Papillary thyroid carcinoma: causes, symptoms, stages and features of treatment. Prognosis for a cure. Types of cancer: papillary

Papillary thyroid carcinoma is one of the most common thyroid cancers. this body, and is diagnosed in every third person who applied with characteristic symptoms to a medical institution.

This type malignancy is considered the most dangerous, but timely diagnosis tumors, and high-quality treatment, provide high percent recovery of patients.

What is the feature of papillary thyroid carcinoma

Cancer of this type develops in the tissues of the thyroid gland most often from other oncological diseases.. Malignant formation is formed due to healthy cells and tissues of the thyroid gland. Visually, carcinoma is identified as a cyst or tumor body of irregular shape. In 80% of cases, patients recover completely and get rid of carcinoma.

Distinctive feature is that this kind of tumor develops over a long period of time, and its metastases rapidly penetrate into nearby The lymph nodes. First of all, the submandibular and subclavian lymph nodes are affected.

Reasons for the development of the disease

Oncology scientists believe that the main reason for the development of this type of cancer is the mutation of healthy cells. What caused this phenomenon is unknown. So far, there are only assumptions, because of which the generation of altered cellular material occurs. There are the following factors that provoke the development of papillary thyroid carcinoma:

• Iodine deficiency in the body. This element plays a key role in the stable functioning of the gland. The lack of iodine in the body leads to deficiency states, the productivity of the organ decreases.
• Radiation. It has been proven that the thyroid gland most acutely reacts to radioactive rays in the environment.
• Hormonal disorders. The thyroid gland produces vital hormones and secretions. If their production is carried out in insufficient or excessive quantities, then this can also cause cancer.
• Genetic abnormalities in the development of the body. It happens that people are already born with a diseased gland. Pathologies can be different, but the result is always the same - the absence of normal thyroid function.
• Alcohol abuse, smoking. Alcoholic beverages and cigarettes are a source of carcinogens that cause cell mutations.
• Chronic inflammation of the respiratory tract and larynx.

Depending on the characteristics of the organism, other factors that have a harmful effect on a person can become the cause of the development of carcinoma.

Signs of a disease

This type of cancer is characterized by slow development and division of degenerate cells in the early stages. Therefore, as a rule, the disease is discovered absolutely by chance during a routine examination, or the person feels slight discomfort in the throat area. Nevertheless, it is worth considering in more detail what kind of symptoms are inherent papillary carcinoma thyroid gland.

• Subclavian lymph nodes are enlarged. In most cases, the lymph node is more prominent on the side where the main part of the tumor body is located.
• Pain in the front of the neck.
• During swallowing, it feels as if something is blocking the throat.
• Breathing may be disturbed.
• The voice suddenly becomes hoarse.
• During a slight pressure on the larynx, a person experiences significant discomfort.

These symptoms appear already in the later stages of the development of the disease, when the tumor reaches a significant size. If such signs appear, you should immediately visit a general practitioner, and later, if necessary, an endocrinologist.

General clinical picture of the disease

The first signal of the development of thyroid carcinoma is the formation of a nodular seal on the neck in its front part. In most cases, the formation is solitary, and its metastasis spreads to the nearest lymph nodes through the lymphatic channels.

If the tumor has reached a size of 1 cm or more, then its presence can be determined by the endocrinologist during the examination by palpation. At this stage, the disease is suspected, and the patient is sent for an ultrasound scan, the results of which confirm cancer diagnosis or refute it.

Treatment of papillary thyroid carcinoma

The therapy of this oncological disease is as specific as the pathology itself. The basis of treatment is formed by surgical intervention, which is performed by a surgeon oncologist. Operation is the only effective method against this type of carcinoma. The patient may be prescribed surgery two types:

• Partial thyroidectomy. A part of the affected thyroid tissue is removed along with the tumor body. It is performed in the presence of carcinoma with a small degree of organ damage.
• Total thyroidectomy. The surgeon removes the thyroid gland completely, since the cancer cells of papillary carcinoma have affected the thyroid gland almost completely, and it is not possible to save the organ.

The decision on the type of operation is made by the surgeon together with the attending oncologist who provides therapy to the patient. After the operation, the patient may be prescribed drugs that contain radioactive iodine.

They are used to completely eliminate the remnants of cancer cells that may have survived in the lymph nodes or channels, as well as to support the recovery processes in the thyroid gland. Almost always, recovery occurs quickly enough, and with the right treatment, a relapse of the disease does not occur.

Informative video

Among the variety of cancerous tumors found in the body, thyroid cancer (carcinoma) does not occupy a leading position in terms of frequency of occurrence. However, his appearance in recent times increased, especially among young people. Statistically, the elderly remain the leaders in the development of the disease, and every ten years the incidence rate equivalently rises by ten percent.

Tumors of a benign nature are noted more in women, men are more likely to degenerate nodes into malignant ones. A small proportion of thyroid carcinomas are inherited.

Signs of the appearance of carcinoma

More often, a malignant tumor degenerates from a benign one. At first, the disease does not manifest itself in any way, then the goiter changes its structure, becoming more dense, bumpy. The size of the neoplasm begins to increase.

If a rapidly developing nodule is found without the formation of symptoms, its malignant nature is assumed, despite the fact that single nodes are more often benign.

A malignant nodule usually develops on the underside of one of the thyroid lobes. Sometimes it is found in the isthmus of the gland, then it spreads to both lobes. In the first stages, the tumor is visually smooth, with a denser structure than healthy thyroid tissue. In the course of progression, the neoplasm becomes rough, with blurred boundaries, and gradually begins to occupy the entire share of the thyroid gland. The three-dimensional volume of the tumor also changes: growth goes in the direction deep into the gland, which is why the compression of neighboring tissues, the trachea and the recurrent nerve becomes more and more noticeable. The voice becomes hoarse, shortness of breath begins during physical exertion, other difficulties with breathing. Problems with swallowing (dysphagia) begin, the vascular-venous pattern is clearly visible on the surface of the skin in the region of the gland, the tumor captures more and more tissues, neck muscles.

Lymph nodes on the part of the neck where the tumor is located begin to increase in size, which indicates the degeneration of normal lymphoid tissue into malignant one. This symptom is the main one in diagnosing cancer in children. Compression of the recurrent nerve affects the vocal cord of the affected side, causing paresis in it. Sometimes this does not affect the violation of the timbre of the voice, but the glottis still detects a violation if it is examined by laryngoscopy.

Types of cancer: follicular

An additional nuisance in the detection of follicular cancer from other types of malignant tumors of the thyroid gland is the inability to detect during a biopsy. If the follicular nature of the tumor is detected, the patient is subject to mandatory surgical intervention in order to remove the affected lobe of the gland. To distinguish follicular carcinoma of the thyroid gland from follicular adenoma allows the study of the capsule of the node: with carcinoma, a tumor grows into it.

Types of cancer: medullary

Medullary thyroid carcinoma is less common (only about 6% of all thyroid carcinomas). It is mainly treated surgically. There are two forms of this type of neoplasm:

1. sporadic. The most common form (4 cases out of 5) is not inherited.
2. family. Has a hereditary predisposition, is transmitted along with pheochromocytoma (a tumor in the adrenal glands) and parathyroid carcinoma or parathyroid adenoma (tumors in the parathyroid glands).

These forms of tumors can be distinguished using a genetic study of the 10th chromosome. This chromosome is the localization site of the RET proto-oncogene responsible for the synthesis of tyrosine kinase.

The presence of a mutation in the RET proto-oncogene is the basis for examining close relatives of the patient.

Elevated levels of the hormone calcitonin and a nodule detected during an ultrasound examination indicate medullary carcinoma and immediate surgical intervention.

The promptness of treatment (radioactive iodine treatment is not used in this case) is due to the aggressive nature of this type of cancer. In addition to surgical removal of the gland, tyrosine kinase inhibitors are used.

Types of cancer: papillary

Papillary thyroid carcinoma is the most common cancer of all thyroid carcinomas (about 80% of cases). The least dangerous, develops slowly, occurs even in newborns.

Tumors do not have capsules, their size can vary from a few mm to 4 cm or more. Papillary carcinoma has the appearance of a fern leaf, with a branching stem, the center of which can deposit calcium compounds. In the papillary variant of papillary carcinoma, both the tumor and metastases do not have hormonal activity, and therefore cannot capture the radioactive isotope of iodine-131. The follicular variant of papillary carcinoma exhibits hormonal activity and is therefore treated with radioiodine therapy. In both variants, spread occurs through the lymphatic vessels, and metastases often enter the lymph nodes on the respective side.

The disease often manifests itself in the form of a single node, less often - multiple nodes. Palpation fails to detect thyroid carcinoma less than 10 mm in size. Even such small neoplasms can metastasize to the lymph nodes on the corresponding side of the neck. However, the sluggish nature of cancer makes it possible to establish a favorable prognosis even for such small tumors.

Usually, the tumor is displaced when moving along with the skin. If, nevertheless, it grows into neighboring tissues and organs, it becomes immobile both when swallowing and when trying to move.

Metastases can develop over several years, and only 6 out of ten patients found metastases in the cervical lymph nodes.

It is possible to avoid the appearance of metastases when removing the thyroid gland with benign nodes. In addition to metastases involving lymph nodes, cases of metastasis to another lobe of the thyroid gland are described. And the cases of spread of oncocells to the lungs, bones, etc. are very rare. If this happens, it is papillary carcinoma with encapsulated follicular metastases. In the diagnosis, cancer is recognized only by bone fractures or pain that occurs using x-rays. There are no signs of the disease from the thyroid gland (euthyroid character).

The lethal outcome after the operated papillary cancer is very rare. If such cases occur, then the cancer returns to the rest of the thyroid gland. Almost always it is possible to remove metastases even from bones with iodine-131.

If it is impossible to detect the node by palpation, and metastases to the lymph nodes are obvious, the result of the histological examination of the lymph node decides the issue. Until this moment, the origin of metastases remains a mystery: lymphogranulomatosis, tuberculosis of the lymph nodes, or papillary carcinoma of the thyroid gland.

Although the absence of metastases to the lymph nodes (or single metastases) allows you to save part of the thyroid gland, the practice of surgeons is more radical.

Their fears are understandable: after all, the percentage of metastasis through the lymphatic vessels to the neighboring lobe is quite large and it is not advisable to subject the body to a second operation. Therefore, total thyroidectomy is often used. Sometimes, after surgery, the neck area at the site of the former thyroid gland and local lymph nodes is subjected to X-rays, although papillary carcinoma is not very sensitive to these rays.

Types of cancer: anaplastic

Anaplastic carcinoma is diagnosed in elderly patients. Occurs very rarely. It refers to tumors of an undifferentiated nature, since cancer cells do not have a common functionality with thyroid cells. Therefore, the use of radioiodine therapy is useless. It is found when there are already both metastases in the lymph nodes and distant ones. Due to the late terms of treatment of patients, when there are difficulties in swallowing, breathing, hoarse voice, patients for recovery are shown not only surgery, but also subsequent radiation and chemotherapy.

Varieties of cancer: Hürthle cell

This form is similar to follicular cancer, the feature is more metastasis.

One of the most common oncological diseases thyroid is a carcinoma. It occurs most often in older women and is treatable in most cases. A tumor can arise as an independent neoplasm in healthy tissues, as well as from degenerated cells of benign tumors. To detect papillary thyroid carcinoma, you must carefully consider the appearance of any suspicious signs and sensations in the area of ​​\u200b\u200bits location, immediately consult a doctor for removal.

Papillary carcinoma usually forms as a single nodule, very rarely there is the formation of several nodules. Usually one of the lobes of the thyroid gland is affected. Tumors range in size from a few millimeters to 5 cm.

A small neoplasm is mobile (moves freely on palpation, shifts when swallowed). But as it grows, when it grows into neighboring tissues of the gland, mobility disappears. Cancer cells of this type usually spread only to the nearest lymph nodes (95% of tumors) and very rarely enter other organs (larynx, trachea, lungs, and bones). The low "aggressiveness" of this type of tumor allows doctors in most cases to cope with the disease and completely cure patients.

A feature of papillary thyroid cancer is that the tumor is hormonally inactive, that is, it does not produce hormones and does not cause signs of their excess in the body.

A neoplasm of this type develops very slowly, on initial stage it resembles a cyst or a benign tumor. The formed papillary node under the microscope looks like a capsule with jagged edges, from which papillae extend, capable of growing into neighboring tissues of the thyroid gland. Inside the tumor there are inclusions of calcium.

Forms of the disease

The disease can occur in various forms:

1. Typical, in which the neoplasm grows slowly, characteristic symptoms gradually appear.
2. Hidden when the tumor is small in size and located deep in the thyroid gland. At the same time, it can be detected by palpation or by external manifestations impossible.
3. Follicular-papillary, in which the tumor contains not only papillary, but also follicular cells.
4. Oncocytic - papillary carcinoma of the thyroid gland, which is characterized by distant metastasis. This form occurs only in 5% of patients.
5. Solid - arising in a person who has undergone radiation exposure. The tumor spreads faster than usual throughout the thyroid gland, blood vessels and nearby lymph nodes are affected.
6. Diffuse-sclerotic. Most often found in children aged 7-14 years. The tumor is formed from fibrous tissue cells. It contains many cysts covered with papillae. Cancer cells usually invade the cervical lymph nodes, less often lung tissue. The disease in this form is the most dangerous.
7. Clear cell, which is characterized by the spread of metastases to the kidneys (this occurs only in 0.3% of cases).

Papillary carcinoma is 3 times more common in women than in men. It is usually found in people aged 30-50 years.

Symptoms of papillary carcinoma

It is almost impossible to detect a papillary tumor, which has a small size, by external manifestations. The seal is not palpable, there is no pain in the neck and any other discomfort. There are no signs of hormonal disorders.

Non-specific symptoms and signs

With the gradual growth of the tumor, the first signs of the disease appear: sore throat, feeling the presence of a coma in it, difficulty in swallowing and breathing, hoarseness, dry skin, swelling of the neck. Thyroid dysfunction leads to hypothyroidism (lack of thyroid hormones). Its symptoms are weakness, low blood pressure, slow pulse, dizziness.

After the spread of cancer to the nearest lymph nodes, signs appear that indicate the occurrence of edema in them: sore throat, discomfort in the chest and in armpits. In the last stages of the disease, symptoms of damage to other organs occur. There are also signs characteristic of severe intoxication of the body: a sharp weight loss, the appearance of an earthy skin tone. The patient is being harassed severe pain that can only be suppressed with the help of narcotic drugs.

All these symptoms are classified as non-specific, characteristic not only for papillary thyroid cancer, but also for some of its other diseases.

Specific Symptoms

Specific signs indicating the formation of a papillary tumor are the presence of painless nodes with papillary processes, the spread of the tumor to the lymph nodes, its slow growth and the absence of signs of hyperthyroidism.

Stages of papillary cancer

There are 4 stages of development of papillary carcinoma, taking into account the gradual change in its size and the degree of spread of cancer cells. Characterizing the signs of the disease of stages 1 and 2, experts distinguish 2 age categories of patients: younger than 45 years and older than 45 years. This allows them to more accurately predict the consequences of the disease and the survival rate.

Causes

Thyroid carcinoma occurs due to the fact that under the influence of some adverse factors, a mutation of the cells of this organ occurs.

Mutations can be caused by:

1. Impact on the body radioactive radiation. A tumor of the thyroid gland occurs in people who have been in a zone of increased radiation. The formation of carcinoma may also be a consequence of radiation therapy performed during cancer other organs.
2. Malignant degeneration of benign tumor cells (goiter).
3. Changes in the hormonal background, which occur in women during life much more often than in men. Level fluctuations various hormones occur during each menstrual cycle. Puberty, pregnancy, childbirth, menopause - all these are important physiological periods associated with significant fluctuations in hormone production both in the thyroid gland itself and in other endocrine organs.
4. Metastasis of cancerous tumors formed in other parts of the body (mammary glands, intestines).
5. Inflammatory processes in the thyroid gland, leading to disruption of its functioning.
6. Weakening of the body's immune resistance to the reproduction of cancer cells, as well as the presence of autoimmune diseases thyroid glands.
7. Iodine deficiency due to malnutrition or lack of this element in drinking water or the soil of the area.

The predisposition to the disease may be hereditary. Contributes to the development of carcinoma pollution natural environment habitation, as well as the habit of smoking, frequent drinking.

Video: How thyroid cancer is diagnosed. Importance of prevention

Diagnosis and treatment

The presence of cancerous nodes in the thyroid gland is detected using ultrasound. Their number, shape, location and size are estimated, which allows us to make an assumption about the stage of the disease. In case of doubt about the nature of the tumor larger than 1 cm, a fine-needle biopsy and histological examination of tissues are performed.

X-ray, MRI, CT are used to detect metastases. The basis of treatment is surgical removal papillary thyroid tumor, subsequent radiation and chemotherapy, as well as therapy using radioactive iodine.

Surgical treatments

Partial or complete removal of the thyroid gland is performed. The technique is chosen in accordance with the size of the tumor and the degree of its spread.

Partial excision (thyroidectomy). It is performed when the tumor size is less than 1 cm and there is no metastasis to the lymph nodes or other organs, while a single seal is found only in one of the thyroid lobes. The tumor itself is cut out, a part of the surrounding healthy tissue is captured. Most often, there is no lack of thyroid hormones after such an operation, since they are produced in the 2nd lobe. The need for hormone therapy is rare.

Total thyroidectomy. Both lobes and the isthmus of the thyroid gland, as well as cervical lymph nodes affected by metastases, are removed. After the operation, the patient must take L-thyroxine for life (a drug that is a synthetic analogue of thyroid hormones of the thyroid gland). The dose of the drug is selected gradually, according to the results of blood tests. In the case of hypothyroidism, the dose of the drug is increased, in case of hyperthyroidism, it is reduced.

Thyroidectomy is a fairly simple operation, after which fast recovery patient's health. A complication may be a change in the timbre of the voice due to damage to the vocal nerve. Very rarely damage occurs parathyroid glands, which leads to a violation of phosphorus-calcium metabolism.

Radioiodine therapy

It is performed more frequently after surgery or cancer recurrence. Reception in the form of solutions or capsules of preparations of radioactive iodine-131 leads to the destruction of tumor cells. Therapy is carried out within 2-3 months. Stop taking any hormonal drugs in advance. The patient does not experience any discomfort associated with taking iodine preparations. Only the thyroid gland itself is exposed to it. It does not apply to other organs.

Radiation therapy and chemotherapy

They are used only for stage 4 carcinoma, when extensive spread of metastases occurs.

Prognosis for a cure

The prognosis for recovery from papillary thyroid carcinoma is favorable. After removal of the tumor, patients can live from 5 to 20 years, depending on the stage of cancer treatment. The five-year survival rate for patients with stage 1-2 carcinoma is almost 100%. With stage 3 disease, it is 93%. After treatment of patients with stage 4 disease, survival for 5 years is observed in 50-70% of patients.

After treatment, the patient must periodically undergo a preventive examination: check the content of thyroid hormones in the blood, do an ultrasound scan, a study of radioactive iodine (scintigraphy).

Video: Control monitoring of the state of the thyroid gland after surgery

Medical statistics show that thyroid diseases at the present time are one of the most common. They are diagnosed in every third person, especially in old age. The most dangerous disease is cancer (carcinoma) of the thyroid gland. This diagnosis frightens everyone who only hears such words. But in fact, everything is not as scary as it seems. Modern medicine is so developed that it allows you to determine the disease on early stage and successfully get rid of it. Let us consider in detail one of the types of cancer, which is called "papillary thyroid carcinoma".

Features of the disease

Papillary cancer is more common than other types. A malignant formation appears from a healthy tissue of an organ, is visualized as a cyst or an uneven large tumor. In 80% of all cases, the patient manages to completely recover from this kind of carcinoma.

If we talk about other types of cancer, then in comparison with them, papillary cancer tends to develop for a very long time. Another feature is that metastases of papillary thyroid carcinoma often spread to the lymph nodes.

As a rule, only 1 node is found in a patient, in rare cases there are several. Most often suffer from this disease at the age of 30-55 years, mostly women (but sometimes men are also diagnosed with this disease).

The reasons

So far, no one can exactly determine why thyroid cancer develops. Doctors suggest that, most likely, the reason lies in cell mutation. Why such mutations occur is also not clear.

The tumor develops after the cells have mutated. They begin to grow, gradually affecting the healthy tissue of the organ.

As scientists suggest, papillary thyroid carcinoma develops due to:

insufficient amount of iodine in the body; environment; ionizing radiation; hormonal disorders; congenital pathology; bad habits(smoking, alcohol abuse); frequent viral and bacterial infection respiratory tract.

signs

This form of cancer develops slowly, so initial stages it is determined by chance, and not from any symptoms. A person does not experience discomfort, nothing hurts, he lives a full life. When the tumor begins to grow, it leads to pain in the neck. A person can feel for himself a foreign seal.

In later stages, papillary thyroid carcinoma causes the following symptoms:

enlargement of the cervical lymph nodes (in most cases on one side, where there is a malignant tumor); pain in the neck; feeling foreign body when swallowing; sometimes the voice becomes hoarse; there are difficulties in breathing; when squeezing the neck (especially when a person lies on his side), significant discomfort is felt.

stages

Is papillary thyroid cancer classified somehow? Stages, the signs of which are the basis for the diagnosis:

1. Age up to 45 years:

I stage: the size of education any. Sometimes cancer cells spread to nearby tissues, such as lymph nodes. Metastases do not spread to other organs. The person does not feel any signs of illness, but sometimes there is a slight hoarseness, small pains in the neck. II stage: stronger growth of cancer cells. Metastases affect both lymph nodes and organs that are located close to the thyroid gland (lungs, bones). The signs are quite pronounced, they can not be ignored.

2. Age after 45 years:

Stage I: the tumor is no more than 2 cm, no other organs affect papillary thyroid cancer. Stage symptoms: a person does not feel any special changes, or the signs are mild. Stage II: the tumor does not go beyond the boundaries of the thyroid gland, but the size reaches 4 cm. Stage III: the size is more than 4 cm, cancer cells affect nearby organs.

Big Picture

The appearance of a node or seal is the first thing that begins with thyroid cancer. Carcinoma of the papillary thyroid gland is characterized by solitary formations, in rare cases multiple. If the node is deep, and its size is insignificant, then a person cannot find it on his own. Malignant tumors up to 1 cm cannot be determined even by an endocrinologist. Only after an ultrasound scan are such small formations found or after the cancer cells have begun to spread to the lymph nodes, and they, in turn, have increased.

At small size nodes, the disease is called "hidden papillary carcinoma". Such formations are not very dangerous, even at the stage of metastasis. The tumor moves freely in the thyroid gland, can be displaced during swallowing. But when cancer cells spread to surrounding tissues, malignancy becomes immobile.

Metastases very rarely spread to other organs (except lymph nodes). This happens only in the advanced stages of the disease. Metastases have a property long time don't let yourself know. In most cases, papillary cancer affects the lymph nodes, rarely spreads to another lobe of the thyroid gland.

Cell Features

The main characteristic of a malignant formation:

size - from several millimeters to several centimeters; in rare cases, mitoses are observed; in the center of the formation there may be calcium deposition or cicatricial change; the tumor is not encapsulated; the cells do not have hormonal activity.

Survey

Initially, the doctor palpates the neck in the thyroid gland. The cervical lymph nodes are also palpable. If the doctor detects something, then the patient is sent for an ultrasound scan, with which it will be possible to determine the presence of formations, their size and structure.

The cytological picture of papillary thyroid carcinoma is the main task of the examination. For this, a fine-needle aspiration biopsy is used, which is carried out strictly under ultrasound control.

To understand if there are metastases in other organs, the patient is not sent an x-ray.

Important!

Cytological papillary thyroid carcinoma is an incorrect definition that does not make sense. There are concepts of "cytological examination" (determination of the structure of cells in order to identify pathology) and "papillary carcinoma".

Treatment

How to help a patient diagnosed with papillary thyroid carcinoma? Treatment consists of surgical intervention. With such a disease, a thyroidectomy is used. There are two options for the operation:

partial thyroidectomy; total thyroidectomy.

For the complete destruction of cancer cells, they resort to radioactive iodine therapy, which is carried out after surgery.

Partial thyroidectomy

Surgical intervention this type is indicated for patients with a small size of a malignant tumor located in one of the lobules of the organ. It is important that cancer cells do not spread anywhere else. As a rule, in such cases, the node does not exceed 1 cm in diameter. The duration of the procedure is no more than 2 hours.

The patient is not threatened with the development of hypothyroidism, because the hormone is synthesized by the unaffected lobe of the thyroid gland. Sometimes hormone replacement therapy is required.

Total thyroidectomy

The procedure involves the complete removal of the thyroid gland. Both lobes of the organ are excised, as well as the isthmus that connects them. Sometimes it becomes necessary to remove the cervical lymph nodes. This happens in those cases when they are greatly enlarged, and metastases are found in them. The duration of the procedure is approximately 4 hours.

After this type of operation, the patient will have to take hormone-containing drugs for life. After all, there is no thyroid tissue left in the body.

Therapy with radioactive iodine

This therapy is used when the operation has already been done. It is aimed at destroying the remnants of cancer cells. Metastases that have gone beyond the organ, gone to the lymph nodes, are very dangerous. With the help of radioactive iodine, it is possible to kill such cells. Often they remain in the thyroid gland itself after a partial thyroidectomy.

Even if cancer cells have spread to the lungs, radioactive iodine therapy can successfully get rid of them.

Postoperative period

Thyroidectomy is a complex surgical intervention, but recovery after it is quite fast. Most patients who have to undergo such an operation do not feel much discomfort after the procedure. A person can return to their usual way of life immediately after discharge from the hospital.

It seems to some that after the procedure there will be no opportunity to fully eat, drink water. But it is not. The incision does not affect the swallowing of both solid and liquid food.

Possible complications

In rare cases, the operation ends with complications:

Damage to the recurrent nerve that is responsible for the voice. Hoarseness or slight change in voice. Sometimes the voice changes forever. Damage to the parathyroid glands. They are located behind the thyroid gland, so they can be affected during the operation. But this happens very rarely in inexperienced surgeons. Damage threatens to disrupt the exchange of phosphorus and calcium. As a result, all this leads to hypoparathyroidism.

Forecast

What can papillary thyroid carcinoma cause for a person? The prognosis is favorable in most cases. Even if cancer cells have spread to the lymph nodes, the patient can live for a long time. Statistics show that after surgery a person lives:

more than 20 years in 70% of cases; more than 10 years in 85% of cases; more than 5 years in 95% of cases.

As you can see, papillary thyroid carcinoma is not so terrible. The survival rate is quite high even in cases where the tumor has spread beyond the thyroid gland.

Further examination

After full course treatment, a person should regularly visit an endocrinologist. This is necessary in order to monitor the general state of health. Sometimes the cancer comes back, so you will have to undergo a full examination every year:

blood test (the effectiveness of replacement therapy is determined, as well as the presence of malignant tumors, remaining metastases); ultrasound of the thyroid gland and lymph nodes; body scan with iodine.

Papillary thyroid cancer is a dangerous disease, but in most cases it can be completely eliminated. The main method of treatment is surgery, after which it is necessary to resort to radioactive iodine therapy.

Oncoprocesses in the thyroid gland are quite rare. They can develop in several histological forms: follicular, anaplastic, medullary, papillary, etc.

The most common type of thyroid cancer is the papillary form. Papillary thyroid cancer is a non-uniform cystic carcinoma that develops from healthy glandular tissues and.

The papillary formation is distinguished by the presence of many protrusions (papilla - papilla), sometimes it resembles a fern leaf. The share of papillary malignant oncology of the thyroid gland accounts for approximately 75-80% of cases, and in the female population, such a tumor is detected much more often.

Timely therapy in more than 90% of cases leads to a complete recovery, the life expectancy of such patients often exceeds the 25-year period.

Reasons for development

Papillary thyroid cancer is a highly differentiated tumor cell structures which are similar to healthy cells.

The exact causes of oncopathology are not completely clear to specialists, however, there is a version that the tumor is formed under the influence of genetic mutations, the etiology of which is also unclear. Against the background of genetic abnormalities, malignancy of the cellular structures of the thyroid gland occurs, which further leads to the active reproduction of pathogenic cells.

Cancer cells do not die at the end of their life cycle, they multiply and grow at a slow pace, forming a tumor and attacking healthy organs.

are important in the development thyroid oncology and factors such as:

radiation exposure. The thyroid gland is particularly sensitive to ionizing effects. Thus, thyroid tumors are often found in nuclear power plant employees. The passage of a course of radiation therapy, frequent x-ray procedures also increase the likelihood of developing malignant papillary oncology; Availability chronic processes like thyroid, digestive or genitourinary pathologies; The presence in the family of cases of thyroid goiter; Iodine deficiency; Unfavorable oncogenic heredity; If a woman already has a benign formation in the tissues of the gland and she takes oral contraceptives, then this can provoke malignancy of the tumor; Unhealthy addictions like alcohol, smoking, etc.; To belong to female gender. Scientists have proven that papillary form thyroid cancer is more prone to women 30-50 years of age.

Patients over 50 years of age are prone to more aggressive types of papillary oncology. If thyroid cancer is treated on time, then the patient has every chance for a long remission and a final cure.

Symptomatic manifestations of thyroid cancer are conventionally divided into two categories: nonspecific and characteristic.

Nonspecific symptoms can also be observed in other pathological processes, therefore, they cannot reliably indicate the development of thyroid cancer.

Such signs include:

The presence of a seal in the neck; Discomfort behind the ears and in the larynx; Noticeable swelling of the cervical lymph nodes; Unexplained hyperthermia; Difficulty swallowing, coughing and hoarseness, breathing difficulties; If the resulting seal presses on the vascular parathyroid passages, then a vascular network forms on the neck; If education puts pressure on nervus vagus in the larynx, the patient develops vocal dysphonia.

At first, the development of thyroid cancer is hidden. During endocrinological examination, patients show signs typical for oncopathology:

In the tissues of the thyroid gland, from a certain side, a nodular seal is palpated, which has a papillary surface and does not causing discomfort; At ultrasound diagnostics germination of the formation in the glandular capsule and adjacent tissues is detected; Slow tumor growth is observed; On the part of education, there is a characteristic increase in lymph node structures; Laboratory blood tests revealed increased content thyroglobulin - a tumor marker in the presence of cancer. In addition, the level of CEA in the blood is increased; Violations of the thyroid gland in papillary cancer are usually absent.

Metastasis spreads through the thyroid gland, then to the lymph node structures. Distant metastasis in malignant oncology of the thyroid gland practically does not occur.

Degrees and their forecast

Papillary thyroid cancer forms in 4 stages:

First degree - the node has a local location, does not change the thyroid capsule, does not give metastases; Second degree a - a single, non-metastasing formation that changes the shape of the thyroid gland; Second degree b - a single tumor with metastases on one side; The third stage is a tumor that goes beyond the boundaries of the glandular capsule or presses on neighboring structures, lymph node metastases are localized on both sides of the thyroid gland; The fourth stage - there is a germination of the tumor in the nearest and distant organic structures.

When detecting and treating oncopathology at stages 1-2 five-year survival reaches almost 100% level. If the tumor is detected at stage 3, then the survival rate will be about 95%, and at stage 4 - 45%.

How to diagnose carcinoma?

Diagnosis of thyroid cancer begins with an endocrinological examination, after which the doctor refers the patient to additional procedures such as:

Ultrasound diagnostics, which allows you to determine the boundaries and structure of the thyroid gland; Aspiration biopsy - a mandatory diagnosis that allows you to personally determine the degree of malignancy of the tumor; Tomographic techniques such as PET, MRI or CT, which visualize the tissues of the thyroid gland and tumors and allow you to determine the presence of metastasis; Radioisotope scanning, which is usually prescribed for thyroid hyperfunctionality; Laboratory diagnostics - it includes blood tests for tumor markers, the level of pituitary and thyroid hormones, etc.; Histological examination of the biopsy.

Treatment and prognosis of patients' life after surgery

Thyroid cancer is one of the few oncopathologies that can be completely cured or achieve a long-term remission.

The basis of therapy is surgical treatment, which involves the removal of not only the tumor, but also the thyroid gland (in whole or in part). Such radicalism in treatment avoids relapses and prolongs the life expectancy of cancer patients.

The scale of surgical manipulations is determined by a specialist on an individual basis based on data on the size of the tumor, its metastasis, etc.

Papillary thyroid cancer belongs to the category of the least aggressive formations, therefore, with a small size of the formation (less than a centimeter), it is allowed partial removal glands. With larger sizes of 1-4 cm without metastasis, doctors, if possible, try to leave an insignificant part of the gland in order to minimize the use of hormonal drugs. If the tumor is larger than 4 cm, then the thyroid gland is removed completely. In the presence of lymphatic metastasis, removal of the affected lymph nodes is indicated.

Additional radiation therapy is recommended after surgery to kill any remaining cancer cells.

Quite an effective direction in anticancer thyroid therapy with a papillary type of tumor, radioactive iodine treatment is used, which accumulates in the places of localization of cancer cells and kills them. If the tumor in the thyroid gland is very large and inoperable, then the administration of anticancer drugs (chemotherapy) is prescribed as palliative therapy.

After treatment, patients have every chance for a long life. With papillary thyroid cancer, about 80-90% of patients live for more than 10 years. If there has been metastasis to the lungs and bone tissue, then the prognosis is seriously deteriorating, however, a positive outcome is quite possible.

Cases of death after removal of the tumor occurred only with the re-formation of cancer on a piece of the thyroid gland left after the operation. After the removal of the gland, the quality of life of cancer patients does not suffer at all, except that the voice may change somewhat, and even then only temporarily.

Recurrent papillary thyroid cancer

In order to avoid recurrence, patients after surgery should undergo an endocrinological examination annually.

The probability of recurrence in papillary cancer is about 30%, and a recurrent tumor can develop even ten or more years after surgery to remove it.

The development of relapse can be indicated by symptoms such as soreness, shortness of breath, hoarseness and cough, voice disorders, etc.

Most often, relapses occur within the first year and a half after treatment. If there is a local-regional recurrence, then the prognosis is noticeably worse, because a second operation is needed to remove it, which often results in the development of different kind complications like nerve damage, parathyroid tissue trauma.

Therefore, you need to regularly visit an endocrinologist and systematically check the blood for tumor markers, then a relapse can be prevented.

Video about the surgical treatment of papillary thyroid cancer in high-risk patients:

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 remote metastases are possible. Although this pathology is favorable in terms of prognosis, the severity of the problem should not be underestimated, the earlier the diagnosis is made, the greater the percentage of cure and survival (more than 15 years).

Causes of papillary thyroid cancer

To date, the direct etiology of the development of papillary thyroid cancer 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, there is a high probability of 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 as a short-term effect higher doses radiation, as well as prolonged exposure to slightly increased radiation exposure, increase the risk of oncology;

Bad habits (unhealthy eating and excess eating, smoking, large doses alcohol weaken antitumor immunity);

Benign tumors and long-term inflammatory processes thyroid glands (adenoma, autoimmune thyroiditis);

Violations of the work of other endocrine glands;

Receipt radiation treatment associated with malignant processes in other organs;

Prolonged lack of iodine;

prolonged stress and depressive states worsen the processes of metabolism of carcinogens;

Changes in hormonal levels during menopause and pregnancy;

Polyps of the rectum and colon cancer;

Formations of the mammary glands are malignant and benign, especially associated with hormonal disorders;

Usage oral contraceptives with a benign formation of the thyroid gland, they can provoke a malignancy of the process;

Female;

Age (patients over 50 years of age are more likely to develop thyroid cancer and have a more aggressive form this disease).

Early stage papillary thyroid cancer

Thyroid cancer papillary variant, morphologically, is an uneven cystic neoplasm arising from normal cellular elements of the thyroid gland. 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 parotid region, in the larynx area, an increase in the cervical lymph nodes, unexplained fever, a lump in the throat, lack of air, perspiration and coughing, swelling of the cervical veins. If the neoplasm presses on the vagus nerve, there is a malfunction 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;

Education growth is slow;

An increase in regional lymph nodes from the side of the occurrence of a neoplasm;

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

Based on the histological structure of neoplasms, the following forms are distinguished:

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 a high percentage of distant 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 carcinoma - rarely occurs, differs in metastasis to the renal tissue;

The high cell variant is different great height malignant cells, has a rapid growth rate outside 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 full-fledged therapy, the tactics of diagnostic search is aimed at determining the stage of the oncological process.

To detect papillary thyroid cancer, the following diagnostic procedures are used:

Superficial examination of the cervical region and palpation examination, determines the 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 of the pathological formation. The most accessible and informative effective method detection of nodal structures of the thyroid gland;

Fine-needle aspiration biopsy is 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;

With the help of laboratory methods of blood tests, the functional ability of the thyroid gland is assessed by the level of thyroid hormones, and the presence of an oncological process by 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 - a small nodular element up to 2 cm. Characteristic is the absence of metastasis processes and the germination of malignant cells in the surrounding tissues. 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. The effectiveness of therapeutic measures reaches 95%.

Stage 3 papillary thyroid cancer - the size of the nodular 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 methods of therapy are a surgical method, radiation therapy, 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 at different degrees of the 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 proportion fully compensates for the production of hormones.

Surgery for papillary thyroid cancer

The indication for surgical excision of the 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. Life expectancy 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.

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.

Most terrible diagnosis that can be heard is "cancer". Oncology can significantly reduce the quality and duration of human life. However, do not despair if the tumor is found in the thyroid gland. In most cases, such a neoplasm responds well to treatment, the main thing is to recognize its symptoms in time and undergo a diagnosis.

What is pathology

Thyroid cancer is a malignant tumor that develops from glandular cells. Among all neoplasms, thyroid carcinoma is not very common. The disease is diagnosed only in 1-1.5% of cases of oncology.

Women are more prone to pathology more men, and the disease affects mainly in adulthood and old age - at 45–60 years. Tumors are recorded more often in residents of regions with unfavorable radiation background and where the external environment is depleted in iodine.

The risk group for the disease includes women who have problems with the thyroid gland (especially benign tumors) and those who have relatives with oncology in the family.

Thyroid cancer is a malignant tumor that develops from the cells of the thyroid gland.

Pathology often has a non-aggressive character, the tumor may not grow for years and not metastasize to other organs. AT initial period cancer is successfully treated, does not relapse, and patients after therapy have the opportunity to lead a normal life.

Video - oncologist about thyroid tumors

Varieties of the disease

There are several histological (depending on the cellular structure) forms of cancer:

• papillary - occurs most often (about 70%);
• follicular - a rarer formation (20%);
• medullary - occurs in only 5% of cases;
• anaplastic (undifferentiated) - the rarest and most prognostically unfavorable type of tumor;
• lymphoma - also diagnosed very rarely;
• gyurtle - cell carcinoma;
• mixed - diagnosed not too often - up to 10% of all cases of the disease.

The international TNM system implies a classification of neoplasms depending on the size and extent of the tumor in the gland (T), metastatic involvement of the nearest lymph nodes, that is, the presence of regional metastases (N) and tumor metastasis to distant internal organs (M). Each of these criteria has its own interpretation for assessing cancer staging and treatment prognosis.

Table - classification of thyroid cancer TNM

Thyroid tumors are classified according to their stage of development.

The tumor can be primary or secondary, depending on the place of origin - in the gland itself or through germination from other organs.

There are several stages in the progression of the tumor:

• 1 - the formation is located within the glandular capsule, there are no metastases;
• 2a - a single tumor that violates the shape of the gland or several formations without metastases that do not germinate the capsule and do not deform it;
• 2b - there is a unilateral lesion of the lymph nodes (regional metastases);
• 3 - the tumor has sprouted into the capsule, compresses nearby tissues and organs, while there are bilateral regional metastases;
• 4 - the tumor has grown into other tissues and organs, there are distant metastases.

Varieties of tumors

The thyroid gland is made up of a variety of cells that produce many hormones. Different types of glandular tissue serve as the basis for different forms of malignant neoplasms:

• The most common type of cancer is papillary carcinoma. Such a tumor is the most “calm”, grows slowly and rarely metastasizes. This species responds well to therapy and has the best prognosis among other forms of pathology. Tumor cells are very similar to healthy thyroid cells, that is, this cancer is a highly differentiated neoplasm. Papillary tumor most often occurs in women younger than 30 and older than 50 years.

  

  Papillary thyroid cancer is a highly differentiated tumor and has the least aggressive course.

• The follicular tumor has a more aggressive course. Only in 30% of cases it is minimally invasive, that is, it does not affect neighboring organs and vessels. In other cases, such a tumor grows into the tissues and affects not only regional lymph nodes, but also distant organs. However, this species lends itself well to the effects of radioactive iodine, as it consists of follicular cells that are part of the structure healthy gland. This type of cancer affects older women more than 50 years of age and is associated with dietary iodine deficiency.

  

  Follicular thyroid cancer is prone to metastasis but responds well to treatment

• Medullary carcinoma is a rare tumor composed of parafollicular cells. This form of the disease is much more dangerous than those described above, as it often grows through the glandular membrane into muscle tissue and trachea. In the occurrence of such a tumor, heredity plays an important role, but there is also a sporadic form, when the patient's parents did not suffer from oncology. Medullary carcinoma in most cases is accompanied by multiple endocrine neoplasia - various violations endocrine glands. Treatment of such a tumor has an unsatisfactory prognosis. Neoplasm cells do not absorb iodine, so radionuclide therapy in this case is ineffective, an operation is required with the complete removal of the gland and nearby lymph nodes.

  

  Medullary thyroid cancer is an aggressive tumor that tends to grow rapidly and metastasize to distant organs.

• The most rare and severe form of pathology - anaplastic cancer, in which atypical cells actively divide and develop in the gland. The tumor affects people over the age of 65, it is characterized by aggressive growth and active metastasis. The neoplasm is difficult to treat and has the most disappointing prognosis of all forms of thyroid cancer - it leads to death in about a year from the onset of the disease. This type of cancer usually occurs as a result of nodular goiter with a long duration.

  

  The most severe form of thyroid cancer is anaplastic.

• Lymphoma of the gland is a non-epithelial neoplasm that develops from lymphoid tissue. The tumor can occur on its own or against the background of thyroiditis. Education quickly increases in size, grows into nearby tissues and squeezes them. Lymphoma responds well to ionizing radiation therapy.
• Hürthle cell carcinoma is formed from B-cells of the gland and is similar to a follicular tumor, from which it differs only in a greater tendency to metastasize, both regional and distant, and a lower ability to absorb radioactive iodine during treatment.

Causes and factors of cancer development

Studies show that cancer very often occurs against the background of long-existing pathologies of the thyroid gland - goiter, adenoma, nodes. This is confirmed by the fact that oncology is registered 10 times more often in residents of areas endemic for goiter. Papillary cystoadenoma has a special tendency to malignancy (malignancy).

Risk factors contributing to the development of a tumor:

• Radiation. After the Chernobyl accident, thyroid cancer is registered 15 times more often.
• Ionizing radiation (radiotherapy) to the head or neck. Long-term exposure to radiation can manifest itself years later as cell mutations that begin to rapidly divide and grow. As a result of these processes, follicular or papillary carcinoma may occur.
• Industrial hazards. For workers in hot shops or enterprises where they are involved heavy metals, as well as medical staff whose work is related to x-ray equipment, the risk of getting cancer is higher than that of people in other professions.
• Mature age. In the process of aging, changes begin in glandular cells that can lead to oncology.
• hereditary predisposition. The risk group includes people whose close relatives have dysfunctions and neoplasms of the endocrine glands.
• Bad habits. The abuse of alcoholic beverages weakens the body's immune forces, and tobacco smoke contains a huge amount of carcinogens.
• stressful situations. chronic stress leads to a significant weakening of the protective forces.

Apart from external factors, a significant role in the development of oncology is played by the state of the body and the presence of such diseases as:

• chronic inflammatory processes in the thyroid gland;
• long-term illnesses reproductive system, especially if they cause hormonal disorders;
• neoplasms of the mammary glands;
• tumors and polyps of the colon;
• conditions accompanied by changes in hormonal levels - the period of menopause, childbearing, breastfeeding.

Provoke the occurrence of oncology usually several factors at once.

Manifestations of the disease

At the initial stage, it is very difficult to determine the development of thyroid cancer. The first sign may be a seal in the region of the gland like a small nodule or an increase in the cervical lymph nodes, often unilateral.

With papillary carcinoma, the nodule grows extremely slowly, it is painless and elastic to the touch, as if rolling under the skin. A decrease in the volume of healthy glandular tissue leads to a decrease in the amount of hormones produced, which causes the development of hypothyroidism, which manifests itself:

• lethargy;
• weakness;
• drowsiness;
• hair loss;
• tingling in the limbs.

The follicular form manifests itself as an increase in the cervical lymph nodes and a denser formation. The tumor causes increased output thyroid hormones, leading to hyperthyroidism. Hypersynthesis of hormones by tumor cells is manifested by the following symptoms:

• "tides" - a feeling of heat in the head and chest;
• sweating;
• cramps of the limbs;
• sleep disturbance;
• constant fatigue;
• weight loss
• diarrhea.

Medullary cancer is characterized by rapid growth and the addition of symptoms of damage to surrounding organs and tissues.

Common manifestations of a tumor can be:

• irritability;
• loss of appetite;
• increased fatigue;
• weight loss.

Symptoms worsen as the tumor grows.

As the tumor grows, the patient's neck deforms, the knot becomes visible to the naked eye.

Manifestations of thyroid cancer depending on the stage - table

Diagnostic methods

The endocrinologist deals with the diagnosis of the disease. First of all, the doctor examines the patient, feels the gland and finds out complaints, the presence of chronic diseases, surgeries, tendency to allergic reactions, health status of relatives (whether there are thyroid diseases).

Ultrasound is used to study the state of the gland. The procedure is necessary to determine the size of the organ, the presence of nodes and tumors. Using ultrasound, it is impossible to determine whether the neoplasm is malignant, therefore, in case of suspected cancer, they are used additional methods diagnostics.

MRI (magnetic resonance imaging) makes it possible to distinguish a benign tumor from cancer. CT (computed tomography) allows you to determine the stage of the disease.

Most informative method diagnostics is TAPB - fine needle aspiration puncture biopsy. A needle is inserted into the tumor, with the help of which the doctor takes material for histological examination. If necessary, an open biopsy is performed, during which a small incision is made and a small part of the tumor is excised for microscopic analysis.

For diagnostic purposes, the patient is ultrasound examination, computed tomography and tumor biopsy

Laboratory diagnostic methods:

• An enzyme-linked immunosorbent assay is necessary to determine tumor markers that indicate a specific form of a tumor:
  • elevated calcitonin and changes in the RET proto-oncogene indicate the development of medullary cancer;
  • a high level of thyroglobulin indicates follicular or papillary carcinoma;
  • a large number of antithyroid antibodies indicates a papillary tumor.
• In order to find out how impaired the functional abilities of the gland, the level of steroids in the blood is determined.
• AT general analysis blood reveal anemia and accelerated ESR.

Treatment of pathology

Therapeutic tactics depend on the form of the disease, the stage and the presence of metastases. In the treatment, several methods are usually used in combination, among which:

• surgical intervention;
• targeted therapy (anticancer drugs);
• exposure;
• RNT - radionuclide therapy;
• chemotherapy;
• the use of hormonal agents.

Most often malignant neoplasm responds well to treatment, especially if there are no metastases yet. In the case of inoperable cancer, therapy is aimed at maximizing the destruction of cancer cells and stopping their further growth. Patients with the most advanced forms of the disease undergo palliative care, that is, aimed at relieving symptoms and improving the quality of life.

Therapy with medicines

Currently, the choice of oncologists falls on drugs for targeted therapy of thyroid cancer. These drugs, unlike classical chemotherapy, selectively destroy tumor cells:

• In medullary cancer, the drugs Vandetanib (Caprelsa), Cabozantinib (Kometrik), which suppress tumor growth, are prescribed. The drugs are used for a long time - at least six months.
• Follicular and papillary tumors are treated mainly with surgical methods and with the use of radioactive iodine, but sometimes the appointment of anticancer drugs is justified: the patient is prescribed Sorafenib (Nexavar), Pazopanib (Votrient), Sunitinib (Sutent).

Surgical treatment of cancer

The main treatment for thyroid cancer is surgery. Doctors recommend removing a neoplasm of any size surgically. If the tumor is very small, then one lobe of the gland with the isthmus is cut out - a hemithyroidectomy is performed. The second half of the gland, left after the operation, continues to produce hormones.

Most experts believe that the best option is the complete removal of the organ (total or subtotal thyroidectomy). If nearby lymph nodes are affected, they are also removed.

Before the operation, the patient takes tests: clinical and biochemical blood tests, urinalysis, blood group and coagulogram (clotting). The operation is carried out under general anesthesia, lasts about 60 minutes, if necessary, remove the lymph nodes - 2-3 hours. An endocrinologist surgeon cuts off the gland from surrounding tissues, restores normal blood circulation in nearby organs, and stitches the wound in layers. On the first postoperative day, the wound is drained, that is, a silicone tube is inserted into the incision site to drain fluid (ichorus). The next day, the drainage is removed and the wound is bandaged. If there are no complications, the patient can be discharged as early as 3-4 days after the intervention.

Usually such operations are well tolerated. The patient may be disturbed by pain at the incision site, swelling of the tissues. These symptoms disappear after about 1-1.5 months. The patient can then carry on with her usual full life. If age permits, after the operation, you can become pregnant and successfully bear a healthy child (not earlier than a year after the intervention and prescribed therapy).

Postoperative treatment:

• A month after the operation, the patient is prescribed radionuclide therapy with Iodine-131 to eliminate possible secondary foci.
• Hormone therapy is necessary in case of complete removal of the thyroid gland. Thyroid steroids operated patients have to take for life.
• Suppressive postoperative therapy with Levothyroxine is needed to inhibit the synthesis of thyroid-stimulating hormone by the pituitary gland, which has a stimulating effect on the gland. If the production of the hormone is not suppressed, a relapse may occur.
• After the operation, the patient must be prescribed vitamin and mineral supplements, which are needed for the speedy restoration of organ functions.
• Six months after the removal of the tumor, the patient is examined again: the endocrinologist conducts an examination and prescribes an ultrasound scan. After a year and three years, the patient should again see a doctor and be tested for tumor markers and hormones.

Video - diagnosis and treatment of thyroid cancer

RNT - radioactive iodine therapy

Once in the body, Iodine-131 is completely absorbed by the cells of the gland, which are destroyed. In addition to healthy and tumor cells of the gland, radiation effectively fights metastases, both regional and in distant organs. The method is chosen for the treatment of papillary and follicular carcinomas.

Radiation therapy

Irradiation is not used to combat papillary or follicular formations, as they are amenable to radionuclide therapy. The method is used to treat anaplastic cancer. With diffuse tumor growth, irradiation avoids relapses after surgery and reduces the growth of metastases. The course of radiation therapy is several weeks. The dose of radiation is selected individually.

Photo gallery - methods of treatment of thyroid cancer

Iodine-131 is used to destroy thyroid cells affected by papillary or follicular cancer
Caprelsa is a targeted anticancer drug for the selective destruction of cancer cells.
Hormonal drug Levotherokine is used for suppressive therapy, that is, to suppress the pituitary hormone that stimulates the thyroid gland.
Radiation therapy used to treat anaplastic and medullary forms of thyroid cancer
The main treatment for thyroid carcinoma is surgical removal of the organ.

Diet

After removal of a cancerous tumor, it is not required to adhere to special diet. The diet should be fortified and varied. Vitamins are mostly antioxidants and come to the rescue in the fight against cancer.

Vegetables and greens are useful for the prevention of tumor recurrence: cabbage of all kinds, radish, parsley, parsnips, radish, carrots, celery, green pea, berries, green tea. Meals should include:

• protein food:
  • fish, cheese, cottage cheese, dietary meat;
• sources of simple and complex carbohydrates:
  • fruits, juices, honey, grain and bran bread, various cereals, vegetables;
• fats in the form of vegetable oils.

To prevent cancer recurrence, it is necessary to include as many vegetable dishes in the diet as possible.

It is desirable to remove animal fats, fatty meat, rich confectionery products from the diet, and limit sugar. The use of foods rich in iodine (eggs, soy products, seafood) should be discussed with your doctor. At the time of radionuclide therapy, such products are completely excluded from the diet.

Folk remedies

Non-traditional treatment can be used after surgery as an addition to the prescribed drugs or in the case when medicine is no longer able to help (the tumor is inoperable, the patient is very old or has serious concomitant diseases).

It is necessary to be treated with herbs for a very long time - from six months to 5 years, while not stopping taking herbal remedies immediately after the condition improves. Only a fully completed course of therapy will provide the desired effect.

Nut tincture:

1. Grind 30 unripe walnuts with green peel.
2. Add half a liter of vodka or diluted alcohol and 250 g of honey to the nuts.
3. Leave the mixture in a glass container for 15-20 days in a dark place.

Drink the finished product 1 large spoon in the morning before breakfast.

Infusion of poplar buds to inhibit the production of thyroid-stimulating hormone:

1. Pour 2 large spoons of kidneys with 250 ml of boiling water, insist under the lid for 2 hours.
2. Strain the remedy and drink 20 ml 3 times a day before meals.

Celandine tincture:

1. Twist the roots harvested in May in a meat grinder, squeeze out the juice.
2. Dilute the resulting product with vodka 1:1. The medicine is prepared for 2 weeks in a dark place.

Drink tincture of 5 ml three times a day.

Ready-made hemlock tincture can be bought at a pharmacy. You need to drink the medicine according to the scheme: start with 3 drops three times a day, then every day increase the dose by 2 times (6, 9, 12 drops, etc.) Gradually, the amount of tincture taken daily is increased to 75 drops. At this dose, the medicine should be taken for 3 months, after which the amount is reduced to the original.

In celandine and hemlock there are poisons that have a detrimental effect on tumor cells. It must be remembered that these substances should not be taken simultaneously with radiation or radionuclide therapy.

Powerful bioactive substances and poisons are contained in the plant Aconite Dzungarian. Root tincture is recommended for inoperable cancer to improve the patient's condition. The finished medicine can be purchased at the pharmacy network or prepared at home (20 g of plant root per 200 ml of vodka, leave for 2 weeks). It is better to discuss the dosage regimen with your doctor.

Photo gallery - folk remedies for the treatment of thyroid cancer

Poplar bud medicine is taken to suppress the production of thyroid hormones.
Jungar aconite - a poisonous plant that has a detrimental effect on cancer cells
The hemlock contains substances that destroy the cell of a malignant tumor
Celandine juice contains poisons that help fight cancer
Walnut tincture has long been considered an effective tool in the fight against cancer.

Prognosis and complications

The prognosis of treatment depends on the type of tumor and the stage at which therapy was started. Probability percentage complete cure with early diagnosis of the disease is quite high - 85-90%. The most disappointing prognosis is for lymphoma and anaplastic cancer - fatal outcome occurs 6-12 months after the onset of the disease. There is also a high risk of an unfavorable outcome in medullary cancer, which has a tendency to early metastasis to distant organs. Follicular and papillary carcinomas are most easily cured.

Oncology has a more favorable course in middle-aged patients; in older women, the prognosis is unsatisfactory.

The most serious consequences of the disease:

• recurrence of pathology;
• spread of metastases to various organs: brain, bones, lungs, liver;
• hormonal disorders leading to amenorrhea;
• the possibility of death.

Disease prevention

Prevention of thyroid cancer includes the following activities:

• replenishment of iodine deficiency (due to iodized salt, foods with a high content of the element);
• conducting preventive examinations by an endocrinologist for women at risk;
• reduction of industrial hazards;
• general strengthening of immunity.

What to do to avoid thyroid cancer - video

Early diagnosis of a thyroid tumor is the key to successful treatment of the pathology. Preventive examinations by an endocrinologist are an opportunity to lead a long and fulfilling life, so do not neglect regular visits to the doctor.