Contents
Thyroid Cancer is a malignant nodular formation that can form from epithelium of special characteristics, follicular or parafollicular (C-cells) type. They are naturally produced in the thyroid gland.
Statistics say: about 5% of thyroid nodules are malignant. Such a disease requires the most radical treatment tactics.
The prevalence rate of this malignant formation reaches about 1,5% of existing malignant tumors of various localizations. After the tragedy in Chernobyl, the incidence rate increased significantly. It has become very popular among children. Most often, this disease of the organ of the thyroid gland is diagnosed in women when they are 40-60 years old. This is, in total, 3,5 times more common than in men. In the case of radiation, the disease is susceptible to the accumulation of a substance such as radioactive iodine. If there is no fact of the influence of radiation, the health disorder is most likely more related to age.
The features of the course of such a disease as thyroid cancer are the vagueness and controversy of the clinical picture.
You also need to remember about:
painlessness of palpable nodes,
premature metastasis to the lymph nodes and those organs and cells that are located nearby.
Diagnostics much more often reveals benign nodules in this organ, whose activity is associated with the production of hormones (90% -95% and 5% -10%). This suggests the need for a conscientious differential diagnosis.
Signs and symptoms of thyroid cancer
Patients complain about:
Formation of nodular clots in the thyroid gland.
Noticeable enlargement of the cervical lymph nodes.
The larger the tumor, the more obvious the symptoms. They relate to pressure from the structures of the neck:
hoarse voice,
coughing fits,
swallowing failure,
shortness of breath,
suffocation,
local pain.
Other symptoms of thyroid cancer include:
sweating
causeless weakness,
poor appetite,
noticeable weight loss.
If the patient is a child, the disease is relatively slow and more benign. Younger patients face a predisposition to lymphogenous tumor metastasis. In older adults, germination of the surrounding organs of the neck is often present.
Causes of thyroid cancer
Previous thyroid cancers are benign in nature:
adenoma,
goiter,
proliferating cystadenoma.
Cancer also develops as a result of diseases:
Female reproductive organs.
Directly the thyroid gland and other endocrine organs are among close relatives.
Tumors and dyshormonal diseases of the mammary glands.
Harm at work.
Severe mental disorder.
Often, cancer affects people who live in areas where endemic goiter is distributed. Also, often such a disease becomes a consequence of reaching a certain age.
Types of thyroid cancer
Thyroid tumors can be classified into two broad categories – benign and malignant. In the first category, there are divisions such as follicular and papillary adenoma.
The disease is divided into a number of varieties:
papillary (average 76%),
follicular (average 14%),
medullary (on average 5-6%),
undifferentiated and anaplastic (these varieties account for 3,5-4%).
There are quite rare varieties, which include sarcoma, lymphoma, fibrosarcoma, epidermoid and metastatic cancer. Their share occupies, in total, 1-2% of existing malignant neoplasms of the thyroid gland.
Medullary thyroid cancer
Medullary cancer of an organ such as the thyroid gland is the third most common type of this disease (from 5 to 8%).
This is easy to identify with the help of relevant statistics. Compared to papillary and follicular, which have their own methods of origin, medullary cancer can arise from a source such as parafollicular cells. With their participation, the hormone calcitonin is synthesized. It is not needed for metabolism when compared with the value of other hormones of this organ. The synthesis of this hormone is conveniently controlled by performing an appropriate operation to control the presence of cancer cells and possible recurrence.
This disease is accompanied by a low cure rate against the background of differentiated cases. But in this variety, the effectiveness of treatment methods is even lower. The 10-year survival rate reaches 90% – here cancer cells develop only in this organ, in 70% it spreads to the cervical lymph nodes. 20% are cases with distant metastases.
Follicular thyroid cancer
Follicular thyroid cancer is statistically the second most common form of thyroid cancer (~15%). It often develops in children, as well as in patients of the older age group, which is somewhat higher than the statistics of papillary carcinoma. It has a more aggressive course and is more malignant than papillary carcinoma.
Age remains a very important factor. In patients from the group older than 40 years, the tumor has a more aggressive course. The concentration of radioactive iodine is excluded, as in younger patients. Compared to papillary carcinoma, it almost never develops as a result of radiation therapy. With vascular invasion, the mortality rate from follicular carcinoma increases. In the case of follicular carcinoma, vascular invasion can be diagnosed (tumor tissue grows into a blood vessel).
At the same time, metastasis affects distant organs and can threaten:
easy,
bones
brain,
bladder
skin.
In patients with follicular carcinoma, lymph node involvement is much less common when compared with papillary carcinoma.
papillary thyroid cancer
The most common is papillary thyroid cancer. This form is diagnosed in 85% of all malignant thyroid pathologies. In women, papillary thyroid cancer occurs three times more often. As a rule, it is diagnosed in subjects aged 30-50 years. As a rule, the early stage of papillary cancer is detected by palpation or ultrasound.
In 30%, this formation captures the cervical lymph nodes after the operation. As a rule, papillary thyroid cancer metastasizes to the bones and lungs. The complexity of diagnosis is associated with the slow development of this disease.
Papillary thyroid cancer is treated quite safely. In this case, its early diagnosis is recommended. The operating method is shown, that is, thyroidectomy.
capillary thyroid cancer
Capillary cancer can capture different lobes of the thyroid gland. He has several degrees. It is often diagnosed after an operation on the organ. Concomitant diseases can be distinguished, among which are hypertension, calculous cholecystitis, deforming osteoarthritis of the knee joints, exogenous constitutional obesity at different stages, and chronic atrophic gastritis.
Radioiodine therapy is a branch of nuclear medicine. It is designed specifically as a treatment for papillary thyroid cancer. It is unable to relieve the symptoms of other types of thyroid cancer.
It is necessary to consider: many often make the mistake of trying to find information about capillary thyroid cancer online. It does not exist, and is usually called papillary cancer.
Anaplastic thyroid cancer
Anaplastic thyroid cancer is considered the rarest. It accounts for 0.5 – 1.5%. Meanwhile, this is the hardest form in this case.
This form has such differences as the lowest frequency of cure. For 3 years, only 10% of patients with a diagnosis of anaplastic thyroid cancer survived. As a rule, after its detection, the patient can live only a year.
Anaplastic cancer belongs to differentiated forms and can even originate from a goiter. There are frequent cases when it is diagnosed only after a considerable number of years (more than 20) after the patient has been exposed to radiation. If the presence of metastases in the areas of the cervical lymph nodes is detected, we can talk about the frequent occurrence of relapses and high mortality.
This pathology differs in that, as a rule, it manifests itself quite noticeably. The patient himself or one of his close relatives, one of the attentive people around him is able to identify it, since the swelling on the neck is quite noticeable. It is clear to the patient himself: the swelling grows literally before our eyes, within a few days, in a long-term case – weeks. When carrying out the palpation, it is easy to distinguish it by its large size and density. The tumor grows very quickly. Every day its size increases.
Anaplastic cancer captures neighboring tissues and organs, giving metastases to the region of the cervical lymph nodes and those organs that are somewhat further away, not excluding the lungs and bones. When this disease is detected, the tumor begins to grow into the trachea in 25% of cases. Accordingly, often in patients with a similar diagnosis, there is a need for a tracheostomy.
When the diagnosis is established, lung metastases are detected in 50% of patients. This type of cancer grows very quickly in those organs of the neck that are considered vital. That is, when diagnosed, it already becomes inoperable. Even the use of the most intensive therapy – hyperfractionated radiation, chemotherapy and surgery is ineffective.
Stages of thyroid cancer
Understanding how far the tumor has spread is very important. Thyroid cancer is staged to determine treatment options. This can be done after the disease is diagnosed and additional studies are carried out. This helps to determine how spread the cancer cells are and whether they have metastasized to other parts of the body.
The stage of the disease remains a decisive role in planning the appropriate treatment or surgery. This oncological disease is not a leader in the category of malignant pathologies. But its consequences can be dangerous. Diagnosis, in this case, is quite accurate, but still, over the past decades, the incidence has increased. Moreover, the disease is detected at the onset of advanced stages, when a successful cure seems unlikely. Symptoms are a big problem. In the early stages, it is almost absent. The patient consults a specialist when the disease has acquired an advanced form.
stage 1 thyroid cancer
Stage 1 thyroid cancer is a small tumor. It does not exceed 2 cm in diameter. Its location is inside the gland. The patient is able to independently identify a small seal.
stage 2 thyroid cancer
Stage 2 thyroid cancer is recognized by an enlarged tumor (up to 4 cm), but it is still within the boundaries of the capsule.
Of the symptoms – slight discomfort, the formation can be felt and seen. If you start treatment at this stage, it will be successful in 95% of cases.
stage 3 thyroid cancer
Stage 3 thyroid cancer becomes larger than 4 cm. Symptoms become very pronounced. Due to the fact that the tumor compresses nearby organs, in particular, the trachea, swallowing is difficult. Due to physical exertion, shortness of breath occurs, an asthma attack can be diagnosed.
As a result of squeezing the esophagus, dysphagia occurs. Due to damage to the recurrent nerve, the mobility of the vocal folds is impaired. This results in hoarseness or hoarseness. But there are times when changes in the voice are not very pronounced. Then the lesion can only be detected through laryngoscopy. At this stage, the size of the lymphatic regional nodes will be increased.
stage 4 thyroid cancer
Stage 4 thyroid cancer can be recognized by the worsened condition of the patient. Neighboring organs and tissues are covered by the tumor, and its metastases are easily detected in the systems of the lungs, bones, esophagus, etc.
Clinical manifestations will depend on what kind of organ is affected by metastases. If it touched the lungs, coughing fits, the appearance of blood in the sputum are characteristic. If the brain is affected, causeless headaches occur.
Stage 4 symptoms are as follows:
anorexia,
seemingly unexplained weight loss
marked increase in body temperature
How to identify thyroid cancer?
To confirm the diagnosis, some tests are needed. Previously, the basic measure was considered to be the clarification of the functions of the thyroid gland. If they were violated, then there was a disease. But thyroid cancer cannot be diagnosed in this way. According to statistics, the work of hormones in relation to the affected organ changes markedly, their activity is shown by 1% of thyroid formations.
When the disease is just activated, it is recognized by an increase in a small tumor that occurs in one of the lobes of the organ. It is characterized by certain sensations:
unevenness, bumpiness,
a problem with mobility
the organ affected by the pathology is as if squeezed by something,
suffocation.
There are several classical methods for diagnosing this disease:
The medical facility will offer a radioisotope scan. This is not the best method, it will not help to figure out what kind of pathology it is – benign or malignant. This method has become valuable for diagnosing metastases of a developing disease, since they have the property of accumulating iodine-containing drugs.
Puncture biopsy allows most accurately, under medical conditions, to diagnose benign and malignant nodes of the organ, when differentiation is maintained. This is the best opportunity to obtain accurate data on the presence of a histological form of the tumor. Also, with its help, they will find out how much the tumor has grown.
There are cases when the diagnosis of the disease is complicated – then it makes sense to resort to the histological base of analysis, research, when the operation is already being performed. On the basis of the data that can be obtained, many useful conclusions are made – about the need for medical intervention, its volume, and so on.
To identify the degree of deterioration of the recurrent nerves can be a number of methods:
Laryngoscopy If such a pathology of the vocal cords as paralysis has already developed, we can say that the head nerve is affected.
Bronchoscopy. If you want to establish the condition of the trachea and determine how much it is narrowed, enough bronchoscopy.
In some cases, it makes sense to turn to the help of X-ray instruments:
In such a diagnostic procedure as pneumography of the thyroid gland, the task is to identify the size of the tumor.
With the help of angiography, a picture of a violation of the vascular network is drawn
A procedure such as an X-ray of the trachea, followed by a barium-based contrast detection of the condition of the esophagus, may be prescribed – this helps to determine what the patient’s pressure is or how far the germination of the tumor has started.
Considerable importance in the diagnosis is assigned to ultrasound (ultrasound) of the organ, despite the controversial attitude towards this method. It allows – but with some problems – to distinguish cancer. But this does not diminish its security in the least. This method gives excellent visual results. This explains why this not new tool is used as an effective technology for preventive examinations of patients of the so-called “high risk” category. Ultrasound is the best way to understand if nodular structures of the thyroid gland have formed if they could not be detected by palpation.
Prognosis of the disease
The prognosis of the disease of a malignant tumor of the thyroid gland should be justified visually. This is possible thanks to simple research. Unfortunately, this is of little help if cancer is suspected. Less than 1% of thyroid tumors can be endowed with hormonal activity.
At a certain stage, the diagnosis is carried out quite simply, in this case, it is possible to get by with the detection of an increase in the tumor of one of the lobes of the gland. The clinical picture is based on the morphological structure of the tumor.
Highly differentiated are characterized by slow growth, often without leading to a violation of the function of the gland. It is worth paying attention to:
the rapid growth of each diseased node, especially in men (palpation brings pain, the formation seems dense, hilly, without clear boundaries),
growth of the lymph nodes of the neck (palpation brings a feeling of painlessness, they are dense, fused together),
signs characteristic of compression of the mediastinal organs, the area of the sympathetic nerve trunk,
symptoms of transition to the cartilage of the larynx, trachea (dysphagia is formed, hoarseness of the voice, swallowing is difficult, as is speech).
Some laboratory parameters are also important. So, the presence of a slight leukocytosis is characteristic of the pseudo-inflammatory form, the ESR remains normal or slightly increased, etc.
Treatment of thyroid cancer
To determine the tactics of treatment, it is required to determine the histological nature of the formation, the degree of its aggressiveness, the number of diseased cells, age, and so on. To determine these data, each case must be studied separately, since there is always room for some features within the limits of the possible.
Thyroidectomy. If we talk about radical treatment, in this case, it is recognized as a thyroidectomy of the lymph nodes and tissue in the neck (in other words, their removal). In order to have a chance to avoid subsequent possible endocrine disorders in childhood, a small volume of the unaffected area of the thyroid gland is kept (a similar operation is called subtotal thyroidectomy).
With untimely diagnosis before surgery, minimal intervention is sometimes carried out. This means that a second operation is inevitable when a radical volume with radiation is organized. This procedure is carried out at the pre- or postoperative stage. If a certain situation develops, then it is better to resort to another method – a systemic one. First of all, remote gamma therapy will be required for the primary tumor, which also extends to the areas of regional metastasis in the neck area. Then they resort to the technique that represents a radical surgical medical intervention.
Hormones. If hypothyroidism develops after the removal of the gland by the surgical method, you have to prescribe thyroid hormone in the form of a medication for life. It is also known that the production of thyroid-stimulating hormone is suppressed by medication.
radioactive iodine. The variant of active treatment in relation to metastases of a remote location is considered to be a unique characteristic of the development of the disease. If we talk about other organs in which metastasis can be localized, especially multiple, a radical effect is contraindicated.
Metastases of such a pathology as thyroid cancer can be easily cured with such a medical remedy as radioactive iodine. It has it on distant metastases, they disappear almost completely. This is not a panacea, but radioactive iodine can significantly improve the condition of a patient with thyroid cancer.
Chemotherapy, radiation and tracheostomy. When forms of especially common thyroid cancer are diagnosed, palliative methods are resorted to, such as radiation therapy or chemotherapy. Then comes the stage when a tracheostomy is acceptable (an operation with opening the trachea and inserting a special tube into the resulting lumen to restore breathing). If the patient has already reached especially dangerous stages, one has to deal with a very disturbing syndrome. It is associated with a feeling of compression of the trachea. Then the operation should be carried out as soon as possible. Otherwise, asthma attacks will begin with the risk of asphyxia. Technically, it can be presented as extremely complex, since the tumor array serves as an obstacle to the trachea.
Disability in thyroid cancer
Thyroid cancer is a disease that is difficult to get rid of with one method of treatment. A combination of several treatments is needed. This category includes surgery, radioiodine therapy, radiation therapy. After treatment, the patient requires lifelong hormone therapy, whose purpose is to replenish the body’s need for hormones. Often the patient prefers to forego the necessary step, because he believes that this will lead to disability. But this is not an aggravating factor, but such is metastasis in thyroid cancer.
In group III, the following should be diagnosed:
moderate hypothyroidism;
mild hypoparathyroidism;
dysfunction of the shoulder joint.
Group II is given to those who suffer from:
bilateral damage to the recurrent nerve.
hypoparathyroidism II degree and severe hypothyroidism;
conducting non-radical treatment;
who is diagnosed with a dubious prognosis;
Group I is determined when:
severe hypoparathyroidism;
undifferentiated oncology and generalization of the process;
severe hypothyroidism with the development of severe myopathy, as well as myocardial dystrophy.
With a malignant neoplasm of the thyroid gland, the average period of temporary disability of patients who have undergone radical treatment is up to 3 months. After the operation, a period of rehabilitation is required. Its duration is calculated depending on the type of malignant tumor, the stage of the disease and the method of surgical intervention. If radiation and chemotherapy are performed, a longer period of disability can be expected. Statistics confirm: partial rehabilitation occurs in 77% within three years. Full rehabilitation requires more time – sometimes up to 5 years or more.
The indication may be a recurrence of cancer, the absence of the effect of therapy in those affected by undifferentiated forms.