombocytopenia.

Hypercalcemia: Some tumors will obviously increase the decomposition of bone and release calcium ions into the blood. However, the symptoms of hypercalcemia are usually not obvious, which is quite similar to the discomfort of cancer patients, so it is difficult to distinguish them. You can know by taking blood and checking calcium ions in the blood. When hypercalcemia occurs, possible symptoms include fatigue, headache, weakness, disturbance of consciousness, arrhythmia, nausea, vomiting, constipation, abdominal pain, polyuria, thirst and dehydration.

Q7: How can radiotherapy for bone metastases help me? Did the pain stop immediately after the photo was taken?

Radiotherapy for bone metastases has three main therapeutic purposes:

1. Relieve pain

2. Maintain the patient's motor function and independent action.

3. Reduce the follow-up complications caused by fracture or nerve compression.

The main mechanism of radiotherapy to relieve pain is not to completely eliminate all tumor cells, but to restore the damaged balance between osteoclasts and osteoblasts to a normal state through radiation.

After radiotherapy, about 65-80% patients' pain can be partially or completely improved. Among them, about 20% patients can completely improve the pain.

After irradiation, the pain usually does not improve "immediately", but it will gradually see the effect within 2-3 weeks; About 40% patients can feel pain relief within 10 days.

If the pain does not improve significantly one month after the first course of treatment; After the doctor's evaluation, you can also consider the second course of radiotherapy within the "safe range". About 30% of patients have the opportunity to get further relief.

Question 8: How long does a course of treatment take?

The most common irradiation method is once a day (Monday to Friday), * * * is 10- 14 times, and the common total dose is 30-35 Gy.

For some patients with poor physical strength or short life expectancy, we can also consider shortening the total number of treatments to 1 time (8 Gy) or 5 times (total dose of 20 Gy).

The analgesic effect of each different method is similar, between 60-80%. If you choose a single treatment, the probability of needing radiotherapy for the same site in the future will increase slightly, about 20%. Please consult your attending physician for details.

Q 9: How will I feel after receiving radiotherapy for bone metastases?

Fatigue: If the patient has multiple bone metastases, resulting in extensive radiation, the feeling of fatigue will be more obvious.

Temporary aggravation of pain: In about 30-40% of patients, the pain will attack first in the first few days of treatment and last for about 1-2 days.

When radiation irradiates a tumor, it will first cause a temporary inflammatory reaction, which will cause local swelling of nerves near the irradiated site and make the pain temporarily aggravated. This situation can be prevented or alleviated by oral steroid drugs.

Symptoms depend on the irradiation site:

Cervical vertebra: if the bone metastasis is located in the cervical vertebra, because the right front part of the cervical vertebra is the throat and esophagus, the treatment will cause inflammation of the throat and esophagus. Therefore, when the course of treatment is about 6-8 times, patients will have slight hoarseness, foreign body sensation when swallowing, and may also have symptoms of swallowing pain. But these symptoms usually gradually improve within two weeks.

Thoracic vertebra: If the bone metastasis is located in the thoracic vertebra, the treatment will cause inflammation of esophagus, lung and pericardium because the esophagus, lung and heart are all in front.

? Esophageal inflammation: the common symptom is foreign body sensation or pain when swallowing, and most patients will recover within 2-3 weeks.

? Pulmonary inflammation: Because the total therapeutic dose is only about 30-35 Gy, although slight inflammation may appear in the lungs, such as dry cough, fatigue or slight fever, after 1-2 months of irradiation, it usually gradually relieves itself within 2-3 weeks.

? Pericarditis: A few patients will have dyspnea, chest tightness or respiratory pain, but because the total dose is not high, even if there are symptoms, they will generally get better within 2-3 weeks.

Lumbar spine and pelvis: The organs and intestines in the abdominal cavity are in front of the lumbar spine, so the organs and intestines will receive some doses during irradiation. Because the total dose of treatment is only 30 Gy, radiotherapy for bone metastasis rarely affects bladder, liver and kidney.

More common, it is mild gastrointestinal inflammation. Therefore, patients may have symptoms similar to gastroenteritis, such as mild abdominal cramps, increased defecation times (but the probability of watery diarrhea is not high), mild nausea and vomiting.

The appetite may also get worse, but it will generally be relieved within 1-2 weeks after the treatment is completed. If the symptoms of nausea and vomiting are obvious, you can ask the doctor to prescribe medicine to relieve the symptoms.

Limbs and joints: the tissue near the irradiated site can feel slight swelling and tightness; There may be slight edema at the ends of hands and feet, but usually no treatment or treatment is needed.

Skin: After the second week of treatment or 1-2 weeks, the irradiated skin will show symptoms of dryness, itching, blackening and slight peeling. Hair near the irradiated area will fall off.

Sudden spinal nerve compression: rare. This situation mostly occurs in patients with severe compression of spinal nerves and physical inability or unsuitability for surgery.

Because most tumors will not become smaller immediately after receiving radiotherapy, there will be inflammatory reaction and local swelling first; When the spine has been seriously damaged by bone metastasis and severely compressed to the spinal nerves, slight swelling caused by radiotherapy may aggravate the compression and aggravate the neurological symptoms.

However, in this case, radiotherapy is actually no choice. Although there are risks, there are still opportunities for improvement if you receive treatment. If you are too worried about the risk and afraid of receiving treatment, the tumor will continue to grow, and the spinal nerve will still escape the fate of oppression.

But in general, because the total dose of radiotherapy for bone metastases is not high, the side effects caused by radiotherapy are mostly light and last for a short time. If radiotherapy is combined with chemotherapy or targeted therapy, the severity of side effects may increase slightly.

Q 10: What other treatments can I receive?

medicine

? Analgesics: In addition to radiotherapy, drugs can also be added to treat patients' pain. At first, common oral analgesic and anti-inflammatory drugs will be used. If the response to traditional anti-inflammatory drugs is not good, doctors will prescribe weak morphine drugs. If the pain intensity increases again, the doctor will replace the weaker morphine drugs with powerful morphine drugs or painkillers.

? Steroids: Oral or intravenous. Steroids have repercussive, antiemetic and anti-inflammatory effects.

? Bisphosphonate: After injection, about 50-75% of these drugs will adhere to the bone surface after intravenous injection. Bone-eating cells also eat bisphosphonates when they break down bones. For "bone-eating cells", bisphosphonates are like deadly wine, so bone-eating cells will die and decompose. This can reduce the damage of osteoclasts to bones.

? Denosumab: the trade name is "Prolia" or "Xgeva", which is used to bind "RANKL" and prevent RANKL from combining with osteoclasts. RANKL is like a nutrient for osteoclasts. After injection of Denosumab, osteoclasts can not differentiate well and become mature osteoclasts, which will lead to a decrease in the number of osteoclasts and naturally reduce the damage to bones.

Surgical therapy

When the patient's tumor causes spinal instability, compression of spinal nerves, or serious damage to load-bearing bones (such as spine or lower limb bones), and pathological fractures have occurred (or are about to occur), surgery can be considered.

Surgery can quickly relieve the pain, relieve the symptoms of oppression immediately and quickly, and also accelerate the recovery of patients. If it is evaluated by a neurosurgeon or an orthopedic surgeon, surgical treatment can be considered.

After general surgical treatment, radiotherapy will be added to the surgical site.

Vertebroplasty or kyphoplasty.

Under the guidance of image, low-temperature bone cement was injected into the spinal column of compression fracture through hollow needle tube to relieve pain and stabilize the spinal column.

The difference between them is that kyphoplasty is to support the gap with water ball first, and then inject bone cement; Vertebroplasty is direct injection of bone cement.

Bone cement will harden rapidly within 0/5-20 minutes after injection, which can fuse bone fragments, reduce sliding and relieve pain. Radiologists need to evaluate whether it is suitable for surgery.

Systemic anticancer therapy

Including chemotherapy, targeted therapy, anti-hormone therapy and immunotherapy. If it is effective for tumors, it can also achieve the effect of relieving pain. However, the pain relief rate of systemic anticancer therapy is usually slow.