Thyroid cancer is a malignant tumor that grows from the epithelium of the thyroid gland. In the thyroid gland, there are three types of cells: A, B and C. Of cells of type A and B that normally produce thyroid hormones thyroxin and triiodothyronine, the most commonly differentiated types of thyroid cancer develop: follicular and papillary, as well as a rare and dangerous tumor Anaplastic thyroid cancer. Type C cells develop medullary thyroid cancer (medullary thyroid carcinoma or C-cell carcinoma).
Prevalence of thyroid cancer
Currently, in scientific papers, there are often allegations of an increase in the incidence of thyroid cancer in the inhabitants of our planet. However, if we analyze the statistics, it becomes clear that this is not a true increase in the incidence of thyroid cancer, but an improvement in the detectability of these tumors due to improved diagnostic capabilities (primarily due to the appearance of very sensitive and accurate ultrasound devices that are used in practice Everywhere). Now the diagnosis of thyroid cancer is often made at a node size of 4 mm, and even such small thyroid tumors can cause regional metastases (metastases in the lymph nodes) and distant metastases (in the lungs, bones, liver, brain).
At the same time, the prevalence of thyroid cancer in recent years in some regions has increased not only due to increased diagnostic capabilities. It is well known that accidents at nuclear facilities (and above all the Chernobyl disaster) have led to a significant increase in the incidence of thyroid cancer in Ukraine, Belarus and some regions of Russia. After the accident at the Chernobyl nuclear power plant, a sharply increased number of patients with thyroid cancer and, in particular, patients of childhood, was registered in Ukraine for some time. Fortunately, by the present moment this "wave" of morbidity has come to naught, but among the victims were thousands and thousands of patients.
It is important to note that the regional structure of the incidence of thyroid cancer does not have a clear geographical connection. Widespread in Russia fears that the sun and southern climate can cause thyroid cancer or worsen the lives of patients after surgery, do not have any scientific justification. Southern countries are not characterized by an increased incidence of thyroid cancer. On the contrary, in the northern regions of our planet autoimmune diseases of the thyroid gland are more common, which in some cases can lead to the development of thyroid cancer.
Causes of Thyroid Cancer
Among the possible causes of thyroid cancer, ionizing radiation, heredity, and the presence of autoimmune thyroid diseases (primarily autoimmune thyroiditis) can be indicated. It should be noted that age is not a factor that increases the number of people with thyroid cancer - the peak incidence of follicular cancer and papillary cancer accounts for 30-35 years. Only anaplastic thyroid cancer is directly related to age - it is extremely rare in patients younger than 60 years.
Diagnosis of Thyroid Cancer
Thyroid cancer is most often detected with ultrasound of the thyroid gland in the form of nodal formation. Specific ultrasound signs, which allow to establish the diagnosis of thyroid cancer with 100% accuracy, do not exist. At the same time, a number of signs are described that allow one to suspect the presence of thyroid cancer: they include the dark color of the node (hypoechoence), the presence of fuzzy or uneven contour of the node, the appearance of microcalcinates in the node, the appearance of increased blood flow in the node, specific changes in the ones located next to the thyroid Glandular lymph nodes of the neck (rounding of nodes, appearance of cystic cavities in them).
Diagnosis of thyroid cancer is based on carrying out fine needle biopsy of thyroid nodules. It is this simple, but very informative study that allows you to establish a diagnosis of thyroid cancer. When biopsy without any doubt, can be detected papillary thyroid cancer, medullary thyroid cancer, anaplastic thyroid cancer, squamous cell carcinoma of the thyroid gland and lymphoma. The diagnosis of follicular thyroid cancer with fine-needle biopsy can not be established - it can only be suspected and diagnosed as "Follicular tumor", i.e. A tumor with a 15-20 probability of malignancy.
For differentiated forms of thyroid cancer (follicular cancer, papillary thyroid cancer), as well as for anaplastic cancer, specific hormonal markers do not exist. For medullary thyroid cancer, such an oncomarker is a calcitonin hormone produced by C-cells of the thyroid gland. When there are tumors of the thyroid gland from C-cells, the concentration of calcitonin in the blood increases significantly and usually exceeds 100 pg / ml. If a borderline increase in the level of calcitonin is detected (from 20 to 100), it may be recommended to study the stimulated level of calcitonin, i.e. Study after intravenous calcium gluconate (usually conducted in specialized centers of endocrine surgery and endocrinology).
Symptoms of Thyroid Cancer
It should be noted that in the vast majority of cases, thyroid cancer does not show serious signs and causes almost no complaints. Most patients have a completely normal level of thyroid hormones. For many patients, the diagnosis of "Thyroid cancer" becomes an unpleasant surprise on the background of complete health. Signs of thyroid cancer in most patients are completely absent - it is important to remember this.
However, there are symptoms of thyroid cancer, which can be called very worrying. These include the appearance of hoarseness of voice, a sharp compaction in the thyroid gland, visible to the eye and rapidly growing in the volume of tumor formation in the thyroid gland, violation of swallowing and breathing.
Prognosis of thyroid cancer
It should be remembered that in the vast majority of cases, thyroid cancer is curable at the modern level of medical development. Of course, if a patient is diagnosed with thyroid cancer, the patient will have to be operated on, and the thyroid gland in most cases will have to be completely removed (in some cases, with the surrounding lymph nodes), but after the thyroid gland is removed, the patient remains a perfectly normal person, able to maintain a full Life without any restrictions.
An important role in thyroid cancer is played by the timeliness of the operation performed. Currently, there is scientific evidence that in some cases anaplastic thyroid cancer - the most malignant human tumor - is formed from long-term unoperated papillary thyroid cancer - the most "benign" malignant human tumor. That's why you should not postpone treatment for years. In the vast majority of cases, thyroid cancer requires surgery within 1-2 months after diagnosis, although there are situations that require much faster treatment - for example, if anaplastic thyroid cancer or medullary thyroid cancer is detected.
The best prognosis is papillary thyroid cancer. Mortality in papillary thyroid cancer can be very close to zero - of course, if thyroid cancer is treated by specialists with sufficient experience in this field of medicine, and if the patient accurately fulfills the doctor's recommendations. At the same time, follicular thyroid cancer and medullary thyroid cancer at early stages are completely curable - early diagnosis can significantly improve the results of treatment.
Treatment of Thyroid Cancer
Treatment for thyroid cancer should be carried out by specialists - this is an unshakable rule that is not questioned. The best results are achieved with the treatment in a specialized clinic of endocrine surgery. The concentration of patients with one diagnosis in such clinics leads to the fact that doctors of endocrine surgery clinics are well aware of all the features of treating patients with thyroid cancer. Operations for thyroid cancer should be performed only by endocrinologist-endocrinologists who have an oncologist certificate and perform at least 100 surgical interventions a year on the thyroid gland.
The North-West Endocrinology Center is the Russian leader in the field of thyroid surgery - more than 2100 operations are performed annually in the center. In Europe, there are only three centers that perform a similar volume of operations annually - in Pisa (Italy), in Munich (Germany) and in St. Petersburg. Thyroid cancer is operated in the center of endocrinology daily. Annually more than 700 patients with thyroid cancer are treated in the center. Most of the center's cancer patients have papillary thyroid cancer, somewhat less - follicular thyroid cancer. A rare form of thyroid cancer - medullary cancer - is found in the practice of the center is also very rare. In 2013, 35 patients with medullary thyroid cancer underwent surgery in the center. The leading surgeons of the Endocrinology Center perform up to 400 surgeries on the thyroid gland per year for a long time, so their qualifications are not questioned.
The principle of "one doctor" is professed in the Endocrinology Center: the optimal results of treatment of thyroid cancer can be achieved if both the diagnosis, operation, and further observation for one patient are carried out by one physician who is well versed in the specific nature of this type of tumor and individual characteristics Specific patient. Surgeons-endocrinologists of our center have specialization in surgery, oncology, endocrinology, ultrasound diagnostics, so they can perform all stages of diagnosis and treatment: ultrasound of the thyroid gland, and fine needle biopsy of the node, and operation, and the appointment of additional radiation treatments, and optimal dose selection Hormonal therapy.
Surgery for thyroid cancer
If a patient has thyroid cancer, surgery is unavoidable. In some cases, thyroid cancer requires surgery in the volume of thyroidectomy - complete removal of the thyroid gland. In other cases (with tumors of small size, tumors of low aggression), surgery can be performed in the volume of removal of half of the thyroid gland. When lymph nodes are affected, various kinds of lymphodissection are performed: central lymph node dissection (removal of paratracheal, pre-tracheal, pregortane groups) and lateral lymph node dissection (removal of lymph nodes on the side of the neck).
If a patient has developed advanced thyroid cancer, the operation can be accompanied by significant technical difficulties. Often the tumor has time to surround the vocal nerves or germinate in them. There are also cases of tumor germination in the trachea, esophagus, larynx, muscles surrounding the thyroid gland. For the operation with advanced cancer, it is very important to have a full range of modern equipment: from high-quality operating lamps, microscopes for surgeons to the system of search for the vocal nerves and parathyroid glands.
In the North-West Endocrinology Center, patients with tumors of the thyroid gland are operated using modern equipment:
- ultrasonic harmonic scalpel Ethicon Ultracision (USA),
- bipolar electrocoagulator with feedback ERBE VIO (Germany),
- coagulating clamp ERBE Bi-Clamp (Germany),
- binocular operating loops Univet (Italy),
- NeuroSign neuromuscular stimulator (UK),
- endoscopic operating complex Karl Storz (Germany).
If there is a proper experience in the treatment of thyroid cancer and the necessary equipment for this, in 95% of cases for the operation to be performed it is necessary to spend 2-3 days in a hospital. Skilled surgeons of the North-West Endocrinology Center in 90% of cases do not use the draining of the postoperative wound and apply absorbable cosmetic sutures or skin glue, which allows the patient to take a shower as early as the day after the operation and eliminates the need to bandage and remove the suture after surgery.
In the department of endocrine surgery, where patients are treated, the most favorable and comfortable conditions for patients have been created: each room is equipped with a quality bathroom with a shower, air conditioning, telephone, TV. Free Wi-Fi is available throughout the center for patients. You can see the situation in the center of endocrinology by viewing the virtual tour below.
In a number of cases, after surgical treatment of thyroid cancer, one more treatment stage may be required: treatment with radioactive iodine. Radioiodine therapy is used only for differentiated forms of cancer: papillary thyroid cancer and follicular thyroid cancer. The remaining forms of thyroid cancer do not accumulate radioactive iodine, therefore its use is useless when detected.
Remote radiation therapy is used only in cases when the tumor of the thyroid gland has not completely been removed because of its prevalence, and the treatment with radioiodine can not be performed (the tumor does not accumulate radioactive iodine).
In a number of cases (for example, if a patient is diagnosed with advanced medullary thyroid cancer or papillary cancer with distant metastases that do not accumulate radioactive iodine), chemotherapy is prescribed to patients. Unfortunately, the "classical" chemotherapy for thyroid cancer is practically useless. Treatment of cancer requires the use of the most modern chemotherapeutic drugs from the group of kinase inhibitors (vandetanib, sorafenib, etc.). Some of these drugs are registered in Russia, some are still in the last stages of clinical trials. Specialists of the North-West Endocrinology Center have a significant range of scientific connections in the world, therefore, for patients with thyroid cancer and who need the most modern chemotherapy, participation in treatment in Russia or abroad can be recommended, including treatment In the clinical trials of the most modern drugs.
Treatment after surgery
After the operation and (if it was required) the therapy with radioactive iodine, an important stage of monitoring the patient begins, selecting the right therapy, monitoring the results of treatment. At this stage, there are a significant number of tactical errors caused by insufficient knowledge of the specific treatment of thyroid cancer by physicians. In the vast majority of cases, we have to deal with "re-treatment" of the patient, i.e. Using excessive number of diagnostic and treatment procedures that do not improve the final results of the patient's treatment. Only an experienced endocrinologist-surgeon can determine that "golden mean" in the diagnosis and treatment of thyroid cancer, when, with a minimal number of used medical and diagnostic procedures, ultimately, thyroid cancer is completely cured.