Public Enemy No 1*
The enemy is: deadly adversary, aggressor, harm to someone or something, often crouched, acts on us harm, intruder and uninvited guest. It is undoubtedly a cancer.
Malignant neoplasms are the second leading cause of death in Poland and on the world right after cardiovascular diseases. In Poland, each year, over 140 thousand people learn that they are suffering from malignant neoplasia and bravely face the enemy. Every year almost 100 thousand people lose this battle.
Malignant neoplasms are defined as a group of about 100 diseases classified in the International Statistical Classification of Diseases and Health Problems. Different types concerns women and men with different frequencies.
Each type of cancer needs specific treatment. Before we start to treat, the enemy must be located precisely.
Sherlock Holmes and Dr. Watson
It is no exaggeration to say that one of the most famous and most effective detectives in the world was Sherlock Holmes. He was unparalleled in detecting "bad guys". A real Sherlock Holms in the detection of tumors is a Positron Emission Tomography combined with CT (PET/CT). PET enables oncological diagnostics and helps to monitor progress of treatment. In addition, it is easy to determine whether we are dealing with primary malignancy or metastatic lesions. PET/CT is considered to be one of the most powerful and sensitive diagnostic techniques, and what is important, it is a safe and non-invasive method. Having the results of the PET examination, the physician can appropriately tailor the therapy plan to the patient.
Sherlock Holmes had his faithful associate - Dr. Watson. As duo they were extremely effective. To effectively detect the cancer via PET/CT is needed a special Dr. Watson - the radiopharmaceutical.
Radiopharmaceutical is a biologically active substance labeled with a short-lived radioactive isotope. As biologically active molecules in radiopharmaceuticals, naturally occurring compounds such as glucose and amino acids are used. They accumulate in the tissue in which the processes involving them are most intense, e.g. cancer tissue. The most common radioisotopes used in radiopharmaceuticals are 18F fluoride or 11C carbon. PET detects the radiation generated by the annihilation of positrons emitted during the decay by the nucleus of a radioisotope. As a result we get a three-dimensional image of the patient's body along with the location of the pathological change. Just as Sherlock Holmes and Dr. Watson were unmatched in detecting criminals, so PET/CT and appropriately selected radiopharmaceuticals are capable of detecting different types of cancer.
The most commonly used radiopharmaceutical is 18FDG (fluorodeoxyglucose). Its accumulation within the cancer cells reflects the processes of glycolysis. These processes are very intense in the cells of tumors. The list of indications for use of 18FDG is very long. It should be emphasized that with 18FDG it is possible to diagnose primary and secondary tumors, diagnosis of infection, assessment of the progression of cancer, assessment of range of inflammatory changes, and monitoring progress of treatment.
For some types of cancers, a special radiopharmaceutical must enter to diagnostics. Currently, about 2,000 different special radiopharmaceuticals, or rather radioisotopically labeled substances, are described in the literature. However, the most commonly used are:
Fluorocholine is used in the diagnosis of prostate cancer and hepatocellular carcinoma.
FET (fluoroethyl-L-tyrosine) intended for imaging studies in oncological diagnostics with increased uptake of amino acids by specific organs or tissues. I use it primarily in neuroscience for imaging and monitoring of glioma therapy. It is possible to assess glioma brain damage, biopsy, glioblastoma classification, tumor tissue line definition before radiotherapy, and definition of viable tumors if glioblastoma persists or is suspected.
FLT (fluorothymidine) is accumulated in malignant cells according to their degree of mitotic activity (proliferation). FLT is used for assessment of response for therapy of tumors. The literature describes its use, among other, for the diagnosis cancers of lung, bone, nervous system, skin, pancreas, head and neck.
FES (fluoroestradiol) is used to evaluate the expression of estradiol receptors in the diagnosis of breast cancer. High estradiol receptor activity is indicator for use of antiestrogen therapy.
FMISO (fluoromizonidol) is used to estimate tumor hypoxia (necrosis), which is one of the indicators of aggressiveness of the tumor. The presence of necrosis is sadly associated with poor prognosis. An FMISO test can provide important information needed to decide on further treatment or surgical strategies for any type of brain tumor.
In our Research and Development Center, we have necessary equipment and qualified staff to work on a variety of special radiotracers.