Docyard | New scans for tumours
Cancer is a major killer. It can affect any organ of the body. Some cancers are curable; others are controllable till nature takes its course. Some cancers were thought to be rare because there were no sensitive methods to detect them. Neuroendocrine cancers are such cancers.
They occur in different areas of the body arising from special neuroendocrine cells which have the ability to produce active hormones. Symptoms occur when these hormones are secreted in excess, like flushing, hypoglycaemia, diarrhoea. When they do not produce hormones, they just grow quietly and become manifest when the size becomes big and starts creating pressure on nearby structures. By then it is already too late to cure them.
Till recently, CT and MRI were the only modalities available to detect these neuroendocrine tumours. The detection efficiency was not very high. Most of these tumours express somatostatin receptors on their surface. This can be detected by nuclear medicine scans which target these receptors. About 10 years ago, a new diagnostic scan called Gallium-DOTATATE PET-CT scan was introduced.
This revolutionised the diagnosis of neuroendocrine tumors, which could now be detected with great sensitivity and specificity. Suddenly, the incidence of neuroendocrine tumours rose and now they are considered no longer rare, almost equalling other cancers in occurrence, due to the ability to detect them with the new scans.
Several nuclear medicine centres with PET-CT scanners in India offer these scans. The radioisotope is injected intravenously into the patient and the whole body is scanned one hour later, accurately detecting where the neuroendocrine cancer is originating and where it has spread.
This is of great importance since the treatment of these cancers is surgical: to remove as much of the tumour as is possible, completely if it is small and localised. If the tumour has spread extensively and cannot be removed, other options are available.
Aggressive tumours are given chemotherapy. Again recently another Nuclear medicine modality called PRRT (Peptide Receptor Radionuclide Therapy) was introduced where a lethal isotope called 177 Lutetium is labelled with DOTATATE and injected into the body intravenously.
This compound targets all the tumour cells expressing the somatostatin receptors and destroys them selectively, sparing normal body tissues. This therapy which was available only in Europe and would cost Rs 32 lakh is now offered in several centres in India for a cost ranging from Rs 1 lakh (some government centres) to Rs 4 – 9.5 lakh (private centres) for the complete therapy, which consists of 4 cycles at two-month intervals.
This therapy results in arresting the progressive disease in 80 per cent of the cases and curing it in 1-5 per cent. There is an improvement in the quality of life and dramatic reduction of symptoms in many cases.
The speciality of Nuclear Medicine, thus has introduced the branch of Theranostics (therapy and diagnosis of disease using similar isotopes) which has revolutionised the diagnosis and treatment of neuroendocrine tumours.
The writer is Dr Vikram Lele Director, Department of Nuclear MedicineJaslok Hospital & Research Centre,Mumbai
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