MIBG Therapy
What is MIBG Therapy?
MIBG Therapy is used as part of the treatment for certain types of cancer.
MIBG is the name of the chemical we use. It stands for Meta-Iodo-Benzyl-Guanidine.
It is used to treat cancers formed from the same sorts of tissues as found in the adrenal glands. Examples include:
paraganglioma
How does the treatment work?
Before injection, the MIBG is attached to radioiodine. This is a form of iodine that is radioactive. The MIBG chemical is taken up by the cancer. The cancer cells are then killed off by the radioactivity. No surgery is involved. Your doctor considers that this is the best form of treatment for you.
What preparation is there?
Normally, the thyroid takes up iodine. Because we want the MIBG to go to the cancer and not to the thyroid, we will ask you to take a medicine before and during the treatment. The medicine will ‘block’ the thyroid while the treatment takes effect.
Where else does the radioactivity go?
Most of the iodine is taken up by the cancer. The rest of the iodine mainly passes out of your body in the urine.
What is involved in the treatment?
Because the amount of MIBG used is quite large, you will need to stay in the hospital for a few days.
So that you will pass on as little radiation as possible to others, you will have a special suite to yourself. You will have a TV set and your own bathroom.
How is the MIBG given?
You will be given the MIBG by intravenous injection. The MIBG needs to be put into the body slowly. Therefore, we will place the syringe into a syringe driver. The injection will take about one hour.
When will I be discharged?
At various points, a member of the Medical Physics staff will measure how radioactive you are by holding a detector towards you.
We will discharge you when the amount of radioactivity in your body has reduced to a specific level as defined by legislation.
The majority of patients are discharged after three or four days.
What happens after I am discharged from hospital?
When you leave hospital, you will still be slightly radioactive. In order to keep the amount of radioactivity you pass on to others to a minimum, we will ask you to observe a few precautions.
Special arrangements may be required for your transport home
You may travel home by public transport if your journey takes less than ½ an hour.
You may travel home by private transport, with a maximum of one other person in the car. You may drive yourself. If you are travelling with someone else, please ensure that you are seated diagonally opposite to the other person.
An ambulance will be organised for you if necessary.
Travelling on public and private transport
For the week after your discharge, please avoid travelling on public transport as much as possible. This is to avoid being next to the same person for too long, e.g. greater than one hour. If you do use public transport during the first week after your discharge, try to ensure that you do not spend, for any one journey, more than 1/2 an hour on a bus, train or aeroplane. For the second week avoid very long journeys, i.e. lasting more than 7 hours.
There are no problems with private transport. Although, in the first few days, if you are sharing a car with a friend or member of your family, try to keep journey times short.
Length of other precautions
The following paragraphs detail other precautions we ask you to take. The length of time they need to be observed will be calculated when you are ready for discharge.
Contact with your spouse/partner
It is advisable that you make arrangements to sleep apart from your partner for a few days.
Contact with family and friends at home
For the first few days you should limit contact with pregnant women and children under 18 years of age to that which is essential.
Contact with children
It would be a good idea if you could arrange for your very young children to stay with relatives or friends for the first few after your discharge if this is at all possible.
You should avoid prolonged close contact with any children for a few days
By close contact we mean to be at a distance of less than a metre or 3 feet. It is safe to be in the same room as children but do not hold them close to you or sit next to them for long periods. Do not let children sleep beside you.
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Whipple's operation
This is an operation to take out the head of the pancreas. Whipple's involves removing- Part of your pancreas
- Your duodenum (the first part of your small bowel)
- Part of your stomach
- Your gall bladder and part of your bile duct
The diagram below shows what your surgeon removes.
So after the surgery, the head of the pancreas is joined to a bit of your small bowel. This diagram shows how the surgeon repairs what is left.
This is the most common operation for operable cancer of the head of the pancreas. This is major surgery. But it is not quite so difficult to get over as total pancreatectomy.
A Pylorus Preserving Kausch-Whipple's is like a Whipple's but none of the stomach is removed. This diagram show what will be taken away.
And this diagram shows how the surgeon repairs what is left behind.
There are not quite as many after effects with these operations as with total pancreatectomy. As you will have part of your pancreas left behind, you should not need to take insulin. And you may not need to take enzymes to help you digest food (although around 1 in 3 Whipple's patients do need enzymes). At first, your doctor will monitor your digestion and blood sugar to make sure you can manage on your own.
Even so, getting over this type of surgery is hard work. It will take time to get back to eating even near normally. Your digestive system will never be the same as it was. There is more about this in the CancerHelp UK section
Diet After Pancreatic Cancer. There is more about the surgery in the CancerHelp UK section Treating Pancreatic Cancer: Having Your Operation.
Total pancreatectomy
This is very major surgery. It involves taking out- The whole of the pancreas
- Your duodenum
- Part of the stomach
- The gall bladder and part of your bile duct
- The spleen
- Many of the surrounding lymph nodes
And this diagram shows you how the surgeon repairs what is left behind.
This operation is not done very often in the UK. When results have been compared, it has not been any more successful than a Whipple's operation. As this operation is harder to recover from, surgeons in the UK tend to opt for Whipple's instead.
To have a total pancreatectomy you must be fit enough to survive such major surgery and a long anaesthetic. You must also be fit enough to cope with getting over the operation. Losing your pancreas will affect your digestive system. You will also be diabetic. Losing your spleen increases your risk of infection. And can affect your blood clotting.
After the surgery you will have to
- Take enzymes to help you digest food
- Have regular blood sugar checks and insulin injections
- Have vaccinations and possibly take antibiotics for the rest of your life to prevent infections (if your spleen has been removed)
Distal pancreatectomy
This means taking out the other part of the pancreas and leaving the head. So surgeons use to to try to cure cancer of the body and tail of the pancreas. Usually your surgeon will take out your spleen as well, because the tail of the pancreas is right next to it.
Unfortunately, distal pancreatectomy is not suitable for everyone. Many people have cancer that has spread and so is not operable. It may be as few as 1 in 20 patients (5%) with pancreatic cancer of the body or tail who can have this surgery.
As with Whipple's, you will have part of your pancreas left behind. So you should not need enzymes or insulin. But as with all the other surgery to cure pancreatic cancer, it involves a major operation and long anaesthetic. There is more about this in the CancerHelp UK section Treating Pancreatic Cancer: Having Your Operation.
Complications of major pancreatic surgery
A complication is something that happens after surgery that makes your recovery more difficult. Chest infection or blood clots are both common complications after any surgery.
All these operations are very major surgery and there are risks attached to them. But they are done to try to cure your cancer so you may feel it is worth taking some risks. Make sure you discuss the possible complications with your surgeon and ask all the questions you need to. It is important that your family are given the chance to talk things through with the surgeon as well.
Complications are most likely with the biggest operations - total pancreatectomy and Kausch-Whipple's. The complication rate is lowest in specialist centres where the surgeons are more practised at doing this difficult surgery.
Overall, about 4 out of every 10 patients having the major operations have one or more complications. The commonest complications are
- Internal infection or abscess
- Fluid collection
- Bleeding
- Fistula
- Chest infection
- Heart problems
Infection can develop because there is blood or tissue fluid collecting internally around the operation site. Or because there is internal bleeding. If you develop an internal infection, you will be given antibiotics through your drip. Abscesses or any fluid that has collected internally will need to be drained. This is usually done by putting in a needle or drainage tube. The needle or tube is guided into place with X-ray or ultrasound.
You may have bleeding straight after your operation because a blood vessel tie is leaking. Or because your blood is not clotting properly. Bleeding in the few days following surgery can happen because there is infection or a fistula forming. How bleeding is treated depends on what is causing it.
'Fistula' means opening. In this case, it means that part of the internal stitching to the digestive system has come apart or broken down. So some of the digestive juices are able to get into your abdomen. Around 1 in 10 patients having major pancreatic surgery will have a fistula. If you get one, you will have a wound drain put in and have drugs to control the inflammation. The drains will be left in until the fistula dries up. The fistula then heals on its own. Sometimes, the surgeon has to operate again to repair the leak.
Chest infection is a common complication of many operations. It happens because you are not moving around enough, or breathing deeply enough after your surgery. What you would normally cough up stays in your lungs and becomes a focus for infection. You can help to prevent this by doing your deep breathing exercises. The physiotherapists and nurses will get you up as soon as possible to help you get moving.
You will have had heart tests before your surgery, but these are very big operations and do increase the strain on your heart. Some people develop heart problems after surgery that they did not have before.
Complications after surgery can be very serious. They are becoming less common as surgeons get better at deciding who is likely to make a good recovery from this type of surgery. And as more of these operations are done in specialist centres. But even so, as many as 1 in 20 people (5%) who have the most major surgery may die directly as a result of complications after their operation.
