Thyroid Cancer: Symptoms and Treatment
Thyroid cancer is a malignant nodule that can develop from epithelium of special characteristics, follicular or parafollicular (C-cells) type. They form naturally in the thyroid gland.
Statistics show that about 5% of thyroid nodules are malignant. Such a disease requires the most radical treatment tactics.
The frequency of the prevalence of this malignant formation reaches about 1.5% of the existing malignant tumors of various localizations. After the tragedy in Chernobyl, the incidence rate has increased significantly. It has spread greatly among children. Most often, this disease of the thyroid gland is diagnosed in women when they are 40-60 years old. This is, in total, 3.5 times more often than men. In the case of radiation exposure, the disease is sensitive to the accumulation of a substance such as radioactive iodine. If there is no fact of the effect of radiation, the health disorder is most likely more related to age.
The peculiarities 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 more often reveals benign nodules in this organ, whose activity is associated with the production of hormones (90% -95% and 5% -10%). This indicates the need for a conscientious differential diagnosis.
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- Signs and symptoms of thyroid cancer
- Thyroid Cancer Causes
- Types of thyroid cancer
- Stages of thyroid cancer
- How is thyroid cancer diagnosed?
- Disease prognosis
- Thyroid cancer metastases
- Thyroid Cancer Treatment
- Disability with thyroid cancer
Signs and symptoms of thyroid cancer
Patients complain about:
- Formation of nodular clots in the area of the thyroid gland.
- A noticeable increase in the cervical lymph nodes.
The larger the swelling, the more obvious the symptoms. They relate to pressure from the neck structures:
- hoarseness of voice
- coughing fits
- swallowing failure,
- local pain.
Other symptoms of thyroid cancer include:
- causeless weakness
- poor appetite
- noticeable weight loss.
If the patient is a child, the disease is relatively slow and more favorable. Young patients are faced with a predisposition to lymphogenous tumor metastasis. In older adults, sprouting of the surrounding organs of the neck is often present.
Thyroid Cancer Causes
Previous diseases of thyroid cancer are benign in nature:
- proliferating cystadenoma.
Also, cancer develops as a consequence of diseases:
- Female genital organs.
- Directly the thyroid gland and other endocrine organs - among close relatives.
- Tumors and dyshormonal diseases of the mammary glands.
- Injury at work.
- Severe mental disorder.
Often people who live in places where endemic goiter is spreading are sick with cancer. Also, often such a disease becomes a consequence of reaching a certain age.
See also: Other Cancer Causes and Risk Factors
Types of thyroid cancer
Thyroid tumors can be categorized 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 the 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 (5 to 8%).
This is easy to identify with the help of relevant statistics. In comparison with papillary and follicular, which have their own methods of generation, 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 in this organ. The synthesis of this hormone can be conveniently controlled by performing an appropriate operation to control the presence of cancer cells and possible relapse.
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 in cases with distant metastases.
Follicular thyroid cancer
According to statistics, the follicular type of thyroid cancer is the second most common form of cancer of this organ (~ 15%). It often develops in children, as well as in older patients, which is slightly higher than the statistics for papillary carcinoma. It has a more aggressive course and exceeds papillary carcinoma in terms of malignancy.
Age remains a very important factor. In patients over 40 years of age, the tumor has a more aggressive course. The concentration of radioactive iodine is excluded, as in younger patients. Compared to papillary carcinoma, it hardly occurs 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:
In patients with follicular carcinoma, lymph node involvement is much less common when compared to papillary carcinoma.
Papillary thyroid cancer
The most common papillary thyroid cancer. This form is diagnosed in 85% of all malignant pathologies of the thyroid gland. 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. Typically, papillary thyroid cancer progresses to bone and lung metastasis. The complexity of diagnosis is associated with the slow development of this disease.
Papillary thyroid cancer is treated fairly well. In this case, its early diagnosis is recommended. The operating method is shown, that is, thyroidectomy.
Capillary thyroid cancer
Capillary cancer can affect different lobes of the thyroid gland. He has several degrees. Often diagnosed after an organ operation. It is possible to identify concomitant diseases, among which are hypertension, calculous cholecystitis, deforming osteoarthritis of the knee joints, exogenous constitutional obesity at different stages, chronic atrophic gastritis.
Radioiodine therapy is a branch of nuclear medicine. It is designed specifically as a treatment for papillary thyroid cancer. It cannot relieve the symptoms of other types of thyroid cancer.
It should be borne in mind: many are often mistaken when trying to find information on the Internet about capillary thyroid cancer. 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 most difficult form in this case.
This form has such differences as the lowest cure rate. Only 10% of patients diagnosed with anaplastic thyroid cancer survived for 3 years. As a rule, after its identification, the patient can live only a year.
Anaplastic cancer belongs to the differentiated forms and can even arise from goiter. There are frequent cases when it is diagnosed only after a considerable number of years (more than 20) after the patient was exposed to radiation. If the presence of metastases in the regions of the cervical lymph nodes is revealed, 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. It can be detected by the patient himself or by someone from close relatives, someone from attentive others, 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 case - weeks. When carrying out feeling, it is easy to distinguish it by its large size and density. The tumor grows very quickly. Its size increases every day.
Anaplastic cancer captures adjacent tissues and organs, spreading metastases to the region of the cervical lymph nodes and those organs that are located somewhat at a distance, 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 tracheostomy.
When a diagnosis is made, 50% of patients have metastases in the lungs. 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 therapy, 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 research is carried out. This helps to determine how common the cancer cells are and whether they have metastasized to other parts of the body.
The stage of the disease has a decisive role to play in planning an appropriate treatment or surgery. This cancer 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 increase in incidence has increased. Moreover, the disease is detected at the onset of advanced stages, when a successful cure seems unlikely. The peculiarities of symptoms are a big problem. In the early stages, it is almost absent. The patient consults a specialist when the disease has become advanced.
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 capsule boundaries.
Of the symptoms - minor discomfort, education 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 more than 4 cm in size. Symptoms become severe. Due to the fact that the tumor squeezes the nearby organs, in particular, the trachea, swallowing is difficult. Due to physical exertion, shortness of breath occurs, an attack of suffocation can be diagnosed.
As a result of compression of the esophagus, dysphagia occurs. Due to the defeat of the recurrent nerve, the mobility of the vocal folds is impaired. This leads to hoarseness or hoarseness. But there are times when the changes in the voice are not very pronounced. Then the lesion can only be detected by laryngoscopy. At this stage, the size of the regional lymph nodes will increase.
Stage 4 thyroid cancer
Stage 4 thyroid cancer can be recognized by the deteriorating 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 which organ is affected by metastases. If it touched the lungs, coughing fits, the appearance of blood in sputum are characteristic. If the brain is affected, there are unreasonable headaches.
Stage 4 symptoms are as follows:
- violation of appetite,
- seemingly unreasonable weight loss,
- noticeable increase in body temperature
How is thyroid cancer diagnosed?
Some tests are needed to confirm the diagnosis. Previously, the basic measure was considered to be the specification of thyroid function. If they were violated, it means that there was a disease. But thyroid cancer cannot be diagnosed 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 its enlargement, a small tumor that arises in one of the lobes of the organ. It is characterized by certain sensations:
- unevenness, tuberosity,
- emerging mobility problem,
- the organ affected by the pathology seems to be squeezed by something,
There are several classic methods for diagnosing this disease:
- The medical facility will offer radioisotope scanning. This is not the best method, it will not help you figure out what kind of pathology it is - benign or malignant. This method has become valuable for the diagnosis of metastases of a developing disease, since they have the property of accumulating iodine-containing preparations.
- Puncture biopsy allows the most accurate, in medical conditions, to diagnose benign and malignant nodes of the organ, when the difference remains. This is the best opportunity for obtaining accurate data on the presence of the histological form of the tumor. Also, with its help they 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 the analysis, research, when the operation is already being carried out. Based on the data that can be obtained, many useful conclusions are made - about the need for medical intervention, its volume, etc.
A number of methods can be used to determine the degree of deterioration in the condition of the recurrent nerves:
- Laryngoscopy. If such a pathology of the vocal cords, such as paralysis, has already developed, we can say that the head nerve is affected.
- Bronchoscopy. If it is required to establish the condition of the trachea and determine how much it is narrowed, bronchoscopy is sufficient.
In some cases, it makes sense to seek the help of X-ray instruments:
- In a diagnostic procedure such as thyroid pneumography, the task is to identify the size of the tumor.
- Using angiography, a picture of a violation of the vascular network is drawn
- A procedure such as an X-ray of the trachea may be prescribed, followed by a contrast detection of the state of the esophagus based on barium - this helps to establish what the patient's pressure is or how advanced the growth of the tumor is.
- Considerable importance in the diagnosis is assigned to the ultrasound examination (ultrasound) of the organ, despite the controversial attitude towards this method. It allows - but with some problems - to be different from cancer. But this does not diminish his safety in the least. This method gives excellent visual results. This explains why this is not a new tool is used as an effective technology for preventive examinations of patients in the category of the so-called "high risk". Ultrasound is the best way to understand if the nodular structures of the thyroid gland have formed, if they could not be detected by palpation.
The prognosis of the disease of a malignant tumor of the thyroid gland must be clearly justified. 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 quite simple, in this case, it is possible to do with the identification of an increase in the tumor in 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 dysfunction of the gland. It is worth paying attention to:
- the rapid growth of each sore node, especially in men (palpation brings painful sensations, the formation seems dense, hilly, without clear boundaries),
- growth of lymph nodes in the neck (palpation bring a feeling of painlessness, 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, hoarseness of the voice are formed, swallowing is difficult, like speech).
Some laboratory parameters are also important. So, the presence of insignificant leukocytosis is characteristic of the pseudo-inflammatory form, ESR remains normal or slightly increased, etc.
Thyroid Cancer Treatment
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, etc. To determine these data - each case must be studied separately, since there is always room for any peculiarities within the possible.
Thyroidectomy. If we talk about radical treatment - in this case, it is recognized as thyroidectomy of the lymph nodes and tissue in the neck (more simply, their removal). So that in childhood there are chances to avoid subsequent possible endocrine disorders, a small volume of the unaffected area of the thyroid gland is preserved (such an operation is called subtotal thyroidectomy).
In case of untimely diagnosis, minimal intervention is sometimes performed before surgery. This means that a second operation is inevitable when a radical volume with irradiation is organized. This procedure is carried out at the pre- or postoperative stage. If a certain situation arises, then it is better to resort to another method - the systemic one. First of all, external gamma therapy will be required for the primary tumor, which also extends to the areas of regional metastasis in the neck region. Then they already resort to the technique that represents a radical surgical medical intervention.
Hormones. If hypothyroidism develops after the removal of the gland by an operation method, it is necessary to prescribe thyroid hormone in the form of a medical preparation for life. It is also known that the production of thyroid-stimulating hormone is suppressed by medication.
Radioactive iodine. An active treatment option for distant metastases is considered 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 a pathology such as thyroid cancer can be easily treated with a medical agent such as radioactive iodine. It acts precisely on distant metastases, they disappear almost completely. This is not a panacea, but with the help of radioactive iodine, the condition of a patient with thyroid cancer can be noticeably improved.
Chemotherapy, radiation and tracheostomy. When diagnosed with forms of especially common thyroid cancer, they resort to palliative methods such as radiation therapy or chemotherapy. Then comes the stage when tracheostomy is permissible (an operation with opening the trachea and introducing a special tube into the formed lumen to restore breathing). If the patient has already reached especially dangerous stages, he has to deal with a very alarming 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 difficult, since the tumor array serves as an obstacle to the trachea.
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Disability with thyroid cancer
Thyroid cancer is a disease that is difficult to get rid of with one treatment method. A combination of several treatments is needed. This category includes surgery, radioiodine therapy, and radiation therapy. After treatment, the patient needs lifelong hormone therapy, whose purpose is to replenish the body's need for hormones. Often the patient chooses to skip the required step because he believes that this will lead to disability. But this is not an aggravating factor, but such is the metastasis in thyroid cancer.
In group III, the following should be diagnosed:
- hypothyroidism of moderate severity;
- 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 has a dubious prognosis;
Group I is determined when:
- severe hypoparathyroidism;
- undifferentiated cancer 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 in patients who have undergone radical treatment is up to 3 months. After the operation, a rehabilitation period 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 have been 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 the recurrence of cancer, the lack of the effect of therapy in victims of undifferentiated forms.
The author of the article: Bykov Evgeny Pavlovich | Oncologist, surgeon
Education: graduated from residency at the Russian Scientific Oncological Center. N. N. Blokhin "and received a diploma in the specialty" Oncologist"