Thyroid cancer: types and causes

Thyroid cancer

– a malignant tumor that develops from thyroid tissue, follicular cells or C-cells (parafollicular). Usually the first symptoms of the disease are swelling and nodes in the neck. Depending on the histological structure, different types of thyroid cancer are distinguished; they differ in varying degrees of aggressiveness and require different approaches to treatment. [1]

Usually, nodules in the thyroid gland are detected during an examination by an endocrinologist or ultrasound, sometimes they are discovered by patients themselves. Nodules can have different sizes, can be single or multiple, “hot” (accompanied by increased levels of hormones) and “cold”. Many patients immediately panic: is it probably cancer?

According to statistics, approximately every twentieth node turns out to be malignant.

. In most cases, this is not cancer, but conditions such as subacute thyroiditis (for example, due to influenza or mumps), Hashimoto's thyroiditis (autoimmune inflammation in the gland), and iodine deficiency.

• Symptoms
• Types of thyroid cancer
• Diagnosis in the early stages
• Stages of thyroid cancer
• Risk factors
• Treatment
• Prevention
• Rehabilitation therapy
• Life expectancy after surgery
• Consequences after surgery
• Life after thyroid cancer treatment

Symptoms

In addition to thyroid nodules, you need to pay attention to symptoms such as:

• swelling and pain in the neck;
• hoarse voice for more than three weeks;
• cough and sore throat;
• difficulty swallowing;
• enlarged lymph node in the neck;
• intestinal upset, facial redness (with medullary cancer).

In the early stages, thyroid cancer often has no symptoms. Regular examinations by an endocrinologist and ultrasound examination help to diagnose it in a timely manner.

Often a malignant tumor develops against the background of other pathological processes in the thyroid gland, such as nodular goiter, adenoma, autoimmune thyroiditis. Already existing nodes gradually increase in size, new ones appear, and their density increases. As metastases spread to regional lymph nodes, they also increase in size. Over time, the thyroid gland becomes so large that the neck becomes deformed.

Often the first symptom of the disease is an enlargement of the affected lymph node. A tumor in the thyroid gland is detected only by the results of a biopsy after its removal. This type of thyroid cancer is called latent.

In the later stages, when the tumor grows into the esophagus, trachea, compresses the recurrent laryngeal nerve, hoarseness of the voice, difficulty breathing, and coughing occur, during which sputum with blood is released. In such cases, the prognosis worsens.[1,4,5]

Thyroid cancer facts and figures:

• In general, the disease is quite rare: no more than 10–20 cases are diagnosed per 100,000 population per year, although rates can vary greatly in different countries.
• Thyroid cancer accounts for approximately 0.5–3% of all cancers.
• Women get sick approximately 2–3 times more often than men. But men usually have a worse prognosis.
• Unlike many other types of cancer, thyroid tumors often occur at a young age. For example, it is the most common type of cancer among women 20–35 years old. Every fiftieth patient is a child or teenager.
• According to American experts, in recent years the prevalence of the disease has been growing by about 5% per year. This is believed to be largely due to improved diagnosis. Doctors began to detect the disease more often.
• Thyroid cancer is relatively treatable. The average five-year survival rate is 98%. In later stages and in the absence of adequate treatment, the prognosis is greatly worsened.[1,2,6]

Book a consultation 24 hours a day

+7+7+78

Signs and symptoms

In the first stages of thyroid cancer, symptoms are almost invisible and signs are completely absent. Often the first factor that causes concern for the patient is the presence of a nodular tumor in the neck.

Nodules in the gland are very common, and only 5% of them are malignant. Despite the fact that the presence of a lump is not a direct indicator that a malignant process is developing in the thyroid gland, already at this stage you should definitely consult a doctor for examination.

As thyroid cancer develops, the severity of its manifestations also increases. The patient appears:

• causeless cough;
• dyspnea;
• choking, sore throat;
• pain in the neck;
• swallowing dysfunction;
• hoarseness of voice, change in timbre;
• sweating;
• excessive fatigue, weakness;
• weight loss due to lack of appetite;
• enlarged lymph nodes.

If any of these symptoms appear and complaints persist for two or more weeks, you should definitely seek help from a doctor. This must be done even if no lump or knot is palpable in the area.

Types of thyroid cancer

The following types are distinguished:

• The most common are differentiated tumors
  .
  Under a microscope, this cancer looks like normal thyroid tissue. , papillary cancer
  occurs .
  Such tumors, as a rule, affect only one lobe of the organ, grow slowly, but often spread to the cervical lymph nodes. They respond well to treatment. Follicular cancer
  for 1 in 10 cases and is more common among people who have iodine deficiency.
  Follicular cancer rarely spreads to the cervical lymph nodes, but more often gives distant metastases. About 3% are oxyphilic carcinoma
  . It is the most difficult in terms of diagnosis and treatment.
• Medullary cancer
  accounts for approximately 4% of all cases. It is formed from cells that produce the hormone calcitonin. It is difficult to diagnose in time and is difficult to treat.
• The least common type - in about 2% of cases - is anaplastic
  , or
  undifferentiated cancer
  . It got its name because tumor tissue under a microscope looks nothing like normal tissue. Such tumors behave very aggressively, grow and metastasize quickly, and are difficult to treat.[4,7]

Observation and forecast

Observation period

• 1st year after treatment – ​​once every 3 months
• 2nd – 3rd year after treatment – ​​once every 4 months
• 4th – 5th year after treatment – ​​once every 6 months
• 6th and subsequent years after treatment – ​​once a year

Forecast

Diagnosis in the early stages

The earlier the diagnosis is made, the higher the chances of successful treatment - this statement is true for any cancer. If the tumor is located within one organ, the likelihood of remission after surgical treatment is highest. With the appearance of distant metastases, the prognosis sharply worsens.

To diagnose cancer in the early stages, screening tests are carried out - regular examinations by an endocrinologist. Often, the doctor can detect the node in time and refer the patient for examination. New growths in the thyroid gland are easily detected by ultrasound, but doctors do not recommend this test for everyone.

A separate risk group consists of carriers of the abnormal RET proto-oncogene

, which increases the risk of medullary cancer. If one of your relatives has been diagnosed with this type of cancer, you should visit a geneticist. If necessary, he will prescribe a genetic test.

If a person is found to have an abnormal RET proto-oncogene, the doctor may suggest one of the following tactics:

• Regular ultrasound of the thyroid gland: this will help diagnose the tumor as early as possible.
• Regular blood tests to check the level of the hormone calcitonin.
• Prophylactic removal of the gland.[8]

Diagnosing thyroid cancer today is not a big problem. However, timely patient referral remains extremely important. If you have any problems with the thyroid gland, you should regularly see a specialist.

Elena Vsevolodovna Murakhovskaya, endocrinologist, candidate of medical sciences

Diagnostic methods

Usually, if a doctor finds nodules in the thyroid gland during an examination, the examination begins with an ultrasound examination

. It helps to assess the size, number, location of neoplasms, study their internal structure, and find out whether the neoplasm is a dense node or a cyst.

A thyroid biopsy helps detect cancer cells and establish an accurate diagnosis. It can be performed if the node is at least 1 cm in size. Most often, gland tissue is obtained using a thin needle, which is inserted under ultrasound guidance. For an accurate diagnosis, you need to obtain several samples. They are sent to the laboratory for histological, cytological and molecular genetic analysis.[9]

According to statistics, for every 20 fine-needle biopsies, one case of thyroid cancer is diagnosed.

Sometimes a definitive diagnosis cannot be made and the laboratory describes the result as “suspicious” or “uncertain.” In such cases, the doctor may make the following decisions:

• Repeat fine needle biopsy.
• Perform a biopsy using other, more invasive methods. For example, use a thicker needle or remove part of the thyroid gland.
• Conduct genetic tests to detect abnormal genes that could indicate cancer.

Radioisotope testing helps detect cancer cells

It is used to diagnose the primary tumor and search for metastases. Before the procedure, safe radioactive iodine-131 is injected into the patient’s body, intravenously, or given in tablet form. Cancer cells accumulate this substance and show up in special photographs. In medullary cancer, cells do not accumulate iodine, so radioisotope scanning will be ineffective.

According to indications, chest X-ray, CT, MRI, positron emission tomography (PET) are performed. This helps to better study the primary tumor and find metastases.

Since the thyroid gland is an endocrine organ, blood tests for certain hormones are often important in diagnosing its malignant tumors:

• Thyroid-stimulating hormone
  is produced by the pituitary gland and stimulates the production of hormones by thyroid cells. If its level in the blood is elevated, this may indicate that the thyroid gland is not working actively enough.
• Thyroxine and triiodothyronine
  . With thyroid cancer, their blood levels most often remain normal.
• Thyroglobulin
  is a protein that helps judge the effectiveness of treatment. After thyroidectomy and radioiodine therapy, the level of thyroglobulin in the blood should remain low. If it grows, it may indicate a relapse.
• Calcitonin
  is produced by C cells and is involved in the regulation of calcium metabolism. Determining its level has diagnostic value in cases of suspected medullary cancer.

, carcinoembryonic antigen, may be prescribed

[1,3,8]

Diagnostic methods

The adequacy of further therapy depends on the clinically correct determination of the type and stage of thyroid cancer. Diagnostics is the most important stage that determines the effectiveness of treatment and control of oncology in general Source: Diagnosis of early thyroid cancer. Shatalova L.S., Kozlova Yu.G., Gaflanova D.M., Selyutin S.A. Bulletin of Medical Internet Conferences, 2020. p. 61-63.

To competently study the disease, the coordinated work of experienced specialists is necessary: ​​an endocrinologist, an oncologist, a therapist. To make a diagnosis of thyroid cancer, the following procedures and tests are used:

• Physical examination. The doctor evaluates the physical changes that have occurred in the organ and feels the lump if it can already be felt with the fingers. At this stage, the patient is also interviewed. The specialist analyzes information about risk factors, exposure to radiation, and the presence of tumors in close relatives. After examination and questioning, the doctor refers the patient for further examination.
• A blood test for the hormones produced by the thyroid gland - thyroid-stimulating hormone, triiodothyronine, thyroxine, etc. It allows you to identify the characteristics of the gland and detect deviations in the production of hormones.
• Blood test for tumor markers. The presence of tumor markers indicates the likelihood of developing a certain form of cancer.
• Ultrasonography. Provides the opportunity to detect the presence, number and size of nodes, to study the features of their contents and blood supply. It does not allow one to distinguish benign from malignant lumps with high accuracy, and therefore requires additional research.
• Radionuclide testing, or scintigraphy. Allows you to clarify the extent of cancer.
• Fine needle aspiration puncture biopsy. Involves taking samples of the tumor. To do this, under the control of an ultrasonic sensor, a thin needle is inserted into the pathological area and tissue is removed through it. The samples are then analyzed in a laboratory to look for cancer cells. The method allows you to obtain the most accurate data about the type of tumor, its stage and characteristics.
• Computer, magnetic resonance, positron emission tomography and other imaging research methods. They are prescribed to identify metastases in other organs and systems.
• Genetic testing. In some cases, the doctor may order tests that will help identify genes that increase the risk of cancer. The test is mainly needed for people who already have a family history of thyroid tumors.

Before diagnosing thyroid cancer, the doctor must carry out a differential diagnosis, eliminating the possibility of the presence of benign tumors and other pathologies that have symptoms similar to oncology. To make a diagnosis, it is not at all necessary to undergo the entire list of tests. The specialist examines each medical case and prescribes only those tests that are necessary for a particular patient.

Stages of thyroid cancer

The stage of thyroid cancer is determined based on the generally accepted international TNM classification. The letter T denotes the size and other characteristics of the primary tumor in the thyroid gland:.

• Tx – characteristics of the primary tumor cannot be assessed.
• T0 – the primary tumor was not detected during the examination.
• T1 – The largest diameter of the tumor is 1 cm or less (T1a) or 1–2 cm (T1b), and it has not spread beyond the thyroid gland.
• T2 – The largest diameter of the tumor is 2 to 4 cm, and it has not spread beyond the thyroid gland.
• T3 – the largest diameter of the tumor is more than 4 cm, or it has spread beyond the thyroid gland.
• T4 – The tumor has spread to organs and tissues outside the thyroid gland. Depending on how far it has grown, substages T4a and T4b are distinguished.

For anaplastic cancer, the classification is slightly different. All such tumors are automatically classified as stage four. In this case, substage T4a means that the cancer is located within the thyroid gland, T4b - has spread to neighboring structures.

The letter N characterizes the presence of tumor foci in regional, that is, adjacent to the thyroid gland, lymph nodes:

• Nx – it is not possible to check whether the lymph nodes are affected.
• N0 – no metastases were detected in the lymph nodes.
• N1 – there are metastases in regional lymph nodes. Depending on which groups of lymph nodes are affected, substages N1a and N1b are distinguished.

The letter M stands for distant metastases:

• M0 – distant metastases were not detected.
• M1 – distant metastases are present.

Depending on the combination of T, N and M values, the following stages are distinguished for different types of thyroid cancer:

The classification of papillary and follicular cancer in people under 45 years of age is slightly different. If there are no metastases, stage I is always diagnosed, and if there are, stage II. [1.5]

Kinds

The most common classification of thyroid cancer is based on the histological features of the tumors. In accordance with this approach, tumors are divided into the following types.

• Papillary. The most common type of tumor, accounting for up to 80% of all clinical cases. It is most common in people between 30 and 50 years of age.
• Follicular. Like the papillary form, it develops from follicular glandular cells. Typical for people over 50 years of age.
• Medullary. It develops from C-cells, whose specialization is the production of calcitonin, so measuring the level of this hormone is used to diagnose a tumor.
• Anaplastic. One of the most aggressive, rapidly developing forms of the tumor, most often affecting people over 60 years of age.
• Lymphoma. Very rare. Develops from immune cells located in the thyroid gland, most common in older patients.

Risk factors

For most cancers, it is impossible to name a clear cause. It is very difficult to understand what exactly led to the mutation that caused a normal cell to become a tumor cell. The only known risk factors are conditions that, to one degree or another, increase the likelihood of developing the disease.

Risk factors:

• Floor
  . For unknown reasons, women suffer from thyroid cancer approximately 3 times more often than men.
• Age
  . In women, the risk increases after 40–50 years, in men - after 60–70 years.
• Family history.
  The risk is increased in people who have first-degree relatives (parents and siblings) with thyroid cancer. It is unknown which genes are involved and how they are involved.
• Heredity
  . This factor is particularly strongly associated with medullary cancer: in 20% of cases it is caused by a mutation in the RET gene precursor.
• Lack of iodine.
  People whose bodies lack this microelement are more likely to suffer from follicular cancer.
• Ionizing radiation. The development of thyroid cancer is promoted by radiation therapy to the head and neck, especially in childhood. At risk are people who lived in the zone of radioactive contamination during accidents at nuclear power plants and the use of nuclear weapons. It is unknown how dangerous radiography is in this regard.
• Children
  are recommended to undergo testing only when clearly necessary and using low doses of radiation. [2]

Find out the exact cost of treatment

What to do if a tumor is detected

If you find any abnormal lumps, protrusions or nodules during your thyroid cancer self-diagnosis, please contact our clinic for examination. But don't panic, the presence of such abnormalities is not always cancer. This could be an enlarged thyroid gland due to hyperthyroidism or a benign nodule.

You can identify any pathology without pain and inexpensively by undergoing an expert ultrasound of the thyroid gland. At the same time, you can take tests for thyroid hormones. A more complex examination - a biopsy is prescribed only based on the results of ultrasound and tests.

You can undergo all types of examinations and then consult with an endocrinologist or oncologist at the Diana Clinic in St. Petersburg. The cost of an expert ultrasound of the thyroid gland is only 1000 rubles.

Treatment

For thyroid cancer, surgical interventions are used, treatment with radioactive iodine, hormone therapy, chemotherapy, radiation, and targeted therapy are used. Treatment tactics are chosen based on the type and stage of cancer and the patient’s condition.

Today we are talking about the fact that the use of modern treatment methods makes thyroid cancer in the vast majority of cases a completely curable disease.

Elena Vsevolodovna Murakhovskaya, endocrinologist, candidate of medical sciences

Surgical treatment of thyroid cancer

Surgery is the main, radical method of treating thyroid cancer. If a fine-needle biopsy reveals tumor cells in the specimen, the first option is surgery, except in some cases of anaplastic cancer.

If, in differentiated forms of cancer (papillary or follicular), the tumor is small and does not spread beyond the thyroid gland, a lobectomy (hemithyroidectomy)

: the affected lobe is removed along with the isthmus. This helps maintain the production of thyroid hormones. Sometimes such an operation is performed for diagnostic purposes if, after a fine-needle biopsy, an accurate diagnosis cannot be established.

However, most often it is necessary to resort to removal of the entire gland - thyroidectomy,

or most of it -
subtotal resection
.
After this, you will have to take a synthetic analogue of thyroid hormones - levothyroxine -
.

If there is a suspicion that cancer cells have spread to the cervical lymph nodes, the latter are also removed. Surgeries to remove thyroid cancer are performed extrafascially, and it is important to carefully examine the entire thyroid gland and all areas where there may be regional metastases. In case of regional metastases on the affected side of the neck, the tissue is excised within the fascial sheaths. Particular attention should be paid to the fiber in the paratracheal zone and the anterosuperior mediastinum. After surgery, radioactive iodine therapy is prescribed to destroy remaining tumor cells and prevent recurrence. [1]

Radioiodine therapy

Almost all the iodine that enters the human body goes to the needs of the thyroid gland. If radioactive iodine is administered to a patient, it will penetrate the gland tissue and destroy cancer cells without affecting other organs. For radioiodine therapy, the radioactive isotope of iodine I-131 is used, the same as for radioisotope research, only the dose of radioactivity will be much higher.

Papillary and follicular cancers are sensitive to radioactive iodine therapy; medullary and anaplastic tumors are insensitive. Typically this type of treatment is prescribed in the following cases:

• For inoperable tumors.
• After surgery, when the lymph nodes were affected, to prevent relapse.
• >If there are distant metastases.

In order for radioiodine therapy to bring maximum effect, the patient’s body must have a sufficiently high level of thyroid-stimulating hormone (TSH). You can increase it in two ways:

• Administer TSH drug.
• After removal of the thyroid gland, stop taking levothyroxine for several weeks. The level of the hormone in the blood will decrease, and the pituitary gland will begin to actively produce TSH to stimulate the no longer existing thyroid gland. During this time, the patient will have to endure some symptoms caused by the lack of thyroid hormones: increased fatigue, constipation, depression, poor concentration, muscle pain.

Before starting treatment, you need to reduce the amount of iodine in the body. The doctor will give some recommendations regarding diet: for 1–2 weeks you will have to give up iodized salt, soy, seafood, eggs, and dairy products. [1,2]

Hormone therapy

After removal of the thyroid gland, the level of thyroid hormones in the human body drops sharply. This leads to some serious disorders, severe symptoms. The pituitary gland is activated and begins to produce TSH to stimulate growth and activate the thyroid gland, but it only stimulates the growth of cancer cells. Thyroid hormone medications help solve both problems. After thyroidectomy they will have to be taken for life. [1]

Radiation therapy

In addition to therapy with radioactive iodine, thyroid cancer can be treated with radiation from external sources, that is, using radiation therapy in the classical form. It is prescribed for medullary and anaplastic cancers that do not respond to iodine. Typically, procedures are carried out 5 days a week for several weeks. [1]

Chemotherapy

Chemotherapy works very little against thyroid tumors, but most often it is not necessary. Your doctor may consider using chemotherapy in two cases:

• For anaplastic cancer in combination with radiation therapy.
• For advanced cancer that does not respond to other treatments.

Targeted therapy for thyroid cancer

Targeted drugs are most widely used for medullary tumors that do not respond well to radioactive iodine therapy. Vandetanib is prescribed

or
cabozantinib
. Both drugs come in tablets and need to be taken once a day. They help stop the growth of cancer, but it is unknown how much they can prolong the life of patients.

For differentiated cancer that does not respond to other treatments, sorafenib

and
lenvatinib
. These drugs block the growth of blood vessels that feed the tumor and some proteins that promote the proliferation of cancer cells. [1.13]

Book a consultation 24 hours a day

+7+7+78

Treatment methods

The choice of therapeutic regimen is entirely based on diagnostic results. When drawing up a treatment plan, doctors take into account the type of tumor, its stage, the presence of metastases, as well as the patient’s overall health, chronic diseases or complicating factors Source: Efficiency of diagnosing thyroid cancer. Varganov M.V., Pronichev V.V., Ledneva A.V., Kostareva E.Yu., Zagrebina N.I., Sukhanov S.A., Goloviznina E.V., Poryvaeva E.L. Medical Bulletin of the North Caucasus, 2016. p. 515-517.

Modern endocrinology has a wide range of techniques that can effectively combat thyroid cancer. In some cases, doctors combine several approaches, thereby achieving maximum effectiveness and maintaining a high percentage of patients cured.

Most patients are indicated for surgical removal of the tumor along with all or part of the gland. The following types of operations are used to fight cancer:

• Thyroidectomy - complete excision of an organ along with cancer. The operation is performed through a small incision at the base of the neck, about four centimeters wide. The surgeon may also provide access in the armpit or through the floor of the mouth. The main task of the surgeon is to completely remove the thyroid gland and neoplasm, preserving the integrity and functionality of the parathyroid glands and nerves.
• Hemithyroidectomy is a fragmentary excision of the thyroid gland along with the formation. It is carried out in the early stages of cancer development, when the formation is still very small and has not spread to both lobes of the thyroid gland. In this case, the surgeon manages to preserve the integrity of one lobe.
• Removal of lymph nodes . The operation is an addition to the above methods. It is necessary if cancer cells are found in the lymph nodes of the neck.

After removal of the thyroid gland or part of it, patients need to take hormonal medications that compensate for the functions of the lost organ. You need to do this throughout your life.

In addition to surgery, clinical recommendations for the treatment of thyroid cancer include the following approaches:

• Radioiodine therapy . Involves taking radioactive iodine in the form of a custom-made capsule. After entering the body, the substance is absorbed by normal and cancer cells of the thyroid gland, so it has virtually no effect on organs and systems. Radioiodine selectively destroys cancer lesions and cleanses the body of malignant cells. After a few days, most of the radioiodine is excreted in the urine. As a rule, it is prescribed after surgery to completely remove residual cancer cells. The method is also used in the fight against relapse of the disease.
• Radiation therapy . With this method, X-rays are directed at the tumor, which destroys the cells. One irradiation session lasts several minutes. Treatment is carried out in courses with daily procedures for 3-5 weeks. Often, external beam radiation therapy becomes an alternative to surgery for those patients who have direct contraindications to surgical treatment. Sometimes the method is used to irradiate the postoperative area if there is a high chance of relapse.
• Chemotherapy . Drug treatment with cytostatic drugs in the fight against thyroid cancer is rarely carried out, as it shows lower effectiveness when compared with other approaches. But sometimes chemotherapy becomes the only effective treatment for those patients who do not have a proper response to radiation or radioiodine therapy. In some cases, it is prescribed as an addition to external radiotherapy.
• Targeted therapy . It involves taking drugs that, unlike chemotherapy drugs, do not act on the entire body, but only on cancerous tissue. This therapy specifically destroys cancer lesions and has minimal side effects.
• Palliative care . Supportive care that aims to relieve symptoms and manifestations of the disease. Provides not only medical assistance, but also psychological assistance. Most often, palliative therapy is needed during the period of active treatment, as well as in cases where cancer is detected at a late stage and other methods of therapy will no longer bring results.

The choice of treatment method remains with the doctor. After completing the treatment course, patients need to be examined regularly in order to promptly detect recurrence, metastases or other complications of thyroid cancer that could not be identified during the initial examination.

Prevention

Many people who get the disease do not have any risk factors, so it is not known how to prevent thyroid cancer.

Since exposure to radiation in childhood increases the risks, you need to be very careful about any methods of radiation diagnostics and therapy in children, and use them only when clearly necessary. Every person's diet should contain a sufficient amount of iodine.

If a person is diagnosed with medullary cancer associated with a genetic mutation, his relatives need to visit a geneticist and get tested. And in general, if one of your close relatives has been diagnosed with cancer, you need to pay more attention to your health, ask your doctor what types of screening and at what intervals you should undergo.

When should you see a doctor?

If you have any of the symptoms described above, and the complaints persist for more than 2 weeks, you should consult a specialist. Thyroid cancer is not the most common disease, so your doctor may need to look into other causes of your complaints.

At the Rassvet clinic, highly professional specialists (oncologist, endocrinologist, therapist) work in one well-coordinated team, this allows us to make a diagnosis and begin treatment as soon as possible, while avoiding unnecessary examinations.

Rehabilitation therapy

Thyroid hormones perform important functions in the body, so after its removal, hormone replacement therapy is prescribed. The drug levothyroxine is used.

After treatment, the risk of relapse remains, so the doctor will prescribe an examination program:

• For papillary and follicular thyroid cancer with a high risk of recurrence,
  a study with radioactive iodine is prescribed after 6–12 months. If it shows a negative result, no further examination is required. Tests for TSH and thyroglobulin levels will also be ordered. If the level of the latter increases, this may indicate a relapse. In such cases, positron emission tomography (PET) is prescribed.
• For papillary and follicular cancer with a low risk of recurrence,
  periodic examinations by a doctor, ultrasound examination of the thyroid gland and chest x-ray are prescribed.
• For medullary cancer,
  blood tests for calcitonin and carcinoembryonic antigen are prescribed. If their levels begin to increase, the doctor will prescribe an ultrasound of the neck, CT, or MRI to look for metastases.

Histogenetic classification of thyroid cancer

Life expectancy after surgery

The prognosis for cancer is assessed by the five-year survival rate - the proportion of patients who remain alive five years after they were diagnosed with a malignant tumor. Prognosis after surgery for thyroid cancer (five-year survival rate) depending on the type and stage of the tumor are presented in the table:

First of all, survival rate for thyroid cancer depends on the stage and type of tumor. While differentiated tumors respond relatively well to treatment, medullary and anaplastic cancers are often diagnosed at later stages and behave aggressively. The age of the patient and his state of health also matter. Survival rates are higher among younger men and women who do not have underlying health conditions.

Treatment for thyroid cancer may come with some complications and side effects. Some of them are temporary, others persist for a long time or even for life. In most cases, they can be kept under control. [10,11]

Types of cancer

Oncologists distinguish four different types of thyroid cancer, which are characterized by specific symptoms and special treatment tactics:

• Papillary cancer . It accounts for up to 60% of all cases of oncology of this localization. Most often, this type of cancer occurs before the age of 40, and it predominantly affects women.
• Follicular carcinomas . They account for up to 15% of all types of oncology. Most often registered in old age.
• Medullary cancer . On average, it is registered in 5-8% of cases of thyroid cancer, has a familial nature, occurs at different ages and with equal frequency among women and men.
• Anaplastic form of cancer . The rarest of all types of oncology, has an aggressive course, usually registered after 60 years Source: A.A. Fedorov, E.L. Bederina, N.Yu. Orlinskaya Clinical and morphological characteristics of thyroid tumors according to histological examination of surgical material // Medical almanac, 2014, No. 3(33), pp. 154-156.

Papillary and follicular forms are differentiated forms of cancer and have the same treatment.

Consequences after surgery

The main complication after surgery for thyroid cancer (if the entire gland or a significant part of it was removed) is hypothyroidism. This condition causes severe symptoms because thyroid hormones have important functions. However, hypothyroidism can be successfully corrected with hormonal drugs. You will have to take them for life.

Other possible complications after surgery:

• Hoarseness or loss of voice
  . This symptom may be temporary or permanent. It often occurs due to irritation of the larynx by the endotracheal tube. A more serious cause is accidental damage to the laryngeal nerve during surgery.
• Damage to the parathyroid glands
  . They are small glands that are located on the posterior surface of the thyroid gland, in pairs above and below. The parathyroid glands produce hormones that regulate calcium levels in the blood. When they are damaged, the level of calcium in the blood drops, which is manifested by muscle spasms, tingling and numbness in the arms and legs.
• A large hematoma
  can form in the neck area with intense bleeding. As after any surgical intervention, infection and suppuration are possible. To prevent such complications, antibacterial drugs are used. [1]

What is the thyroid gland and why is it so important to the body?

The thyroid gland is a small and very delicate organ located at the base of the neck. Despite its size, it is a vital organ, and if its functions are impaired, a person feels unwell. The thyroid gland is part of the endocrine system, which is a complex of glands that secrete the necessary hormones into the circulatory system. The thyroid gland produces hormones that affect almost every part of the body. They maintain metabolic balance while supporting the healthy functions of important organs such as the brain, kidneys, liver, heart and reproductive organs.

Life after thyroid cancer treatment

There are no specific recommendations on how to reduce the risk of thyroid cancer coming back after treatment has gone into remission. Doctors usually give general recommendations, advising you to eat right, exercise, and give up bad habits.

You need to monitor your health, undergo timely examinations and take tests that are included in the rehabilitation program. If you have any unclear symptoms that persist for a long time, you should consult a doctor.

Usually, nodules in the thyroid gland are detected during an examination by an endocrinologist or ultrasound, sometimes they are discovered by patients themselves. Nodules can have different sizes, can be single or multiple, “hot” (accompanied by increased levels of hormones) and “cold”. Many patients immediately panic: is it probably cancer?

According to statistics, approximately every twentieth node turns out to be malignant . In most cases, this is not cancer, but conditions such as subacute thyroiditis (for example, due to influenza or mumps), Hashimoto's thyroiditis (autoimmune inflammation in the gland), and iodine deficiency. [2]

Can the tumor resume its growth after treatment?

Resumption of tumor growth after treatment is called relapse.

Despite treatment, in some cases, thyroid cancer can return even if the thyroid gland has been completely removed. This can happen if microscopic cancer cells have spread beyond the thyroid gland before it is removed and remain in surrounding tissue or lymph nodes.

Recurrence of thyroid cancer may manifest as:

• thyroid tissue left during surgery (local relapse);
• lymph nodes of the neck (regional metastases);
• other parts of the body (distant metastases).

Recurrent thyroid cancer can also be cured. It is important to identify it at the earliest stage. To do this, after treatment, patients must remain under the qualified supervision of an oncologist and endocrinologist.

Doctors at the Rassvet clinic will prescribe the necessary blood tests and thyroid scans at certain time intervals - for proper monitoring after treatment and to identify early signs of relapse.

Read also:

• Stage 4 thyroid cancer
• Papillary thyroid cancer
• Removal of the thyroid gland
• Hemithyroidectomy
• Ultrasound of the thyroid gland
• Thyroid cancer with metastases
• Removal of thyroid adenoma
• Anaplastic thyroid cancer

Book a consultation 24 hours a day

+7+7+78

Bibliography:

1. Clinical guidelines: Thyroid cancer. — Ministry of Health of the Russian Federation, 2022.
2. Makarin V.A. Thyroid cancer. Patient's Guide. - M., 2016. - 168 p.
3. N.V. Shidlovskaya, V.A. Petrukhin, F.F. Burumkulova - Thyroid cancer and pregnancy. Features of the course and perinatal outcomes / Russian Bulletin of Obstetrician-Gynecologist 6, 2017.
4. T.V. Pavlova, I.D. Pavlov. — Clinical and morphological aspects of thyroid cancer / Pharmacy. — 2011, No. 4(99). Issue 13.
5. Clinical guidelines: Medullary thyroid cancer. — Ministry of Health of the Russian Federation, 2022.
6. G.A. Chervyakova, D.Z. Kamensky, E.N. Tomilova / Thyroid cancer. — General medicine, 4. — 2005
7. A.V. Gostimsky, A.F. Romanchishen, M.V. Gavshchuk. – Undifferentiated thyroid cancer. – Bulletin of Surgery, 2016.
8. L.S. Shatalova, Yu.G. Kozlova, D.M. Gaflanova. – Diagnosis of early thyroid cancer. – Bulletin of Medical Internet Conferences, 2022. Vol. 10, No. 2.
9. V.A. Beloborodov, O.S. Olifirova, S.P. Shevchenko. – Morphological verification of thyroid cancer. – Siberian Journal of Oncology, 2007, No. 2(22).
10. Vanushko V.E., Kuznetsov N.S., Garbuzov P.I., Fadeev V.V. Thyroid cancer. Problems of Endocrinology. 2005;51(4):43-53.
11. I. Hey. Papillary thyroid cancer: clinical manifestations, relapses and prognosis. Bulletin of surgery. Volume 165, No. 1, 2006.
12. S. Filetti, C. Durante, D. Hartl. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. doi.org/10.1093/annonc/mdz400
13. Maria E, Cabanillas, Mabel Ryder, Camilo Jimenez. Endocr Rev. 2019 Dec 1;40(6):1573-1604. doi: 10.1210/er.2019-00007. Targeted Therapy for Advanced Thyroid Cancer: Kinase Inhibitors and Beyond. DOI: 10.1210/er.2019-00007

Fine needle aspiration biopsy

Fine needle aspiration biopsy. When identifying the first symptom, a tumor in the thyroid gland, by palpation or visually, it is important to perform an ultrasound scan of the neck. During an ultrasound examination, the doctor must describe the main characteristics of the node - three sizes, blood flow, location relative to the lobe, understand whether there are calcifications, it is also important to describe the lymph nodes of the neck.

If the size of the node in the largest section reaches 10 mm or more, a fine-needle aspiration biopsy (FNA) is indicated. FNA is currently the “gold standard” for diagnosing thyroid nodules. Using a biopsy, the doctor determines with high accuracy whether the thyroid tumor is benign and prescribes further examination or treatment tactics.

Consequences of treatment

Possible consequences are determined by the volume and content of the therapy performed.

After surgery, hoarseness and decreased voice volume may sometimes be observed due to the close proximity of the ligaments, as well as temporary complications caused by hormonal disorders.

Side effects from taking radioactive iodine are rare, last about a month, and include dry mouth and eyes and impaired sense of taste and smell. They usually go away within 4-8 weeks.

The consequences of radiation therapy and other types of treatment depend on the characteristics of the method, the disease and the patient’s body.

Metastasis

Tumor cells that travel through blood vessels to other organs are called metastases; in thyroid cancer, the process of cell spread depends on the type of cancer.

Diagnostics

The first diagnostic method is examination and palpation of the gland. Adenocarcinoma may be palpable, especially if the lesions contain calcifications. The surface and density of the thyroid gland, mobility relative to other organs are also assessed. The lymph nodes are examined to see if they are enlarged. Ultrasound examination is the most important and primary method for visualizing the structure of the thyroid gland. The ultrasound doctor describes the volume of the lobes, the characteristics of blood flow, the growth of blood vessels, the presence of nodular formations with their boundaries, and so on.

Ultrasound-guided node biopsy allows microscopic identification of cancer cells and differentiation of their origin. An important point when performing a biopsy is that you cannot get the needle into the vessel, since in this case the result is uninformative.

If there is a nodule in the gland, but it is not known whether it is malignant or not, scintigraphy can be used. This method can also be used to estimate the prevalence of the process. It involves the introduction of an iodine isotope and its absorption by the gland. According to the degree of iodine absorption, “hot” or “cold” nodes are distinguished. In addition to instrumental methods, laboratory tests, including thyroid hormones, calcitonin, and thyroglobulin, are useful for diagnosis.

Symptoms in women

The specificity of the disease is a high percentage of diagnostic errors. This is caused by the absence of pronounced symptoms of thyroid cancer in women in the early stages.

Detection of the disease is even more complicated due to the presence of background ailments (goiter, thyroiditis): in these situations, doctors lose their sense of oncological alertness and pay attention only to concomitant pathology.

Meanwhile, the fact of the presence of a tumor (even if it is less than a centimeter) is easily established by ultrasound.

Signs that should motivate you to visit an ultrasound room:

• the feeling that the collar of clothes has become narrower;
• the presence of a “lump” in the throat;
• discomfort accompanying swallowing food;
• tightness in the neck (see photo);
• change in voice sound;
• shortness of breath, worsening with neck movement.

If the presence of a tumor is confirmed, a small amount of material is removed from the thyroid gland using a needle and syringe for examination. In a laboratory setting, specialists make a verdict on the category of neoplasm (benign/malignant).