Winter 2004 Department of Surgery healthpoints NewYork-Presbyterian ALL THE POSSIBILITIES OF MODERN MEDICINEE DIABETES Knowledge is Power ALSO IN THIS ISSUE: in a Complex Disease Approximately 17 million people in the United States have the disease. While an estimated 11.1 million have been diagnosed, 5.9 million people remain unaware that POSITRON EMISSION they have the condition. It is the fifth leading cause of death by disease in the U.S.— TOMOGRAPHY (PET) contributing to the deaths of more than 210,000 Americans each year. And its origin Approved for the Fight remains a mystery. Against Thyroid Cancer Diabetes is a complex disease which results from the body’s inability to create or page 2 properly use insulin. A hormone produced by the pancreas, insulin helps the body convert sugar, starches, and other food into energy. If the body doesn’t make enough insulin or if the insulin doesn’t work the way it should, glucose (sugar) cannot enter into the body’s cells. Instead, ISLET CELL glucose remains in the TRANSPLANTATION bloodstream, raising the The Search for a Cure blood sugar level and for Type 1 Diabetes ultimately causing page 7 diabetes. The signs of diabetes are often subtle, which can make detection of the disease a greater AIDING THE HEART challenge. Some Medicare Approves common symptoms LVADs as Destination include excessive thirst, Diabetes strikes people of all ages, races, and genders. Therapy frequent urination, page 8 unusual weight loss, increased fatigue, slow wound healing, extreme hunger, and blurry vision. However, individuals who experience none of these signs may still have diabetes. “Until the blood sugar is elevated, diabetes has no symptoms,”says Robin Goland, MD, THE MANY FACES Director, Naomi Berrie Diabetes Center at Columbia University Medical Center. BEHIND “A major misconception about diabetes is that if you have no symptoms, you cannot A MISSION have the disease. The importance of screening people can’t be overemphasized,” Dr. Jeffrey Ascherman's Dr. Goland adds. Humanitarian Mission Diabetes is typically detected through a routine blood glucose test or a urine exam. to China People can develop diabetes at any age, and it manifests itself in different forms— page 9 which further contributes to its complexity. While there is no cure for diabetes, individuals with the disease can live long and healthy lives if they take control of the disease. When it comes to diabetes, knowledge is definitely power. If patients take care of themselves with exercise, watch their diet, and maintain a healthy lifestyle, treatment continued on page 4 Positron Emission Tomography (PET) A GROWING CONCERN cancers and can typically be treated and chemotherapy. Patients should According to the American Cancer successfully if detected early. review these options with their physician Society, approximately 22,000 Americans While no one knows the cause of to select the best treatment approach for were diagnosed with thyroid cancer in thyroid cancer, certain risk factors, such their individual case. 2003 and 1,500 will die from the disease. as family history, gender (female), age Thyroid cancer is two to three times more (over 40), and race (white) are associated PET AND THYROID CANCER common in women than men. Unlike with the disease. Children who experience Follow-up care is a critical component of most cancers, the incidence of thyroid external irradiation to the head and neck thyroid cancer treatment, since 30 percent cancer has actually increased over the past also have an increased risk. Studies of patients will experience a recurrence of few years. revealed a sharp increase in childhood the disease. Today, there are nearly A butterfly-shaped gland located thyroid cancer rates followed exposure to 300,000 thyroid cancer survivors in the in the front of the neck, the thyroid the Chernobyl nuclear accident. United States. These patients undergo produces hormones that affect heart rate, A range of options exist for treating regular screenings to detect recurrences, energy level, and body temperature. thyroid cancer, including surgery, thyroid including: The vast majority of thyroid tumors— hormone therapy, radioactive iodine ● physical examinations 131 80-90%—are papillary or follicular therapy (I ), external radiation therapy, ● thyroglobulin studies (a protein pro- duced by the thyroid, thyroglobulin becomes elevated in individuals with thyroid cancer) RENÉ PEREZ 131 ● diagnostic I scans (the radioactive iodine I131 collects in and destroys thy- roid cancer cells throughout the body) ● ultrasound scans In October 2003, Medicare and Medicaid added Positron EmissionTomography (PET) to this arsenal for detecting recurrences in select thyroid cancer patients. PET goes beyond the other testing modalities by providing a color-coded account of body chemistry. Recurrences appear visually as areas of higher metabolic activity. According to Robert J. McConnell, MD, Associate Clinical Professor of “PET can affect treatment for Medicine at Columbia University College of Physicians & Surgeons and Co- recurrent thyroid cancer by Director of the New York Thyroid Center, locating lesions throughout “PET is a specialized tool. We use PET to the body that may be image metastatic thyroid cancer for a amenable to therapy.” 2 healthpoints • winter 2004 Approved for the Fight Against Thyroid Cancer PET scans detect areas of increased metabolism in the body. In the scan to the left, thyroid cancer appears as a darkened region in the neck (outlined by the red box). This scan also shows areas of healthy increased metabolic activity, such as the brain, heart, and liver. subset (10-15%) of patients who have Columbia, “PET can affect treatment for elevated thyroglobulin levels, but negative recurrent thyroid cancer by locating I131 scans.” lesions throughout the body that may be How PET Works “When thyroid tumors spread amenable to therapy, such as surgery or throughout the body, they can become directed radiotherapy.” PET scans display color-coded images of less differentiated and no longer take up While Medicare and Medicaid the body’s metabolic and chemical I131 ,” explains William B. Inabnet, MD, currently recommend the use of PET to processes. Before having a PET scan, Chief of Endocrine Surgery at Columbia detect recurrences in thyroid cancers of patients receive an injection of a harm- University Medical Center, NewYork- follicular origin, Dr. Fawwaz predicts that less tracer that attaches to glucose in Presbyterian Hospital and Assistant PET will ultimately be used to detect the body. Cancerous tissue absorbs Professor of Surgery at Columbia recurrences for all types of thyroid cancer. greater quantities of glucose than University College of Physicians & Ultimately, Dr. Inabnet hopes that healthy tissue. Glucose “feeds” the Surgeons. “PET is a great advance because ongoing academic research will enable tumor, allowing it to more rapidly multi- it allows imaging of metastatic thyroid physicians to use PET not only to detect, ply and expand. By revealing areas of lesions by a different mechanism than but also to treat thyroid cancers—much increased glucose consumption in the with I131 .The sensitivity of PET is quite as they use I131 today. body, PET scans can spot active tumors. high in that 60-90% of patients who meet Many other imaging technologies, the screening criteria will have positive For more information about PET for such as MRI (magnetic resonance findings.” thyroid cancer, please contact the imaging) and CT (computed tomography), According to Rashid A. Fawwaz, MD, Columbia Kreitchman PET Center at Professor of Clinical Radiology at 212.923.1555 or [email protected] show the internal structures of the body. By focusing on metabolic changes, PET can often highlight tumors before struc- tural changes appear. CASE STUDY Individuals with thyroid cancer typically undergo a “full-body” PET scan, A physician referred a female patient to Columbia which covers the neck and trunk of the Kreitchman PET Center for a whole-body PET body. The full-body approach enables scan. The woman had previously undergone a total thyroidectomy (removal of physicians to detect whether any tumors the thyroid gland) to treat her follicular thyroid cancer. As part of her follow-up have spread beyond the initial site of the 131 care, she received regular diagnostic I scans and thyroglobulin studies. thyroid. A full-body PET scan typically 131 Radioactive iodine I collects in (and destroys) differentiated thyroid cancer takes less than one hour and only a small cells; the protein thyroglobulin becomes elevated in individuals with thyroid portion of the patient is covered by the cancer. scanner at any time. The radiation Over a year after her thyroidectomy, a test showed that the woman had an exposure is similar to that from an X-ray 131 elevated thyroglobulin level. The diagnostic I scan remained negative, or CT scan. suggesting a recurrence of a less differentiated cancer. A PET scan was ordered to help her physician make a firm diagnosis. The scan showed a recurrence in her right superclavicular area. The woman underwent surgery to remove the recurrence. www.columbiapet.org healthpoints • winter 2004 3 PATIENT PROFILE Glenda Daggert DIABETES CONTINUED FROM P. 1 When 15-year-old Glenda can be very successful. Dr. Goland emphasizes that treatment Daggert was diagnosed with success is completely dependent on a patient’s motivation. diabetes in the early 1960s, “you hid diabetes.” In spite of her Type 1 illness, Glenda went on to earn Formerly called juvenile diabetes, type 1 is an autoimmune disease degrees in physical education and that results from the body’s failure to produce insulin. The disease instructional technology, then occurs when the body’s immune system destroys the pancreatic RENÉ PEREZ taught for several years. She cells that produce insulin. Type 1 usually develops before age 20 married Ira Copperman, moved to New York, and joined and is typically first diagnosed in children, teenagers, or young IBM as a leadership trainer, a position she still holds today.