VERIFIED CONTENTConsultation: Prof. dr hab. n. med. Marcin Barczyński, specialist in general surgery, specialist in oncological surgery, SCM clinic in Krakow

Thyroid cancer is currently in the sixth place in terms of the frequency of occurrence in women and already accounts for 4 percent of all malignant neoplasms diagnosed in Poland. What are the risk factors and symptoms of thyroid cancer? What is its diagnosis and treatment? These questions are answered by prof. dr hab. Marcin Barczyński, specialist in general and oncology surgery, with European subspeci alty in the field of endocrine surgery from SCM clinic in Krakow.

Thyroid cancercan occur at any age, but the most cases are between the ages of 40 and 50. Prof. dr hab. Marcin Barczyński notes that it is difficult to clearly identify factors predisposing to it, while it is assumed that the mere presence of benign nodules may be a factor contributing to the occurrence of more serious problems. And yet nodular changes in the thyroid gland occur in nearly half of the Polish population. Fortunately, most of them are mild in nature, with only 1-2 percent being cancer.

Thyroid cancer - symptoms

Thyroid cancer often has no specific symptoms. Therefore, as emphasized by prof. dr hab. Marcin Barczyński, it is worth carrying out regular thyroid self-examination.

- It allows us to check if we do not notice any lumps or asymmetries within the thyroid gland, and whether we feel any clear hardening under the fingers. To do it, just lift your head and watch your thyroid gland in the mirror while swallowing. Then, in the same pose, carefully touch this part of the neck - explains the oncologist.

In addition, regular ultrasound of the thyroid gland is a very important preventive examination. It allows you to visually assess this gland - its size, structure and the presence of any nodules, as well as their phenotype.

- The change that should be worrying, usually has irregular boundaries, is hypoechoic and has microcalcifications - adds the specialist. If the disease is already well developed, symptoms such as:

  • shortness of breath
  • hoarseness
  • difficulty swallowing

This is itrelated to the large size of the tumor that infiltrates the surrounding structures on the neck.

Thyroid cancer - causes

- The incidence is several times higher among women for whom past pregnancies constitute an additional burden. The reasons for this are not fully understood, but it is assumed that women are subject to much greater hormonal influence than men, which in this case may be of key importance - says Prof. Marcin Barczyński.

Obese people and those who also suffer from insulin resistance are also exposed to thyroid cancer. It turns out that the greatest increase in the incidence is observed in highly developed, rich countries, where we have a lot of obesity. Because obesity is a risk factor for many cancers, including thyroid cancer.

As emphasized by prof. dr hab. Marcin Barczyński, adipose tissue can serve as a reservoir of environmental toxins, such as pesticides, which damage the DNA of thyroid cells and activate carcinogenic pathways.

In addition, ionizing radiation contributes to the formation of this type of changes. It was previously assumed that the Chernobyl catastrophe had an impact on the increase in the incidence of thyroid cancer in Poland, which has not been proven.

It has been estimated that throughout his life, a statistical Pole will receive a dose of about 0.9 mSv from the Chernobyl fallout, i.e. 0.5 percent of the dose that will be irradiated from natural sources.

For example, the annual background radiation dose (mainly due to radon present in the house) is approx. 3 mSv. However, the widespread use of radiological examinations in medicine, especially computed tomography, is not without significance.

For example, a single CT scan of the abdominal cavity is associated with a dose of about 10 mSv. However, it should be clearly stated that the performance of such a test is considered safe, as long as it is justified on medical grounds.

The thyroid is also adversely affected by the lack of nutrients in the diet that are necessary for its proper functioning, such as iodine, iron, zinc, selenium, B vitamins, as well as vitamin C and vitamin D.

Thyroid cancer - diagnosis

The biggest problem for people struggling with thyroid cancer is too late diagnosis. At the time of diagnosis of a thyroid tumor or suspicious focal lesions, it is necessary to perform a fine needle aspiration biopsy (FNAB). Cytological evaluation of the collected material allows for a preliminary diagnosis, which in turn enables the selection of the optimal procedure for a given patient, e.g. further observation or possible surgeryoperating.

AspirationFine needle aspiration consists in aspiration of the cell suspension together with the intercellular fluid from the examined lesion by inserting a thin needle. Therefore, only cells are collected from the patient, not tissue samples, which are then subjected to cytological examination. During the examination, the pathologist assesses their appearance without assessing the tissue structure.

Fine-needle biopsyis usually performed under ultrasound guidance (it is then called a targeted fine-needle aspiration biopsy - FNAB), thanks to which it is possible to precisely collect material even from small lesions. Due to the fact that thin needles are used, it is performed without anesthesia. It is a simple and quick examination with usually no complications.

Blood tests are not helpful in this case, apart from determining the concentration of calcitonin - a hormone secreted by the C cells of the thyroid. A significant increase in its concentration suggests the diagnosis of medullary thyroid cancer.

Thyroid cancer - types

There are four main types of thyroid cancer:

  1. papillary,
  2. bubble,
  3. core
  4. and anaplastic.

Other types of thyroid neoplasms are: lymphoma, sarcoma, fibrosarcoma and metastases to the thyroid gland of neoplasms in other locations. About 10 percent of patients with nodular goiter have cancer (latent cancer) in the removed thyroid parenchyma.

  • Papillary carcinoma of the thyroid gland ( carcinoma papillare )

Papillary thyroid cancer is the most common - it currently accounts for over 80% - 85% of malignant thyroid neoplasms. It is considered the mildest form: it grows slowly and has a mild clinical course. It usually occurs at a young age, and is twice as common in women.

Papillary cancer is often multifocal, rarely crosses the capsule of the thyroid gland, and may metastasize to regional lymph nodes. Papillary carcinoma may be asymptomatic or as a form of latent carcinoma, detected accidentally in the examination of the removed gland due to nodular goiter. Papillary thyroid carcinoma less than 1 cm in diameter is called papillary thyroid carcinoma.

  • Thyroid follicular cancer ( carcinoma folliculare )

Thyroid follicular carcinoma accounts for about 10% -15% percent of malignant thyroid neoplasms, most often it occurs in people between 40 and 50 years of age who live in areas of iodine deficiency.

It grows slowly, and through blood vessels it metastases, usually to bones and lungs. It occurs most often as a single tumor, and invasively infiltrates the purse,gland flesh and blood vessels.

  • Medullary thyroid cancer ( carcinoma medullare )

Medullary thyroid cancer accounts for approximately 5 percent of all thyroid cancers. It usually appears after the age of 50, is multifocal, and develops slowly in both lobes of the thyroid gland. This cancer spreads through the lymphatic pathways and metastasizes to the lymph nodes in the neck and mediastinum.

Blood metastases are most often found in bones, liver and lungs.

Medullary thyroid cancer may coexist with other neoplasms of the endocrine glands. There are two types of medullary cancer:

  1. sporadic medullary thyroid cancer - accounts for about 75 percent of cases of this type
  2. genetically-hereditary medullary thyroid cancer accounts for approximately 25 percent of cases of this type.
  • Undifferentiated cancer or anaplastic carcinoma of the thyroid gland ( carcinoma anaplasticum )

Anaplastic thyroid cancer is a high-grade neoplasm with a very poor prognosis, often in the absence of radical treatment. It accounts for 5 to 10 percent of all thyroid cancers and appears most often in the 4th decade of life and beyond.

Develops rapidly in both lobes of the thyroid gland and invades adjacent tissues. They spread rapidly, both to the regional lymph nodes and through the bloodstream to the lungs, bones and brain.

  • Metastasis of other malignant neoplasms to the thyroid gland

Metastasis of other neoplasms to the thyroid gland accounts for as much as 5 percent of all malignant neoplasms of the thyroid gland. Metastases to the thyroid gland result in kidney cancer, lung cancer, breast cancer, ovarian cancer, melanoma. The prognosis is usually unfavorable and results from the advancement of the primary tumor (blood metastasis).

Thyroid cancer - treatment

Treatment of thyroid cancer is complex. Its basis is the excision of the entire organ or one lobe (depending on the size of the tumor), as well as the metastatic lymph nodes in the neck.

Surgical treatment is supplemented by the administration of radioactive iodine, which is designed to destroy the remnants of diseased tissue and metastases.

There is also a group of patients who benefit greatly from suppressing TSH with L-thyroxine, a hormone secreted by the thyroid gland.

  • Surgical techniques in the treatment of thyroid cancer

The thyroid gland is located on the neck, in a very visible place. It is therefore not surprising that patients, especially women, are concerned about the scars that may remain after surgery on this gland. Currently in thyroid surgery (similarlyas in other surgical fields), the goal is to be minimally invasive. This is to improve the cosmetic effects of the operations performed.

As emphasized by prof. dr hab. Marcin Barczyński in Poland, surgeries of thyroidectomy through the atrium of the oral cavity (TOETVA) are already performed.

- These types of operations do not leave any scars on the skin, and their effectiveness and safety is the same as in the case of traditional cutting. Of course, the patient must first be properly qualified for such an operation. What's more, during such an operation, as in the case of traditional ones, you can use neuromonitoring. It is a technology that allows you to avoid another very unwanted complication of thyroid surgery, i.e. problems with the voice.

- Due to the fact that the thyroid gland adheres to the larynx, hoarseness or weakening of the volume of voice may be a side effect after surgery, which results from damage to the mobility of the vocal cords. In most cases, these problems are of a temporary nature, but there are also cases of permanent voice damage, which is associated with the need for phoniatric rehabilitation. The solution to this problem may be prevention, i.e. surgery using neuromonitoring of the laryngeal nerves - says the SCM clinic specialist.

The operation with the use of neuromonitoring consists in intubating the patient with a tube with the so-called integrated electrodes placed between the vocal folds. The electrode tube is attached to the monitor, and during the operation, the doctor uses a probe to monitor the condition of the nerves responsible for the voice, while stimulating the tissues with a low-intensity current to locate the nerves.

It is also possible to apply an electrode to the vagus nerve, so that it is possible to automatically control that the entire reflex arc of the nerve responsible for voice production is preserved.

Highly differentiated thyroid cancer (papillary cancer and follicular cancer), which is the most common, has a very good prognosis. This is evidenced by the fact that despite the increase in morbidity observed in recent years, the number of deaths due to this disease remains at a constant and relatively low level. This is due to the access to detailed diagnostics and continuous development of treatment methods.

What is life like after a total thyroidectomy?

The patient is forced to take medications that replace thyroid hormones for the rest of his life, which the excised gland can no longer produce. The thyroid removal procedure is synonymous with hypothyroidism, so the treatment of such a patient is similar to that of a patient undergoing treatment for hypothyroidism.thyroid gland.

Additionally, after the gland excision surgery, you need to undergo regular checkups with an endocrinologist, including TSH level monitoring and possible thyroxine dose modifications.

If the thyroidectomy was due to non-neoplastic diseases or a malignant neoplasm, and the patient does not require further oncological treatment, remain under the supervision of an endocrinologist.

If there is a need for further complementary oncological treatment, it is carried out by a multidisciplinary team of doctors, incl. endocrinologist, oncologist, nuclear medic and others.

Convalescence after thyroidectomy

It is recommended that the patient should refrain from physical exertion or even excessive exercise immediately after the operation, as this may lead to wound dehiscence and bleeding. In order to speed up recovery, it is recommended that you massage your neck after the procedure, or ask someone else to do it, as well as perform exercises that gradually expand the mobility of the neck and head.

Usually after a few (3-4 weeks) after the thyroidectomy, the patient may return to the activity undertaken before the surgery. There are no particular contraindications as to the amount and type of exercise that will be chosen by the patient. The same goes for diet.

The postoperative scar is hardly visible because the sutures used to sew the wound are either dissolving or are removed quickly, usually as early as 4-5 days after the procedure. After 2 weeks, you can use scar preparations in the form of a gel or ointment. This is good news, especially for people who care about aesthetic appearance.

Convalescence after thyroidectomy also includes the need to perform the aforementioned check-ups and oncological examinations (if necessary).

  • Thyroid nodules (thyroid adenomas) - causes, symptoms, treatment
  • Removal of the thyroid gland: postoperative examinations and checks
  • Thyroid diseases: causes, symptoms, tests, treatment
  • Hashimoto's disease: causes, symptoms, treatment
About the ExpertProf. dr hab. n. med. Marcin Barczyński general surgery specialist, specialist in oncological surgery

Prof. Dr. Marcin Barczyński, MD, PhD is a specialist in general and oncological surgery, with a sub-specialization in endocrine surgery at SCM clinic in Krakow. He is the president of the European Society of Endocrinologist Surgeons.

At SCM clinic, he carries out general, endocrine and oncological surgery procedures and is also an ultrasound diagnostician.

Category:

Oncology