Thyroid carcinomas are diverse in form and require different methods of treatment. Nonspecific symptoms and signs. Morphological examination is the main method for diagnosing cancer

Any manifestation of malignant tumors, including carcinomas, is vital to diagnose as early as possible. The sooner the treatment process begins, the more chances a person has to return to a full life.

Performing a function internal secretion, thyroid produces a hormone responsible for the continuity of homeostasis processes.

The thyroid gland belongs to that group of vital organs whose influence on general state body is hard to overestimate. Any, even the most insignificant diagnosis is fraught with extremely Negative consequences, and in the case of a negligent attitude to the disease, the result can be very sad.

About the disease

Under the carcinoma thyroid gland understood as a cancer pathology of the organ. Unlike malignant tumors in other parts of the body, this disease has a favorable prognosis for survival and gives a chance for full life after recovery. Cancer has a multiple nodular form.

The reasons

The reasons that can cause this disease are not exactly confirmed, but experts point to a number of provoking factors of organ cancer:

  • too much radiation – negative impact this phenomenon can greatly increase the risk of developing education;
  • radiation treatment in the neck and head area- prolonged therapy causes a malignant mutation of cells, their rapid division and spread in the thyroid gland;
  • old age– among patients who have been diagnosed with carcinoma this department– people over 45 years old. This is due to cell aging and age-related genetic failures;
  • heredity- experts say that there is a gene whose pathological effect is hereditary. It causes thyroid cancer. If it is found in a person, the chances of avoiding the disease are close to zero. Often, if it is accidentally detected, the patient is advised immediate surgery to remove it;
  • harm at work- the most dangerous - the impact of ionizing radiation emanating from medical equipment, as well as work in steel shops, where heavy compounds are processed;
  • frequent stress and nervous disorders , these manifestations sharply reduce the immune forces of the body, which actively destroy malignant cells;
  • alcoholic or nicotine addiction - Tobacco carcinogens and alcohol-containing substances kill the body's natural protective barrier against cells with atypical nature.

Kinds

All oncological manifestations in the thyroid gland can be classified into two categories, based on the nature of their origin:

  • benign;
  • malignant.

The disease is divided into the following types:

  • papillary carcinoma - occurs in 85% of cases, while women are affected by this type of disease several times more often than men. On the early stage it can be determined by ultrasound or simple palpation. After some time, the cancer flows to the cervical nodes, metastasizes to the bone tissue and lungs. Not bad treated surgically;
  • follicular carcinoma- it affects about 14% of all patients with thyroid cancer. Often affects not only the elderly, but also children. Characterized too aggressive course, is never a consequence of irradiation. The mortality threshold is higher in vascular invasion, in which cancer cells sprout inside blood vessels;

    • medullary- the third type of tumor in the list of the most common cancerous manifestations of the organ. Easily transforms from parofullicular tissues. They synthesize calcitonin. The disease is almost not amenable to known methods of treatment.

    If the tumor metastasizes, only 12% of patients pass the 5-year threshold. Optimal, although not always effective solution- operation;

    anaplastic carcinoma- the rarest subtype of cancer of the organ in question. At the same time, it is very difficult, the mortality rate is huge. It is considered a differentiated form, it can be in a state of latency for many years.

    Quickly affects neighboring departments and systems. Distinctive feature- visible external swelling, due to which the formation can be diagnosed independently. Practically inoperable and incurable;

  • gyurtle- cell carcinoma is extremely rare. Almost always metastasizes. In terms of symptoms and clinical properties, it is similar to a follicular tumor. It is treated in the same ways, however, almost to no avail. This type very little studied, due to its singularity.

stages

Determining the stage of the course of the disease is necessary to identify the optimal solution to the problem. This can be done only if there is a detailed examination, which shows how far the pathology has gone, whether there are metastases.

There are the following stages of thyroid carcinoma:

  • 1 stage- a small, almost immovable tumor. Its maximum diameter is no more than 2 cm. The place of localization is inner part organ. Despite its small size, the pathology can be diagnosed independently with a detailed examination of the neck area - carefully probing this area, it is impossible not to notice the seal. There are no other symptoms at this stage;
  • 2 stage- the malignant formation doubles, but has not yet left the capsule. First signs: slight discomfort in the localization zone, when pressed, it is well palpated. If this moment is not missed and therapy is started, the probability of a cure is still very high;

    • 3 stage- differs in the severity of symptoms - pathology strongly compresses neighboring organs, grows rapidly. Due to the forced narrowing of the trachea by the pressure of the affected organ, the respiratory processes are difficult.

    There is frequent shortness of breath, sometimes - suffocating attacks that provoke dysphagia. There is a slowdown in the mobility of the vocal folds. Outwardly, this manifests itself as hoarseness. Lymph nodes are enlarged;

  • 4 stage- The state of health is extremely difficult. All neighboring departments are irreversibly affected. Metastases penetrate the lungs, stomach, bone tissue, brain. There is a persistent violation of appetite, entailing a sharp weight loss. Almost constantly the body temperature is elevated. Not amenable to treatment.

Clinical picture

The main manifestation is compaction and enlargement of the gland. Formations have a nodular form, multiple. They can also be benign in nature. The function of the organ was preserved almost all the time of the course of the disease.

The rate of tumor growth at all stages of pathology is different. If it is too intense, the patient dies with any type of treatment.

Late signs are marked by episodic hemoptysis, which indicates the inoperability of education. Metastasis is mainly lymphogenous - cervical, clavicular, axillary.

signs

The main signs indicating the development of this type of cancer:

  • lump in the neck- appears already at the initial stage and is the primary sign;
  • pain in the neck, often radiating to the ears- associated with tumor squeezing of the capsule and difficulty in the processes of respiratory circulation;
  • difficulty chewing food and swallowing- as the carcinoma grows, it occupies almost the entire capsule, leaving no free space for other functions;
  • hoarseness, not related to a cold - appears due to the immobilizing processes of the vocal fibers;
  • persistent cough, it is provoked by foreign nodular seals.

Diagnostics

On palpation organs reveal nodular accumulations of a dense structure of a single and multiple nature, often soldered to the surrounding tissues and therefore remaining immobile.

With a detailed ultrasound of the organ determine the size, number of formations. At the same time, this analysis is not able to identify the nature of the tumor as accurately as possible, since a large percentage of the pathologies of this department are benign.

It's almost impossible to tell visually.

Panoramic x-ray examination allows you to diagnose the presence of a seal, determine its shape and size. Photograph of adjacent organs big share probability is able to determine its possible distribution to other parts of the body.

Cytology. It is considered the youngest and most innovative method, giving the maximum exact result. Not a single diagnosis of oncology can do without it. internal organs. Appointed to clarify details clinical picture diseases, as well as quality control of the therapy.

Treatment

The initial therapy for thyroid carcinoma involves surgery, during which the part of the organ affected by the malignant tumor is removed.

Depending on the stage of the disease and the general clinical situation, single lobar removal of the gland, called partial thyroidectomy.

In more complex cases, when the area of ​​spread of cancer cells is quite extensive, it is advisable amputation of two lobes - total thyroidectomy. It is also possible to completely cut off the organ.

Forecast

After the operation, the patient is under the patronage of a group of specialized specialists - he is monitored, trying to exclude any manifestations of relapse as much as possible.

During the healing period (about 3-4 weeks), the patient is in the hospital and strictly adheres to all doctor's prescriptions. After discharge, hormone replacement drugs are prescribed, which a person takes for life.

The survival prognosis for this diagnosis is quite optimistic:

  • 95% of successfully operated patients overcome the five-year threshold;
  • 78% live for about 10 years;
  • 65% - more than 15 years.

This prognosis is adjusted for the fact that the pathology proceeded without metastasizing processes and neighboring departments were not affected.

More useful information about thyroid cancer in this video:

papillary thyroid cancer- This is an oncoprocess that occurs in thyrocytes - cells of the thyroid gland. The main manifestations of this pathology are the appearance of one, rarely many, nodal elements. Statistically, this is the most common oncoprocess among thyroid neoplasms, although prognostically, it is quite favorable, the growth of malignant nodes is very slow, metastasis occurs rarely, only local lymph nodes are involved. The frequency of detection of oncological changes increases after 35 years. Women are more susceptible to this pathology. Children rarely get sick, but papillary thyroid cancer is more aggressive, even distant metastases are possible. Although this pathology favorable in prognostic terms, one should not underestimate the severity of the problem, the earlier the diagnosis is made, the greater the percentage of cure and survival (more than 15 years).

Causes of papillary thyroid cancer

Today, the immediate etiology of development papillary cancer The thyroid gland has not been established, but there are a number of factors that increase the possibility of developing a malignant process of the thyroid gland. These factors include:

- hereditary predisposition (if there are people with this type of oncology in the family, Great chance oncoprocess occurrence in subsequent generations);

- genetic mutations (more often, papillary thyroid cancer occurs with genetic modifications in the BRAF and RET / PTC gene system, and the oncoprocess associated with pathological modification of the BRAF genes proceeds more aggressively);

- radiation background, both short-term exposure to increased doses of radiation, and long-term exposure to slightly increased radiation exposure, increase the risk of oncology;

- bad habits healthy eating and excesses in food, smoking, large doses alcohol weaken antitumor immunity);

- benign formations and long-term inflammatory processes of the thyroid gland (adenoma,);

- Disturbances in the work of others endocrine glands;

- receiving radiation treatment associated with malignant processes in other organs;

- prolonged iodine deficiency;

- rectal polyps and colon cancer;

- formations of the mammary glands, malignant and benign, especially associated with disorders in hormonal background;

- the use of oral contraceptives in case of benign formation of the thyroid gland, can provoke malignancy of the process;

- female;

age (patients over 50 are more likely to develop malignant neoplasm thyroid gland and a more aggressive form this disease).

Early stage papillary thyroid cancer

Thyroid cancer papillary variant, morphologically, is an uneven neoplasm cystic appearance arising from normal cellular elements thyroid glands. In the composition, you can find follicular, papillary elements. Psammous bodies are also found, which are radiopaque particles and are used as diagnostic markers.

Papillary thyroid cancer at the beginning of development is often asymptomatic. initial manifestation is a seal in the neck area, often it is a single dense nodal element or several dense nodes. The size of such nodes is from 1 mm to 5 cm. These nodal elements do not connect to the dermis and roll on palpation. One of the manifestations, often the only one, at the beginning of the development of the oncological process, is the occurrence of an increase in one cervical lymph node. Other symptomatic signs - pain, discomfort are absent. With such manifestations, there is a need to consult a doctor, in order to conduct differential diagnosis.

It happens that the carcinomatous node is located in the depths of the thyroid gland, and at the initial stages it is soft in density and mobile, it is not palpable, and other examination methods are used for a full diagnosis. Such a malignant formation is called - latent papillary cancer, it is detected, already at the stage, the appearance of metastatic changes in the lymph nodes. The discrepancy between the sizes of the initial formation and metastasis is characteristic - the metastasis exceeds the initial size of the primary element by 2-4 times.

Symptoms of papillary thyroid cancer

All symptoms manifested in this oncology are divided into two groups: specific and nonspecific.

To non-specific symptoms include those manifestations that are characteristic of other diseases. Such symptoms include dense areas in the neck area, pain in the parotid region, in the larynx area, an increase cervical lymph nodes, unexplained fever, lump in the throat, lack of air, itching and coughing, swelling of the jugular veins. If the neoplasm presses on nervus vagus, there is a violation of the vocal cords, manifested by vocal dysphonia.

Thyroid cancer (papillary variant) is characterized by the following specific manifestations:

- a single node or several nodal elements with a characteristic papillary surface are determined, painless on palpation;

- an ultrasound study visualizes a formation affecting the glandular capsule and adjacent tissues;

- the growth of education is slow;

- an increase in regional lymph nodes from the side of the onset of a neoplasm;

— characteristic feature is the absence of changes in the function of the SC.

Based on histological structure neoplasms, there are the following forms:

- typical papillary thyroid cancer;

- microcarcinoma or latent papillary thyroid cancer;

- follicular papillary cancer accounts for 30% of all cases of this pathology of the thyroid gland. Papillary and follicular cell structures are found in the structure of the tumor. This type of oncoprocess is an encapsulated formation.

Follicular papillary cancer very rarely metastasizes and infiltrates into nearby tissue structures, has no distant metastases. Is the most favorable in the forecast;

- solid, more often this variety occurs after radiation exposure. Compared with the usual form, it often metastasizes and grows into the surrounding tissue;

- oncocytic variant ( rare form) - up to 5% of cases, but very aggressive, has high percent remote metastases;

- diffuse sclerotic cancer. This is the most unfavorable form. Occurs more often in children adolescence. It is characterized by the development of pathological changes in the entire tissue of the thyroid gland, with the formation multiple foci with fibrocystic changes. Metastasis always occurs in nearby lymph nodes, remote metastasis is more often in the lungs;

- clear cell - rarely occurs, differs in metastasis to kidney tissue;

- high-celled variant is distinguished by its high height malignant cells, has a fast growth rate beyond the thyroid gland, a high degree of metastasis;

- the mixed form is characterized by the presence in the histological picture of all types of cells (papillary, follicular, solid). Appears in 50% of cases.

Encapsulated and non-encapsulated thyroid cancer are also distinguished by the presence of their own formation capsule. The encapsulated version is more favorable.

Stages of papillary thyroid cancer

To obtain a complete therapy tactics diagnostic search aimed at determining the stage of the oncological process.

Used to detect papillary thyroid cancer diagnostic procedures:

- superficial examination of the cervical region and palpation examination, determines nodal changes, structure and density of the gland;

– Ultrasound examination visualizes the organ and pathological structures in him. This method allows you to find out the size of the gland, the structure, structure of tissues, the presence and size pathological education. The most accessible and informationally effective way to detect nodal structures of the thyroid gland;

- fine needle aspiration biopsy - the "gold standard" for determining the histological structure of the pathological formation of the thyroid gland. By controlling the process with an ultrasound machine, a specialized needle, the cellular structures of the examined node are aspirated and sent for morphological examination;

- by using laboratory methods blood tests, evaluate the functional ability of the thyroid gland, according to the level of thyroid hormones, and the presence of an oncological process according to tumor markers;

— CT and MRI help to determine the presence or absence of metastatic changes and the degree of pathological changes in the lymph nodes and distant organs.

- radioisotope scanning determines the degree of change in the functional ability of the thyroid gland.

Papillary thyroid cancer is divided into the following stages:

stage 1 papillary thyroid cancer - the nodular element is small up to 2 cm. The absence of metastasis processes and the germination of malignant cells in the surrounding tissues are characteristic. This stage is difficult to diagnose, but responds well to therapy.

stage 2 papillary thyroid cancer - the node grows, its size can reach up to 4 cm, but it remains within the boundaries of the thyroid gland, it is possible to identify the node by palpation of the thyroid gland.

No metastasis - stage 2 a.

Stage 2 b is characterized by metastatic changes in the lymph nodes on the side of the lesion. Efficiency therapeutic measures reaches 95%.

stage 3 papillary thyroid cancer - the size of the nodal element increases by more than 4 cm. The malignant process grows beyond the thyroid gland, compression of nearby organs and tissues occurs. There are metastases in regional lymph nodes. There is shortness of breath, a violation of the act of swallowing, pain, a feeling of lack of air.

stage 4 papillary thyroid cancer - the formation becomes large, becomes immobile, significantly protrudes beyond the boundaries of the thyroid gland, its deformation develops. Enlarged lymph nodes with metastases are revealed. Remote metastasis occurs. Existing manifestations worsen and symptoms develop that occur when remote organs are affected.

Treatment of papillary thyroid cancer

Thyroid cancer (papillary variant) is effectively amenable to therapy. Basic therapies are surgical method, radiotherapy, chemotherapy. These methods are aimed at complete excision of the malignant process, prevention of metastatic changes and recurrence of the oncological process.

The surgical method is used for varying degrees oncological process. The volume of the operation is formed by the size of the pathological node. If the size of the nodal element is up to 1 cm, then partial excision of the thyroid gland and isthmus is possible - partial thyroidectomy. This method is less traumatic, but the possibility of recurrence remains, due to the remaining share.

Total thyroidectomy is a complete excision of the thyroid gland, this method of surgical intervention is preferable in the treatment of a malignant process. Given the state of the lymph nodes, if necessary, remove all metastatic lymph nodes.

Radiation and chemotherapy as monotherapy is not used, more often these are additional treatment options after excision of the thyroid gland. These therapeutic options are used to prevent relapses and prevent the metastatic process. After total thyroidectomy, iodine-131 radioisotopes are used, which reduces the possibility of metastasis and reduces existing metastatic changes in lung structures and bones. When ingested, radioactive isotopes affect thyrocytes, which remain in a small volume even after the most thorough excision of the gland.

After a total thyroidectomy, the use of synthetic thyroid hormones is required, as replacement therapy, for life. When excising the lobe of the thyroid gland, synthetic hormonal agents are not prescribed, since the remaining share fully compensates for the production of hormones.

Surgery for papillary thyroid cancer

Indication for surgical excision thyroid gland is the presence of a thyroid nodule with a histologically confirmed malignant process. With a node up to 1 cm and a high differentiation of cancer cells, hemithyroidectomy can be offered, excision of the thyroid lobe, and the rest of the thyroid gland compensates for the production of hormones. But surgeons consider total thyroidectomy to be safer, in prognostic terms. This is the prevention of recurrence of the oncological process and metastasis.

The operation lasts 1.5-3 hours. The thyroidectomy is performed under general anesthesia. Surgical intervention is carried out with wide access, for a good revision, on the anterior surface of the neck, along the lower edge of the thyroid gland, surgical incision. The next step is to clamp and ligate the blood vessels, the thyroid gland is separated from the surrounding tissues. The artery that feeds the thyroid gland is tied up, the recurrent nerve and parathyroid glands are separated. Some surgeons use the method of autotransplantation of the parathyroid glands into the muscles of the neck. Then the thyroid gland itself is excised. The incision is sutured and a drain is placed to drain the fluid.

If metastatically altered lymph nodes are detected, lymph node dissection is additionally performed - excision of lymph nodes with surrounding adipose tissue. Required after surgery bed rest for one day, after a day, the drainage is removed, the dressing is done and the patient is transferred to the ward regime.

After the operation, a decrease in the timbre of the voice is possible due to swelling of the surrounding tissues, voice recovery occurs in 3-6 months. The patient is discharged within 3-4 days. After surgical excision of the thyroid gland, radionuclide iodine therapy (iodine-131) is used, aimed at the complete destruction of malignant cells, and the prevention of metastasis.

Also after total thyroidectomy is prescribed hormone replacement therapy- hormone thyroxine of synthetic origin, this therapy is lifelong. In the future, such a patient should be constantly registered with an endocrinologist, and examined once a year - ultrasound of the thyroid gland, ultrasound of the OBP, x-ray of the lungs, general clinical tests and thyroid hormones.

Prognosis of papillary thyroid cancer

Papillary thyroid cancer is a highly differentiated cancer, so the life prognosis for this type of malignant pathology is favorable. The duration of life after suffering this disease depends on the stage of detection of the malignant process, the size of the formation, the presence and prevalence of metastatic changes, the age of the patient, and the adequacy of the therapy performed.

If a carcinomatous node is detected at the onset of the disease, the cure rate approaches 100%, so the 5-year survival rate is 97%, more than 10 years - 75% of patients, 60% of those who have undergone this oncology live for 15 years or more.

If the node was small in size and the patient regularly undergoes a medical examination by an endocrinologist to prevent recurrence, then the survival rate is more than 25 years.

If a cancer process is detected at stage 2, the survival rate for 5 years is 55%, at stage 3 - 35%, at stage 4 - 15%. The prognosis worsens if the malignant node is more than 5 cm or distant metastases are detected. The cause of death in this category of patients is distant metastases.

The recurrence of the malignant process significantly worsens prognostic data. The age of the patient also affects the prognosis of the disease, the younger the patient, the greater the chance of a successful outcome of the disease.

The quality of life of people who have undergone total thyroidectomy practically does not suffer, sometimes a decrease in the timbre of the voice is possible, but this condition is passing.

specific preventive measures no. Main preventive actions aimed at normalizing lifestyle (healthy eating, giving up bad habits, avoiding radiation exposure, avoiding stress). Also, patients at risk undergo annual monitoring by an endocrinologist, this allows you to recognize malignant process in initial manifestations.

Prevention of recurrence of the disease implies the need for an annual examination by an endocrinologist.

Rarely found in the thyroid gland malignant formations. Statistics say that they occupy 1% of all types of carcinoma.

Papillary thyroid cancer is formed from gland cells. It is a dense, most often single node, although multiple nodes do occur. Its size can reach 5 cm and even more, the structure is papillary. This type of cancer is the most peaceful, it grows slowly and is successfully treated. Affects papillary cancer mainly only neighboring tissues and lymph nodes. Distant metastases from papillary thyroid cancer are rare, and most often involve the lungs and bones.

papillary thyroid cancer

At risk are people from 30 to 50 years old, although there are cases of the disease among children (even newborns). Women are 2.5 times more likely to suffer from PTC than men.

Classification of papillary cancer

Types of papillary thyroid cancer according to histological features:

  • typical papillary cancer;
  • Microcarcinoma (also called occult cancer). The size of the node is up to 1 cm. This type rarely transforms into significant neoplasms, often it almost does not increase with time or grows very slowly. For these reasons, the prognosis for microcarcinoma is very favorable.
  • Papillary- (30% of PTC). Contains structures of both kinds. Most often it is an encapsulated tumor, it has a low level of metastasis, compared with a typical PR, and is also less likely to invade. Distant metastases are not observed. That's why follicular view the most favorable.
  • Solid. Most of the time, this type of cancer occurs in people who have been exposed to radiation. Solid papillary thyroid carcinoma is more prone to invasion and metastasis to the lymph nodes and bloodstream than the typical type of PR.
  • Oncocytic. Rare species (5% of cases). This variant of papillary thyroid cancer is more aggressive and has high level distant metastasis.
  • Diffuse-sclerotic. It is very rare (up to 1% of all cases of PCTC), more often it is found in children 7-14 years old. It is characterized by large size, multiple foci, localized throughout the thyroid gland and fibro-sclerotic tissue changes. Almost always, metastases develop in the lymph nodes, and distant ones - in the lungs. The most unfavorable type of PTC.
  • Light cell variant. Occupies only 0.3% of all papillary carcinomas, little studied. It is only known that clear cell papillary thyroid carcinoma often metastasizes to the kidneys.
  • High flying. Aggressive variant of PTC. It is characterized by rapid growth beyond the gland, high height of cancer cells, as well as the level of local and distant metastasis.
  • Mixed. Occurs in 50% of cases. Differs in the presence of papillary, solid and follicular structures in equal amounts.

Also, papillary cancer is divided into encapsulated papillary and non-encapsulated. The first option involves a tumor surrounded by its own capsule. Encapsulated cancers have a better prognosis than non-encapsulated ones.

Causes of papillary thyroid cancer

The causes of thyroid cancer are not exactly known, but in oncology there are several factors that can affect the development of the tumor:

  • influence of radiation, various radiations, chemical carcinogens;
  • bad habits (smoking and alcohol reduce immunity, weaken the body's defenses);
  • heredity (if you inherited a gene that provokes the appearance of thyroid cancer, then the probability of getting sick with it is almost 100%);
  • lack of iodine in the body;
  • diseases of the organs responsible for the production of hormones (for example, ovaries, mammary glands or the thyroid gland itself) and inflammatory processes in the body;
  • hormonal changes (menopause or pregnancy);
  • severe stress, depression.

At risk are the elderly and those who have undergone radiation therapy about other diseases.

A malignant tumor of the thyroid gland can develop from a benign one, such as a multinodular goiter or. Papillary thyroid cancer is also caused by metastases from other organs.

What are the symptoms of papillary thyroid cancer?

The curability of carcinoma depends on the stage at which it was discovered and how large it is. Therefore, it is important to detect PR in time.

To do this, you need to know the signs of papillary thyroid cancer:

  • the presence of a node in the neck, which is palpable, is one of the first symptoms (if the size of the tumor is very small, then it may not be noticed), sometimes it can be seen visually. Over time, the knot grows and becomes more visible;
  • enlargement of the cervical lymph nodes. It is too early sign, but it is often overlooked;
  • discomfort when swallowing or breathing, "lump" in the throat;
  • possible pain;
  • hoarseness, unexplained cough.

The last signs appear when the node reaches a large size and begins to compress the esophagus with the trachea. A person's voice can even change. In the last stages, the general condition of a person worsens, he loses his appetite and abruptly loses weight. There is also an increased body temperature, weakness, fatigue.

The main symptoms of a thyroid tumor are initial stages missing. This is the greatest danger, so you need to be attentive to your body, as well as undergo regular examinations.

Most often, non-malignant tumors are found in adults, and cancer is diagnosed in only 5% of patients. But if you notice a knot on your neck, even painless, then be sure to consult a doctor to protect yourself. This is especially true for children, as they benign formations it can not be.

Stages of papillary thyroid cancer

Papillary thyroid cancer, like any other malignant tumor, has 4 stages of its development:

  1. 1 stage. The formation is small in size - up to 2 cm. It does not have metastases and does not grow beyond the thyroid capsule. At stage 1, papillary thyroid cancer responds well to treatment, but it is very difficult to detect it at this stage of development due to the absence of symptoms of the disease.
  2. 2 stage. The node increases to 4 cm, but does not go beyond the thyroid gland. The neoplasm can be detected by palpation, there is a feeling of discomfort in the throat. Metastases are absent. At this stage of papillary thyroid cancer, treatment is successful in 95% of cases.
  3. 3 stage. The size of the formation is more than 4 cm. It extends beyond the thyroid gland and begins to compress neighboring organs. The patient's condition worsens, new symptoms appear (dyspnea, pain, shortness of breath, hoarseness). This stage is also characterized by an increase in lymph nodes and the presence of bilateral metastases.
  4. 4 stage. The large size of the tumor deforms the gland, it becomes immobile. Necessarily the presence of metastases in the surrounding tissues, as well as their spread to other organs. New symptoms appear, which depend on which organ is affected.

Diagnosis of papillary thyroid cancer

Diagnosis of papillary thyroid cancer is carried out by an endocrinologist. It begins with a visual inspection and palpation. You can feel a carcinoma from 1 cm. Laryngoscopy is also necessary to see the condition of the throat and vocal cords. If the doctor finds any abnormalities, nodules or enlarged lymph nodes, then an ultrasound will be necessary. Such a study will help to see the state of the organ, its structure, contours, as well as determine the location and size of the nodes.

A clearer picture of the development of carcinoma is provided by magnetic resonance and computed tomography. But, like ultrasound, such methods do not make it possible to find out whether this formation is malignant or not.

To confirm the diagnosis of papillary thyroid cancer, the fine needle aspiration method is used. This is a procedure for taking a sample of a tumor, it is carried out using a very thin needle, which is inserted into the thyroid cavity under the supervision of an ultrasound machine. The resulting cells are sent to the laboratory, where they can determine the malignancy of the tumor and its type. If the results of a fine needle biopsy are doubtful, then an open biopsy is performed. This is an operation in which the doctor takes a small sample of the tumor. He will also appreciate big picture and prevalence.

In addition to the above studies, the patient needs to donate blood to check for, as well as check the level of hormones that the thyroid gland secretes. These include: and parathyroid hormones, triiodothyronine, thyroxine.

Another, rare way determining the state of the thyroid gland, which is used in the diagnosis of carcinoma - radioisotope scanning.

Treatment of papillary thyroid cancer, what is it and what does it include?

Once the diagnosis is made, treatment should begin immediately. In almost all cases with papillary thyroid cancer, this is. The advantage is given to total thyroidectomy (the thyroid gland is completely removed). They can also remove regional tissues and lymph nodes if they are affected. These measures are necessary to prevent recurrence of the disease.

If the size of the tumor is small (up to 1 cm), then a partial thyroidectomy can be performed. During such an operation, only the affected lobe of the gland and the isthmus are removed. This method is less traumatic, but it is dangerous because some cells may remain.

The operation to remove papillary thyroid cancer is carried out from 1 to 3 hours. Recovery period after surgical treatment short (up to 3 days), during which the patient's life remains familiar.

After a total thyroidectomy, patients need to undergo replacement therapy, since the body requires hormones that the thyroid gland produces. Therapy consists in taking synthetic or animal T4 hormones. After partial removal thyroid gland may also need replacement therapy, only the dose of drugs will be less. To determine it, constantly analyze the level of hormones.

A person undergoing surgery needs constant monitoring. After 6 weeks, you need to undergo a radioactive iodine scan, which will show the presence of residual metastases or tumor cells. Six months later, the patient is given an ultrasound scan, analysis for and check the level of hormones. Such examinations should be carried out regularly every 6 months, and after 3 years, a full body scan is additionally done. All of these measures are aimed at identifying cancer that can return again.

The prognosis after surgery is good: people can perform all normal activities, women have the opportunity to become pregnant and bear a child.

Informative video

Treatment after surgery

Treatment after surgery to remove papillary carcinoma is radioactive iodine therapy. This method is used if the tumor was large, multinodular, or in the presence of metastases in the surrounding tissues and lymph nodes. necessary for the complete destruction of the remaining thyroid cells. It is carried out 2 months after the operation. The thyroid gland has the ability to absorb iodine. When its radioactive species is absorbed, the cells of the gland are destroyed. To increase the effectiveness of the procedure, you need to undergo some training. Substitution therapy should be canceled 5 weeks before the start of RI therapy in order to increase the level of the TSH hormone in the body. It stimulates the uptake of radioactive iodine by cancer cells. Another way is to take a synthetic form. Enhanced level TSH also leads to hypothyroidism, so T3, vitamin D, and calcium are additionally prescribed. The radioactive iodine treatment procedure is quite safe, as other organs do not absorb it.

Within a week after such therapy, you need to beware of contact with people (especially with your family) so as not to harm them. To do this, sleep in a separate room and do not come closer than 2 m to others. Use only personal items, as well as utensils.
Even after the operation, lifelong use of Levothyroxine is prescribed, which reduces the production of thyroid hormone.

Complications and relapses after thyroidectomy

With thyroidectomy, there are such complications:

  • during surgery, the laryngeal nerves responsible for the functioning of the vocal cords can be damaged, which leads to voice changes and hoarseness. Most often this goes away with time, but sometimes the voice changes for life;
  • inaccurate actions of the surgeon can affect parathyroid glands, which are very close;
  • occurrence of hypoparathyroidism. This condition improves after taking calcium supplements;
  • bleeding, swelling. Also eliminated with .

Disability in papillary thyroid cancer occurs only in cases of severe damage to the recurrent nerve, respiratory failure and severe hypothyroidism, when normal human life is limited. Another invalid can be recognized as a patient who has constant relapses, and the treatment does not give results.

All these complications are very rare, the probability of their occurrence is 1-2%, provided that the operation was performed in a specialized department.

Recurrence of papillary thyroid cancer can occur if the doctor does not completely remove the tumor, but sometimes the cancer returns even after it is completely removed, indicating its aggressiveness. This happens over the years, and even decades. Most often, the tumor occurs again in the lymph nodes and other organs (in the lungs, for example). But, detected in time, cancer is again treatable. It is carried out according to the same scheme as the primary one, but the risk of complications is already higher.

Relapses occur in most cases if the thyroid gland was not completely removed. The tumor is again found in another lobe of the gland. Other factors that may affect the return of the cancer are: large tumor size, extensive and multifocal lesion. The risk of relapse also increases with age.
The prognosis for the first two stages is favorable: complete remission occurs in 85% of cases of total treatment.
It is contraindicated for people who have undergone surgery to expose themselves to any radiation and work with heavy loads (including psychological ones).

Prognosis of life in papillary thyroid cancer

High differentiated cancer The thyroid gland (which includes papillary carcinoma) has a good prognosis compared to other types of tumors.

The prognosis of life depends on several factors:

  • stages of the disease;
  • tumor size;
  • the extent of metastases;
  • patient's age;
  • treatment effectiveness.

The forecast is compiled on an individual basis according to special evaluation tables.

If the cancer was detected at stage 1, then the mortality rate is almost zero. The 5-year survival rate at this stage is 97%, the 10-year survival rate is 90%, and 75% of patients live more than 10 years. And if the tumor in the thyroid gland was very small, then you can live for 25 years, but you are constantly treated and observed by a doctor.

For stage 2, the 5-year survival rate is 55%, for stage 3 - 35%, for stage 4 - 15%. With the advent of relapses, life expectancy is significantly reduced (up to 60%), especially in cases where the cancer returns after total thyroidectomy and radioactive iodine treatment. And when repeated cases there is a high chance of death.

The prognosis is also much worse for patients who have distant metastases or tumors larger than 5 cm. The cause of death in thyroid cancer is often metastases to other organs.

Prevention of malignant tumors

What can be done to prevent cancer?

  1. Avoid radiation whenever possible. If you are offered a course of radiation as a treatment for some ailment, then weigh the pros and cons well. Agree only in extreme cases. Although radiation (including X-rays) does not cause cancer, they increase the risk of developing it.
  2. If you live near nuclear power plants, then take potassium iodide for prevention. It's better to move away.
  3. You can go genetic testing to identify genes that cause . If their presence is confirmed, this organ is removed. But such analyzes are not always accurate.
  4. Eat foods that contain iodine or use iodized salt in your cooking.
  5. Treat hormonal and inflammatory diseases in a timely manner.
  6. Give up bad habits that adversely affect health.
  7. Rest enough time.
  8. Remember about proper nutrition.
  9. Avoid stress and anxiety.

Monitor your health, if you are at risk - undergo regular examinations. Pay attention to the symptoms of a thyroid tumor. This will help to detect in time.

Informative video: Diagnosis and treatment of differentiated thyroid cancer

Papillary thyroid carcinoma is most neoplasms of this organ. However, the tumor responds well to treatment, as a result of which the prognosis for this disease is favorable.

The likelihood of developing the disease increases in the presence of risk factors such as:

  • hereditary predisposition,
  • polluted ecology,
  • malnutrition,
  • Smoking,
  • Stress and excessive exercise.

Pathogenesis

Cancer nodule most often affects one lobe of the gland. In the case of the initial appearance of a tumor in the isthmus, the risk of damage to both lobes is high.

Initially, the knot is smooth to the touch, slightly denser than the surrounding healthy tissue. Later, the tumor becomes rough, without clear boundaries. Gradually, the cancer grows into neighboring organs, compresses them, as a result of which additional symptoms may appear:

  • hoarse voice,
  • the appearance of shortness of breath,
  • difficulty swallowing,
  • the severity of the vascular pattern on the skin of the neck.

The progression of the disease is characterized by metastasis to the lymph nodes on the side of the lesion. In this case, the lymph nodes are greatly enlarged in size.

Classification

There are two types of papillary carcinoma: papillary variant and follicular.

In the first case, both the tumor and metastases do not have hormonal activity. Accordingly, it is pointless to carry out therapy with the use of radioactive substances in this variant. With the follicular type of papillary carcinoma, the tumor is hormonally dependent and responds well to radioiodine therapy.

Diagnostic criteria

Papillary carcinoma has a slow pace of development. Therefore, patients who have the corresponding symptoms often turn to the doctor. These signs include tightness in the neck, voice change, difficulty swallowing, and frequent choking.

This pathology of the thyroid gland most often manifests itself in the form of a single node, less often - multiple. Nodes larger than 1 cm are determined by palpation. In this case, the tumor has a dense, bumpy texture and is displaced on palpation along with the skin. AT rare cases when germinating into neighboring organs, it loses mobility.

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Laboratory diagnostics in this case is not very informative, since almost 95 percent of cases of the disease are hormonally inactive.

Ultrasound of the thyroid gland allows you to determine the type of tumor, its size, possible metastasis and germination in neighboring organs.

Fine-needle aspiration biopsy is the method of disease verification for making a final diagnosis. The area of ​​pathological tissue taken for analysis is examined microscopically. The preparation under the microscope is a branching system, consisting mainly of connective tissue and covered with columnar and cuboidal epithelium. This type of cancer is supplied with a network of blood vessels. Visually, the structure of papillary carcinoma resembles a fern leaf.

Papillary carcinoma is characterized by the following changes:

  • Rebirth from a benign tumor;
  • Weak severe symptoms in the first stages of the disease;
  • The rapid pace of development of carcinoma;
  • Variability in size: it can be either a microcarcinoma or a tumor with a volume of several centimeters;
  • Lack of neoplasm capsule;
  • Metastasis to lymph nodes.

Differential Diagnosis

Well-differentiated thyroid tumors are grouped under common name adenocarcinoma. These include follicular, papillary, and medullary cancers. different types malignant tumor have their own characteristics. They are the differential diagnostic criteria for the diagnosis of papillary carcinoma.

  1. Follicular carcinoma. This tumor is encapsulated and is rarely found on biopsy.
  2. medullary carcinoma. Has a hereditary predisposition. When conducting a blood test, an increase in the hormone calcitonin is observed, and the node is clearly visualized on ultrasound.

Principles of treatment

Treatment of papillary carcinoma involves total thyroidectomy - the complete removal of the thyroid gland. This is done in order to eliminate the risk of re-neogenesis and metastasis from possibly remaining cancer cells. Additionally, conservative therapy with the use of radioactive pharmaceuticals is connected.

After similar treatment requires lifelong thyroid hormone replacement therapy.

The survival rate for timely diagnosis of papillary carcinoma is high. Although it is the most common of all thyroid neoplasms and affects even young children, it is the least dangerous and responds well to treatment.

It still seems that it is not easy to cure the thyroid gland?

Given that you are now reading this article, we can conclude that this ailment still haunts you.

You probably also had thoughts about surgery. It is clear, because the thyroid gland is one of the most important organs on which your well-being and health depends. And shortness of breath, constant fatigue, irritability and other symptoms clearly interfere with your enjoyment of life...

But, you see, it is more correct to treat the cause, not the effect. We recommend reading the story of Irina Savenkova about how she managed to cure the thyroid gland...

The thyroid gland is the largest of all endocrine glands, it takes part in all types of metabolism, controlling the work of each organ.

It affects the metabolic rate, calcium metabolism, emotions, intelligence, and the work of other endocrine glands. She is always called ubiquitous, although she only weighs 20 g.

The peculiarity of the gland is that it is actively supplied with blood to obtain iodine from the blood; produces 3 hormones - triiodothyronine, thyroxine (iodine-containing) and calcitonin.

Another feature of the gland is that it does not immediately release the hormones it synthesizes into the blood, but leaves it in itself. It has 2 lobes and an isthmus, localized on the anterior surface of the neck, just below the thyroid cartilage. Covered with a capsule that has trabeculae and divides the gland into lobules. The parenchyma of the gland consists of follicles - glandular vesicles.

Their walls are built from a single-layer epithelium, which also functions in a special way. Normally, it is flat and does not produce hormones. When the supply is depleted, squamous epithelium is converted to cubic and produces them in the right amount. These hormones in the form of triiodothyronine are stored in the follicles until they are released into the blood at the signal of the pituitary TSH.

Causes of a tumor

The exact cause has not been established, but there are a number of predisposing factors. The most established factor is cell mutation at the DNA level. But the cause of the mutations is also unknown. Mutated cells aggressively grow and divide.

Other factors include:

  1. Iodine deficiency.
  2. Heredity (with it, the risk of the onset of the disease is 100%).
  3. Congenital genetic anomalies.
  4. Prolonged inflammatory diseases of the genitals and breast.
  5. Bad ecology, especially radiation, emissions of carcinogens into the atmosphere by factories - living in such areas dramatically increases the chances of cancer.
  6. Ionizing radiation dramatically increases the incidence of thyroid cancer - this was noted in residents of Hiroshima and Nagasaki, the zone Chernobyl nuclear power plant. Radiation does not directly cause cancer, but provokes. Frequent x-ray for various reasons.
  7. Stress, smoking and alcohol - dramatically reduce immunity.
  8. Hormonal changes during pregnancy and menopause.
  9. Age and gender also matter.

In addition, out of the blue, carcinoma does not develop. It must be preceded by long-term pathologies of a different kind. These include:

  • adenoma and goiter of the thyroid gland;
  • chronic thyroiditis;
  • pathology of the ovaries and breast;
  • any benign tumor.

The appearance of cancer and its types

Among various diseases Thyroid cancer is the least common - only 1%. Epithelial cancers (carcinomas) occur so often because the epithelium, wherever it is, is constantly renewed, which increases the risk of failure of the process.

Carcinoma refers to all types of thyroid cancer. The risk of its occurrence increases by 10% every decade over the years. The tumor is possible at any age, but women from 30 to 50 years old are more often affected.

Men are 2.5 times less likely. But in men and the elderly, papillary thyroid cancer is also possible, and in the elderly and children, the course is more severe. Distant metastases are common in children.

Species epithelial cancer(carcinoma) there are 4 - follicular, papillary (PTC), medullary and anaplastic.

Papillary thyroid cancer is more common than others - 80-85%; 10% - falls on the follicular. These 2 species are highly differentiated and have good prognosis. Microcarcinoma of the thyroid gland (MCTC) - when the size of the node is less than 1 cm. Its main localization site is the fibrous capsule of the thyroid gland.

Adenocarcinoma of the thyroid gland can also occur atypically - 20% of cases. The first symptoms then appear with metastases.

Conventional methods do not detect such cancer in its primary form, it is too small. A form of this cancer is called "hidden thyroid cancer." 82.5% of these cancers are papillary adenocarcinoma.

Its main symptom is cervical lymphadenopathy. They do not cause concern to the doctor and can stay for a long time. Aggressive and unfavorable in the prognosis are medullary and anaplastic - they are poorly differentiated.

What is division by differentiation? Poorly differentiated cancer - its pathological cells mutate strongly, divide rapidly and do not have time to mature to look like healthy cells. This, of course, worsens the prognosis.

With highly differentiated species, the growth of the node is slowed down and the chances of a cure are higher.

Features of papillary cancer

Papillary thyroid cancer can have tumor sizes from 1 mm to 5 cm or more. It is without a shell, and resembles the branches of a palm leaf.

Papillary thyroid carcinoma is covered with epithelial cells with a large nucleus with chromatin. Inclusions from follicles actively absorbing radioiodine are possible.

Papillary thyroid cancer or papillary carcinoma - the name is due to the presence of papillae - special papillary outgrowths.

For some reason, some people are looking for information on the net about capillary cancer. There is no such diagnosis. Capillary thyroid cancer is sometimes referred to as papillary thyroid cancer.

In the histology of the cut, the PR resembles the leaves of a palm tree or fern (frond) with many branches and papillae on them - papilli.

Papillary thyroid cancer is characterized by slow growth and usually gives M in the cervical lymph nodes.

Distant metastases in PR often do not happen - only less than 5%. Metastases appear in the complete absence of treatment. They do not depend on the size of the tumor - this is a feature of PR.

thyroid cancer grades

Papillary thyroid cancer has standard 4 stages, on which the treatment tactics also depend:

  • Stage 1 - there are no manifestations and disturbances in the functioning of organs, externally the gland is not deformed. There are no metastases at this stage. The capsule of the gland is not affected. The name of the stage is T.
  • Stage 2 - no symptoms, but the tumor is growing. In people under 45, a large tumor does not happen - no more than 1 cm. In the elderly - more than 1 cm. And at this stage, with PTC, metastasis begins. The lymph nodes are enlarged. Stage 2 - has the designation NX or N0. It is divided into 2 stages.
  • Stage 2a - the gland is outwardly changed, but the tumor is within the borders of the gland. There are no secondary foci.
  • Stage 2b - the node is already combined with lymphogenous M on one, the affected side.
  • Stage 3 - manifested in a strong increase in lymph nodes - N1. The tumor extends beyond the capsule or presses on the surrounding organs. M is already on both sides in the lymph nodes and visible visually.
  • Stage 4 - secondary cancerous foci in other organs are added to the growths in the lymph nodes.

The tumor has spread to other organs. In such circumstances, it is not uncommon deaths(the stage is designated MX - M0-M1).

Symptomatic manifestations

Papillary thyroid cancer (PTC) and its symptoms: due to slow growth, there are practically no symptoms for a long time. But the plus is that due to such slow growth, it is quite possible to cure the process completely.

The first sign may be the appearance of a painless lump on the neck. In addition, there may be:

  • growth of the cervical lymph node;
  • pain in the throat, trachea and esophagus;
  • discomfort when breathing and swallowing;
  • general weakness;
  • causeless cough;
  • the timbre of the voice does not always change, but often.

Most often, the PR consists of one node, but it can also be multiple. The nodes are dense, deep under the skin and not always palpable. The tumor is not soldered to the underlying tissue for a long time and moves freely when swallowed.

Later, growing, the node becomes immobile - at stage 3. In 65% of cases, the neoplasm metastasizes to the lymph nodes, where it is encapsulated for a long time, the surrounding tissues are very rarely affected.

This condition can last for a long time - for several years and without manifestations. The transition of cancer to the adjacent lobe occurs in 25% of cases. Distant metastases are very rare. During the whole process, the work of the thyroid gland is preserved.

Diagnostic measures

Visual examination, palpation and detailed questioning of the patient. Mandatory is an ultrasound of the thyroid gland; MRI, CT. To identify the function of the thyroid gland, a radioisotope scan is also performed. From blood tests, the content of hormones T3, T4, TSH is determined; blood for tumor markers.

Metastases are established using x-rays. Oncology can only be accurately diagnosed on the basis of histological examination biopsy after TAB.

Possible Complications

Complications are only 1-2%. During removal, it is sometimes damaged in vocal cords recurrent nerve, which causes hoarseness.

The endings of this nerve also innervate the myocardium and mucosa of the esophagus. Rarely, the voice can remain hoarse for life, but more often it goes away.

If the parathyroid glands are damaged, Ca metabolism is severely disrupted. Any side effect is treated medically. With severe damage and hypothyroidism, frequent relapses disability may be given.

Principles of treatment

Treatment is surgical only. Papillary thyroid cancer is treated in 2 stages:

  1. Surgical intervention of surgeons.
  2. RYT. The third step is hormone replacement therapy.

PR does not respond to chemotherapy and radiation. This is the great difficulty of treatment. Thyroid cancer treatment is a radical operation - complete removal of the gland and lymph nodes. At the first stage, the affected tissues or completely iron are removed during the operation.

The operation involves 2 options - total and partial thyroidectomy. The total operation lasts about 5 hours. It is used starting from stage 2 cancer.

If the lymph nodes are affected, they are also removed partially or completely. Leave only a small amount of follicles in the region of the recurrent nerve.

With modern techniques, the incision is made small and there is no rough scar left. It is followed by additional measures.

Another variant of the operation is a partial ectomy of the thyroid gland: it is performed with a tumor up to 1 cm, when there is no metastasis yet.

Such an operation is possible when there are no lymph node metastases, no lymphadenopathy, and the tumor has not gone beyond the boundaries of the gland. Its duration is up to 2 hours. The share or only the node is deleted.

The tissues remaining at the same time compensate for the missing and coarse hormonal disruptions no. Relapses after PR surgery are rare. When they appear, the operation is already only radical.

To maintain a normal hormonal background, a lifelong intake of thyroid hormones is necessary, because new thyrocytes are never reborn.

Papillary cancer and recurrence of papillary thyroid cancer: treatment - in case of relapses and metastases in other organs, the treatment regimen for PR does not change.

To exclude relapses, RIT is performed, since relocated gland cells with atypia are aggressive and dangerous. The radioiodine kills the remaining cancer cells. These cells can remain both in the gland and in distant organs. There they also get radioiodine.

Rehabilitation therapy

After these 2 steps, full examination the patient's body. It can reveal all the foci of localization of foci and show the success of the treatment. On this basis, hormone replacement therapy is prescribed. After discharge, the patient is dynamically observed by a doctor and visits him every year for examination and testing.

Analyzes for TSH and T3 and T4 can show the sufficiency or lack of the prescribed dose of thyroxine. These questions are solved only by a doctor, there is no self-treatment.

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