OEM: Carcinoid tumour of thymus and radioisotope exposure

[epombier@mednet.med.miami.edu]

    Here is case that we would appreciate your comments on:
     
        We have just seen a 46 year old man who was employed from 
1969 to 1978 as an oilfield cased-hole logging engineer.  Essentially 
his work involved the underground injection of various radioactive 
isotopes to obtain information on the best method to extract oil and 
natural gas reserves.  He was exposed to the following agents:

Iridium-192          10-20 mcuries       (seldom used)

Cesium-137             3 curies          (used 4-5 times/year)

Ammerisium-berylium    3-5 curies        (used everytime a well was 
                                         logged, approximately 150-
                                         200 times/yr)
                                         
Iodine-131             20 mcuries         (In liquid form, 100 
                                          times/yr)

    He describes the workers attitude towards radioactive hazards as 
"cavalier".  They used no protection whatsoever.  Isotopes would 
spill on clothing, blow into their faces etc.  They would store them 
in the trucks to prevent freezing.  When the patient took a safety 
course on radioisotopes, he recognized the danger and quit this line 
of work!

    He began to experience sharp retrosternal chest pain in 1981.  
After being treated for everything you could possibly imagine, he 
eventually had an open thoracotomy in 1989 at which time the tumour 
was found and a tissue sample was taken.  He has had courses of 
radiotherapy and chemotherapy, his lesion is apparently unresectable. 
There has been impingement on his SVC and a stent has been inserted. 
He is aware that the cancer is terminal but, understandably, no one 
has given him a time frame. He is being followed with CT Scans every 
6 months.

    We have been asked to comment on causation.

    He says numerous other co-workers have had various types of 
malignancy - 2 cases of leukemia, plus bowel, prostate, bladder, 
testicle.  Apparently several have had thyroid abnormalities but the 
patient is unsure exactly what these are. 

    We are in the process of:
    - Alerting our Dept of Labour to the situation
    - Obtaining all his records
    - Searching the literature
    
    Any insight or help with this case the group could provide would 
be most welcome.






Christopher Martin
Resident
Occupational Health Program
University of Alberta
Edmonton, Alberta

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Subject: OEM: Carcinoid tumour of thymus and radioisotope exposure
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