Radiation exposure and thyroid cancer: a review

ABSTRACT The association between radiation exposure and the occurrence of thyroid cancer has been well documented, and the two main risk factors for the development of a thyroid cancer are the radiation dose delivered to the thyroid gland and the age at exposure. The risk increases after exposure to a mean dose of more than 0.05-0.1 Gy (50-100mGy). The risk is more important during childhood and decreases with increased age at exposure, being low in adults. After exposure, the minimum latency period before the appearance of thyroid cancers is 5 to 10 years. Papillary carcinoma (PTC) is the most frequent form of thyroid carcinoma diagnosed after radiation exposure, with a higher prevalence of the solid subtype in young children with a short latency period and of the classical subtype in cases with a longer latency period after exposure. Molecular alterations, including intra-chromosomal rearrangements, are frequently found. Among them, RET/PTC rearrangements are the most frequent. Current research is directed on the mechanism of genetic alterations induced by radiation and on a molecular signature that can identify the origin of thyroid carcinoma after a known or suspected exposure to radiation.

Angiosarcoma in previously irradiated breast in patient with Li-Fraumeni syndrome. A case report / Angiossarcoma em mama previamente irradiada em paciente portadora da síndrome de Li-Fraumeni. Um relato de caso

CONTEXT: Li-Fraumeni syndrome is a rare disease with an autosomal dominant inheritance pattern and high penetrance that defines a 50% chance of developing cancer before the age of 30 years, including cases of breast sarcoma. Patients with this syndrome who require radiotherapy have an increased risk of developing secondary malignancies including angiosarcomas. CASE REPORT: This was a case report on a female patient with Li-Fraumeni syndrome. In October 2005, she was diagnosed with invasive ductal carcinoma of the right breast and underwent sectorectomy. She then received chemotherapy and adjuvant radiotherapy. Trastuzumab and tamoxifen were also part of the treatment. She recently sought care at our hospital, complaining of hyperemia and nodulation in the right breast, and underwent surgical resection that revealed epithelioid angiosarcoma. CONCLUSIONS: When genetic predisposition due to Li-Fraumeni syndrome is documented, the therapy should be adapted so as to minimize the risk. Thus, conservative surgical treatments should be avoided and mastectomy without radiation should be prioritized. In cases in which use of radiotherapy is justified, patients should be followed up intensively. .

CONTEXTO: A síndrome de Li-Fraumeni é doença rara que apresenta padrão de herança autossômica dominante e alta penetrância, definindo possibilidade de 50% no desenvolvimento de neoplasias antes dos 30 anos, incluindo nesses casos os sarcomas em mama. Pacientes portadoras dessa síndrome que requerem tratamento radioterápico têm risco aumentado de desenvolver neoplasias secundárias, incluindo os angiossarcomas. RELATO DE CASO: Este é um relato de caso de paciente feminina, portadora da síndrome de Li-Fraumeni. Em outubro de 2005, ela teve diagnóstico de carcinoma ductal invasor da mama direita, sendo submetida à setorectomia. Recebeu quimioterapia e radioterapia adjuvante; trastuzumabe e tamoxifeno também fizeram parte do tratamento. Recentemente, procurou atendimento em nosso serviço, com queixa de hiperemia e nodulação em mama direita, e foi submetida a ressecção cirúrgica que revelou angiossarcoma epitelioide. CONCLUSÕES: Quando a predisposição genética da síndrome de Li-Fraumeni está documentada, devese adequar a terapêutica a fim de minimizar riscos, evitando tratamentos cirúrgicos conservadores e priorizando a mastectomia sem radioterapia. Nos casos em que se justifica o uso de radioterapia, os pacientes devem ser acompanhados de forma intensiva. .

Cancer patients with oral mucositis: challenges for nursing care / O paciente oncológico com mucosite oral: desafios para o cuidado de enfermagem / El paciente oncológico con mucositis oral: desafíos para el cuidado de enfermería

OBJECTIVE: to analyze nursing care provided to cancer patients with oral mucositis based on the Nursing Process (NP). METHOD: this exploratory, descriptive, cross-sectional and quantitative study was conducted with 213 patients undergoing chemotherapy and/or radiotherapy in two cancer facilities: one philanthropic and one private service. RESULTS: the participants were mainly female, aged 45.8 years old on average, with up to 11 years of schooling and income of up to one times the minimum wage. Severe mucositis was related to chemotherapy associated with radiotherapy. Only 25.3% of the patients reported having received guidance from nurses during their treatment concerning self-care. The perceptions of patients regarding quality of care did not significantly differ between the private and public facilities. The basic human needs mainly affected were comfort, eating, and hygiene. Based on this finding, one NP was established listing the diagnoses, interventions and expected results to establish an ideal, though individualized, standard of nursing care to be provided to these patients. CONCLUSION: to understand oral mucositis is crucial to establish nursing care that includes prevention based on the implementation of an oral care plan. .

OBJETIVO: analisar o cuidado de enfermagem ao paciente oncológico com mucosite oral, pautado no Processo de Enfermagem (PE). MÉTODO: estudo exploratório descritivo, transversal e quantitativo, realizado com 213 pacientes submetidos à quimioterapia e/ou radioterapia em dois serviços de oncologia, um filantrópico e outro privado. RESULTADOS: os sujeitos eram majoritariamente do sexo feminino, com média de idade de 45,8 anos, possuíam até 11 anos de estudo e renda básica de até um salário mínimo. As formas graves de mucosite detectadas relacionaram-se à quimiorradiação. Somente 25,3% dos pacientes relevaram ter recebido orientações de enfermeiros durante o tratamento e sem, conforme concepção dos pacientes, diferença significativa na qualidade da assistência de enfermagem entre serviços públicos e privados. As principais necessidades humanas básicas afetadas nos pacientes relacionaram-se aos componentes conforto, alimentação e higiene. A partir disso, delimitou-se um PE elencando diagnósticos, intervenções e resultados esperados, a fim de se estabelecer um padrão ideal, porém individualizante, de assistência de enfermagem a estes pacientes. CONCLUSÃO: conhecer a afecção mucosite oral é precípuo para formulação de uma assistência de enfermagem que vislumbre a prevenção, a partir da instituição de um plano de cuidados orais. .

OBJETIVO: analizar el cuidado de enfermería para el paciente oncológico con mucositis oral, guiado por el Proceso de Enfermería (PE). MÉTODO: estudio exploratorio descriptivo, transversal y cuantitativo, realizado con 213 pacientes sometidos a quimioterapia y/o radioterapia en dos servicios de oncología, uno filantrópico y el otro privado. RESULTADOS: los sujetos eran en su mayoría del sexo femenino, con promedio de edad de 45,8 años, poseían hasta 11 años de estudio y renta básica de hasta un salario mínimo. Las formas graves de mucositis detectadas se relacionaron a la quimiorradiación. Solamente 25,3% de los pacientes relevaron haber recibido orientaciones de enfermeros durante el tratamiento y sin, conforme concepción de los pacientes, diferencia significativa en la calidad de la asistencia de enfermería entre servicios públicos y privados. Las principales necesidades humanas básicas afectadas en los pacientes se relacionaron a los componentes confort, alimentación e higiene. A partir de eso, se delimitó un PE incluyendo diagnósticos, intervenciones y resultados esperados, con la finalidad de establecer un estándar ideal, sin embargo individualizado, de asistencia de enfermería para estos pacientes. CONCLUSIÓN: conocer la enfermedad mucositis oral es primordial para la formulación de una asistencia de enfermería que objetive la prevención, a partir de la institución de un plan de cuidados orales. .

Primary cutaneous melanoma: an 18-year study

BACKGROUND: Primary cutaneous melanoma still constitutes the main cause of skin cancer death in developed countries, and its incidence in recent years has been increasing in a steady, worrisome manner. OBJECTIVES: This study evaluated the clinical, epidemiological and demographic aspects of this disease, and correlated them with patient prognosis. METHODS: Using epidemiologic and clinical data, we analyzed 84 patients with mild to severe primary cutaneous melanoma treated between 1990 and 2007. Slides containing surgical specimens were analyzed, and new slides were made from archived paraffin sections when necessary. RESULTS: The melanoma incidence was higher in areas of sun exposure, with lesions commonly observed in the trunk for males, and lower limbs for females. In addition to Breslow's thickness and ulceration (p = 0.043 and p < 0.001, respectively), the mitotic rate per mm² also correlated with worse patient outcome (p = 0.0007). The sum of ulceration (0 when absent or 1 when present), the Breslow index (1 when <1 mm, 2 when >1 mm and <4 mm, 3 when >4 mm) and the mitotic index (0 when absent or 1 when >1 per mm²) allowed the establishment of a prognostic score: if the sum was equal to or over three, nearly all (91.7 percent) patients had systemic disease. The 5-year survival was approximately seventy percent. CONCLUSION: Because American Join Committee of Cancer Staging will update the classification of malignant tumors (TNM) staging in the near future, and introduce mitosis as a prognostic factor, our results show the importance of such a feature. Additional studies are necessary to confirm the importance of a prognostic score as proposed herein.

Radiation-induced spindle cell sarcoma: A rare case report.

Ionizing radiation has been known to induce malignant transformation in human beings. Radiation-induced sarcomas are a late sequel of radiation therapy. Most sarcomas have been reported to occur after exposure to a radiation dose of 55 Gray (Gy) and above, with a dose ranging from 16 to 112 Gys. Spindle cell sarcomas, arising after radiotherapy given to treat the carcinoma of head and neck region is a very uncommon sequel. This is a rare case report of spindle cell sarcoma of left maxilla, in a 24-year-old male, occurring as a late complication of radiotherapy with Cobalt-60 given for the treatment of retinoblastoma of the left eye 21 years back.

Análisis de la densidad y distribución anatómica de nevos melanocíticos adquiridos, en adolescentes del estrato socioeconómico bajo de Santiago de Chile / Body distribution and density of acquired melanocytic nevi in adolescents of low socioeconomic stratus of Santiago, Chile

Background: There is an increase in the incidence of malignant melanoma in Chile. Previous studies have shown that the density and size of acquired melanocytic nevi (AMN) are a risk factor for developing malignant melanoma. Aim: To assess the number and anatomical distribution of acquired melanocytic nevi in Chilean adolescents. Material and methods: The number of AMN was counted in 30 anatomical sites in 201 Chilean school children (111 females), aged from 11 to 15 years. The number oí small AMN (2-4.9 mm) and large AMN (>5 mm ofdiameter) was determined. Results: Mean AMN number per person was 32.7 (95 percent confidence interval (CI) 30.7-42.3) in males and 29 (95 percent CI 271-38.6) in females (p =NS). Males had a higher number of AMN in the face, neck and trunk. Females had a higher number of AMN in the upper and lower limbs. Older children, adolescents with history of sunburns and with lighter skin had a higher number of total, small and large nevi. Conclusions: The average number ofAMNfound in this study is similar to that reported in the literature. The differences in site distribution between males and femalesmay be explainedby a differentsun exposurepattern.

Childhood thyroid cancer in Belarus, Russia, and Ukraine after Chernobyl and at present

Thyroid cancer in children is usually rare, but in the individuals exposed to radiation risk of disease increases considerably. After the Chernobyl accident in 1986, an over 10-fold maximal elevation in the incidence of thyroid cancer was registered about a decade later, cumulatively resulting in more than a thousand of newly diagnosed cases in children who lived in the territories of Belarus, Russia, and Ukraine affected by radioactive fallouts. Experience from the epidemic substantially promoted knowledge in clinical pediatric oncology, pathology and basic sciences. This article overviews epidemiology, clinical features, results of treatment and follow-up of childhood patients with radiation-induced Chernobyl thyroid cancer in comparison to sporadic cases diagnosed at present. In addition, we discuss general issues of pathology and molecular findings in childhood thyroid carcinomas.

O câncer de tiróide é habitualmente raro em crianças, mas em indivíduos expostos a radiação o risco da doença aumenta consideravelmente. Cerca de uma década após o acidente de Chernobil, em 1986, foi registrado um aumento de mais de 10 vezes na incidência de câncer de tiróide, resultando cumulativamente em mais de mil novos casos diagnosticados em crianças que viviam nos territórios da Bielorrússia, Russia, e Ucrânia, afetadas pela chuva radioativa. A experiência com essa epidemia resultou em conhecimento substancial de oncologia pediátrica clínica, patologia e ciências básicas. Este artigo analisa a epidemiologia, os achados clínicos, os resultados do tratamento e a evolução de pacientes pediátricos com câncer de tiróide induzido pela radiação de Chernobil, em comparação com casos esporádicos diagnosticados atualmente. Adicionalmente, serão discutidos tópicos de patologia e achados moleculares no carcinoma de tiróide infantil.

Radiation-induced medulloblastoma in an adult: a functional imaging study.

We describe functional imaging findings using MRI, 1H-Magnetic resonance spectroscopy and positron emission tomography in a case of radiation-induced medulloblastoma following radiotherapy for pineal gland tumor. MRS showed a prominent choline peak; FDG, 11C-Met and 11C-Choline PET showed a minimal glucose, increased methionine and choline uptake.

Colorectal adenocarcinoma as a second malignant neoplasm following rhabdomyosarcoma of the urinary bladder: a case report

Following improvements in therapy for childhood malignancies, the striking increase in survival rate over the past 30 years has led to the increase risk of developing second malignant neoplasms (SMNs). We report a case of colorectal carcinoma as a SMN, following treatment for rhabdomyosarcoma. The patient was diagnosed with rhabdomyosarcoma of the urinary bladder at his age of three years, and developed adenocarcinoma in the colon 13 years later. Histologic examination of the surgical specimen revealed adenocarcinoma involving the rectosigmoid area with radiation colitis in its background. The tumor cells showed strong immunoreactivity for p53 protein, suggesting the role of irradiation and p53 mutation in carcinogenesis. This case emphasizes the need for dose observation in survivors of early childhood malignancies treated with radiation and multiagent chemotherapy.

Colorectal adenocarcinoma as a second malignant neoplasm following rhabdomyosarcoma of the urinary bladder: a case report

Following improvements in therapy for childhood malignancies, the striking increase in survival rate over the past 30 years has led to the increase risk of developing second malignant neoplasms (SMNs). We report a case of colorectal carcinoma as a SMN, following treatment for rhabdomyosarcoma. The patient was diagnosed with rhabdomyosarcoma of the urinary bladder at his age of three years, and developed adenocarcinoma in the colon 13 years later. Histologic examination of the surgical specimen revealed adenocarcinoma involving the rectosigmoid area with radiation colitis in its background. The tumor cells showed strong immunoreactivity for p53 protein, suggesting the role of irradiation and p53 mutation in carcinogenesis. This case emphasizes the need for dose observation in survivors of early childhood malignancies treated with radiation and multiagent chemotherapy.

Angiosarcoma cutáneo postirradiación / Cutaneous angiosarcoma postirradiation

El angiosarcoma cutáneo (AC) es una neoplasia cutánea de origen vascular rara y agresiva. Dentro de las distintas variantes, el angiosarcoma posirradiación es sumamente infrecuente. Se comunica un caso de AC en un paciente de 69 años, de sexo masculino, que aparece 56 años después de la irradiación de un hemangioma congénito facial