Thyroid cancer: signs, diagnosis and treatment
Thyroid cancer is a fairly common oncological disease.The cause of this pathology is malignant degeneration of the epithelial cells of the gland.
In the endocrine organ, there are 3 types of cells - A and B cells responsible for the secretion of hormones, as well as C-cells.Table of Contents: Classification Causes of Thyroid Cancer Major Symptoms of Thyroid Cancer Diagnosis Treatment of Thyroid Cancer
According to the current classification, the following forms of thyroid cancer are identified:
- follicular( about 15% of cases);
- papillary( up to 75% diagnosed with carcinoma);
- anaplastic( less than 5%);
- is medullary( about 8%).
Among other types of oncological lesions of the thyroid gland include squamous cell carcinoma, various sarcomas of this endocrine organ, squamous cell carcinoma and lymphoma.
Important: follicular and papillary forms are classified as highly differentiated.They develop from A- and B-cells, as well as the most aggressive tumor - anaplastic cancer.
Medullary carcinoma is a consequence of the degeneration of C-cells.
In the early detection and comprehensive adequate treatment of highly differentiated carcinomas in most cases, the prognosis for the patient is favorable.
A much more serious prognosis for medullary thyroid carcinoma.For this form of oncological disease, the spread of metastases to regional lymph nodes is already in the early stages.The 5-year survival rate ranges from 70 to 80%, and the 20-year survival rate, unfortunately, does not exceed 50%.
The most aggressive form of thyroid cancer is anaplastic carcinoma.It is characterized by rapid growth and the rapid spread of secondary foci in a number of organs.The tumor reacts poorly to the therapy.As a rule, after revealing anaplastic cancer, the patient's lifespan does not exceed 1 year.
Causes of thyroid cancer
Among the possible etiological factors of the disease are:
- ionizing radiation;
- family predisposition;
- is an autoimmune thyroiditis.
Important: anaplastic carcinoma occurs more often in patients older than 60 years, so for this form the elderly patient's age can be regarded as one of the predisposing factors.
The main symptoms of thyroid cancer
For thyroid cancer, the asymptomatic course of the disease is very characteristic.In most cases, the first clinical sign of oncology is a nodal neoplasm in the region of this organ or an increase in regional lymph nodes.
Important: nodular thyroid neoplasms are diagnosed in adult patients quite often, but less than 5% of them are carcinomas.In persons younger than 20 years the probability of a malignant neoplasm is significantly higher.
Functional activity of the gland in cancer can remain normal.The decrease or increase in the secretion of hormones is usually observed with highly differentiated tumors of large size or at the stage of metastasis.
Detection of a suspicious node or the appearance of other symptoms of thyroid cancer requires consultation with an endocrinologist.
When determining the size of the tumor and assessing the condition of the body as a whole, ultrasound is used.
The diagnosis is made based on the histological examination of the neoplasm.The sampling of the material for microscopy is performed by means of a fine needle aspiration biopsy.This diagnostic technique is considered the most informative and less traumatic.With its help, it is possible to take material from the nodes less than 3 mm in diameter.The puncture of the organ is carried out under the control of the apparatus for ultrasound examination.If reliable data can not be obtained using this technique, then open biopsy and express pathohistological examination are used.
Scintigraphy( imaging after the introduction of radioactive isotopes) is often used as an additional technique for instrumental research in the diagnosis of thyroid cancer.
A blood test can detect characteristic tumor markers.
Differential diagnosis of cancer with functional pathologies helps to conduct a laboratory study of the level of thyroid-stimulating hormone.The detection of specific antithyroid antibodies can speak of an autoimmune pathology, which in some cases develops in parallel with a highly differentiated papillary carcinoma.With medullary carcinoma, a change in the level of thyrocalcitonin is possible.The likelihood of developing this form of thyroid cancer requires an additional blood test for the RET protooncogene mutation.
Magnetic resonance imaging and X-ray examination are necessary if there are reasons to assume the presence of distant secondary foci( metastasis).
Treatment for thyroid cancer
In this form of pathology, surgical treatment is most often used, which can be supplemented / replaced by radioiodine therapy and medication use
The main treatment for malignant tumors of the thyroid gland is total organ resection.In some cases, the question of partial preservation of the gland may be raised.If suspicion of the presence of metastases during the operation, cervical lymph nodes are also removed.The volume of surgical intervention is determined directly by the surgeon-endocrinologist.Recurrence of the disease is an indication for repeated intervention to remove secondary foci in the mediastinal lymph nodes.
Suppressive TTG therapy
In the postoperative period, the patient is treated with hormone therapy in the treatment of thyroid cancer.Its goal is to reduce the level of TSH, which is synthesized in the pituitary gland.A low level of thyroid-stimulating hormone allows to avoid stimulation of individual cells left after resection of the gland.
As an additional treatment technique, after total organ resection for papillary and follicular carcinoma, the introduction of radioactive iodine is used.
Direct irradiation is considered to be ineffective.
Konev Alexander, internist