Forms of papillary thyroid carcinoma, symptoms and treatment. papillary carcinoma

One of the most common cancers of the thyroid gland is 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 swallowing). 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, at the 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 is impossible to detect it by palpation or by external manifestations.
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 radioactive 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 penetrate into the cervical lymph nodes, less often into the 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 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 haunted by severe pain that can only be drowned out 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 of radioactive radiation. A tumor of the thyroid gland occurs in people who have been in a zone of increased radiation. The formation of carcinoma can also be a consequence of radiation therapy performed for cancers of 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. Fluctuations in the levels of 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 thyroid diseases.
7. Iodine deficiency due to malnutrition or lack of this element in the drinking water or soil of the area.

The predisposition to the disease may be hereditary. Contributes to the development of carcinoma pollution of the natural habitat, 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 the surgical removal of the papillary tumor of the thyroid gland, followed by 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 the patient's health is quickly restored. A complication may be a change in the timbre of the voice due to damage to the vocal nerve. Extremely rarely, damage to the parathyroid glands occurs, 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 the cure, the patient should periodically undergo a preventive examination: check the content of thyroid hormones in the blood, do an ultrasound, a study of radioactive iodine (scintigraphy).

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

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, its appearance has recently become more frequent, especially among young citizens. 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 very rare cases of cancer cells spreading to the lungs, bones, etc. 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. In connection with the late terms of treatment of patients, when there are difficulties in swallowing, breathing, a hoarse voice, patients are shown not only surgery, but also subsequent radiation and chemotherapy for recovery.

Varieties of cancer: Hürthle cell

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

Papillary thyroid carcinoma accounts for the majority of 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. In 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 cylindrical and cubic 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;
• Mild symptoms in the early 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 collectively referred to as adenocarcinoma. These include follicular, papillary, and medullary cancers. Different types of malignant tumors have their own characteristic features. 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 such treatment, lifelong thyroid hormone replacement therapy is required.

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?

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Carcinoma (cancer) of the thyroid gland is not so common in medical practice: it accounts for about 1% of all cancers. Nevertheless, it requires serious attention, both from the doctor and the patient: the sooner it is diagnosed, the better the prognosis for the patient will be.

Our detailed review and video in this article will help you figure out what this pathology is, what morphological types distinguish it (papillary, medullary, follicular thyroid carcinoma), how to recognize cancer at an early stage, and defeat the disease forever.

Despite extensive clinical research being carried out in relation to oncopathology, the exact causes of thyroid cancer are not yet known.

Among the risk factors that provoke malignant degeneration of cells, there are:

• iodine deficiency in the environment;
• goiter, benign tumors of the thyroid gland;
• hereditary predisposition (thyroid carcinoma in one of the close blood relatives);
• hormone-dependent tumors in women (cancer of the ovaries, uterus, mammary glands);
• hormonal fluctuations caused by pregnancy and childbirth, menopause;
• harmful factors at work (ionizing radiation, heavy metals).

Note! Age is another risk factor for thyroid carcinoma. This disease often develops in women over 40-45 years of age and in men over 55 years of age.

Carcinoma occurs from the papillary or medullary epithelium of the thyroid gland.

The tumor may be:

• primary developing directly from the tissues of the endocrine organ;
• secondary, provoked by the germination of cancer cells in the thyroid gland from neighboring organs, as well as their hematogenous or lymphogenous spread.

Important! Benign tumors can also degenerate into carcinoma over time. Therefore, thyroid adenoma in most scientific sources is considered as a precancerous condition and requires dynamic monitoring.

Morphological classification

Depending on the morphological type of cells from which the tumor develops, and the degree of their differentiation (maturity), several types of thyroid carcinoma are distinguished.

papillary carcinoma

Papillary cancer ranks first in prevalence. It accounts for about 70% of all malignant tumors of the thyroid gland.

This form of carcinoma got its name due to the special morphological structure. If you look at a tissue section under a microscope (pictured), you can see the characteristic papillary (from the Latin papilla - papillary) protrusions on the surface of cancer cells.

As a rule, such carcinoma has a favorable prognosis: the tumor grows slowly and in 80-90% of cases affects only one lobe of the thyroid gland. Somewhat worsens the chances of recovery metastasis to nearby lymph nodes.

Follicular carcinoma

Follicular adenocarcinoma of the thyroid gland occurs in 5-10% of cases of all malignant lesions of the organ. It develops from follicular (producing thyroid hormones) cells.

Note! Along with hereditary predisposition, the main factor in the development of follicular thyroid cancer is the lack of iodine in the body.

This form of malignancy is considered more aggressive, but rarely spreads beyond the thyroid gland. Metastasis to the lymph nodes, lungs and bone tissue occurs in the case of late diagnosis and lack of adequate treatment.

Medullary carcinoma

The medullary type of malignant lesions of the thyroid gland is rare: it accounts for about 5%. Such carcinoma develops from the parafollicular cells of the organ (C-cells), which are responsible for the production of the hormone calcitonin.

Medullary cancer is prone to spread, so its distant metastases to the lymph nodes, trachea, lungs and liver can be diagnosed even before the primary focus is determined.

microcarcinoma

Thyroid microcarcinoma is a specific subgroup of thyroid tumors that are less than 1 cm in size. This form of cancer can develop from any type of cell - papillary, follicular or medullary. Although small, this carcinoma can be very aggressive and spread to nearby lymph nodes.

Clinical signs: how to recognize the first signs of the disease

The symptoms of thyroid carcinoma are not always obvious, so the disease can go unnoticed for a long time. A palpable dense nodule on the neck, the size of which ranges from 5 millimeters to several centimeters, makes the patient pay attention to the health problems of the patient.

Is a thyroid nodule always cancer?

Do not be alarmed ahead of time: most of the nodules in the thyroid gland are not cancer. Even if the node reaches a significant size, in 95% of cases it is benign. The prevalence of nodular goiter increases with age: it is a common problem in people over 35-40 years of age.

Nevertheless, it is important for each patient to undergo a comprehensive examination in order to accurately determine the morphological structure of the node.

Typical signs of carcinoma

Most often, patients with thyroid cancer go to the doctor with complaints of:

1. One or more knots in the neck. With carcinoma, the formation is dense to the touch, has bumpy edges.
2. Swelling of the neck can be noticeable with a significant size of nodular formations, especially when the patient makes swallowing movements.
3. Enlargement of regional cervical lymph nodes.
4. Hoarseness occurs when a large tumor node compresses the larynx and disrupts the process of normal sound production.
5. Violation of free breathing and swallowing appears with the pressure of the tumor node on the trachea and esophagus.
6. Pain in the throat and neck area is also sometimes found in thyroid carcinoma. They are not a typical symptom of the disease, but may indicate extensive damage or spread of cancer to neighboring organs.

Methods for early diagnosis

The standard algorithm for examining patients with suspected thyroid cancer is presented below:

• Collection of complaints and anamnesis. Tell the doctor in detail about when the first signs of the disease appeared, whether you took any drugs or traditional medicine made by yourself.
• Examination and palpation of the thyroid gland will allow the doctor to determine the size, density and consistency of the tumor node.
• Lab Tests:
  1. general clinical blood and urine tests: with carcinoma, leukocytosis, anemia (decrease in hemoglobin levels), accelerated ESR are observed;
  2. analysis for thyroid hormones: TSH, T3, T4; is prescribed to assess the endocrine function of the thyroid gland;
  3. determination of the level of thyroglobulin - a specific carrier protein, the concentration of which increases with thyroid cancer. This allows us to consider this substance as a tumor marker.
  4. Analysis for calcitonin (increased in medullary thyroid cancer).
• Instrumental research methods:
  1. Ultrasound of the thyroid gland and cervical lymph nodes;
  2. Biopsy with morphological examination of the obtained biomaterial.

Morphological examination is the main method for diagnosing cancer

To reliably determine the morphological structure of the cells of the tumor node and confirm or refute the diagnosis of carcinoma, it is necessary to conduct a fine-needle biopsy with a study of the obtained biological material. The procedure is carried out under ultrasound control and consists in piercing the neck and taking a small piece of thyroid tissue.

Microscopy of the obtained sample will determine the cellular structure of the formation and make a correct diagnosis, including the type and extent of the tumor.

Table 1: Indications for biopsy:

Principles of treatment

The main method of radical treatment of carcinoma is the surgical removal of the thyroid gland. A promising direction in the therapy of highly differentiated forms of cancer is the use of radioactive iodine (I131 isotope).

This method of treatment makes it possible to achieve targeted destruction of tumor cells that were not removed during the operation, as well as to fight distant metastases.

Important! Modern medical instructions do not require the immediate removal of small (less than 1 cm) thyroid nodules, which have become an accidental finding on ultrasound. If the patient does not complain, and the hormonal background is not disturbed, dynamic monitoring is preferable.

Taking levothyroxine preparations will help to ensure the body's need for thyroid hormones and prevent the re-growth of thyroid tissue. The selection and correction of the dosage of the agent is carried out by the doctor individually on the basis of laboratory and clinical data.

Forecast

In most cases, thyroid carcinoma is a curable disease. A favorable prognosis is considered for young patients with papillary, follicular and, to a lesser extent, medullary cancer.

Adverse factors for the life and health of the patient can be called:

• elderly age;
• large size (4 cm and above) of the primary tumor;
• the presence of metastases in the brain and internal organs.

Note! The prognosis of thyroid carcinoma depends not only on the stage of the tumor process, but also on the degree of differentiation of cancer cells. Highly differentiated (mature) forms of the tumor are considered less aggressive and rarely cause damage to neighboring organs or germination into blood vessels. Poorly differentiated (immature, similar in structure to stem cells) forms are more malignant and lead to the development of complications.

Despite the difficulties in the diagnosis and treatment of malignant tumors of the thyroid gland, papillary, follicular or medullary carcinoma has a relatively favorable course and prognosis for the patient. After the therapy, most patients are considered recovered, and with the exception of the need for daily hormonal drugs, their lives return to normal.

The 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 much more prone to pathology than 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 an 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. In the 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 disrupts 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 of a 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 the 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 disorders of the endocrine glands. Treatment of such a tumor has an unsatisfactory prognosis. Neoplasm cells do not absorb iodine, so radionuclide therapy is ineffective in this case, an operation is necessary 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 is 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 against the background of nodular goiter, which has a long course.

  

  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. Workers in hot shops or enterprises where heavy metals are involved, as well as medical staff whose work is related to X-ray equipment, have a higher risk of getting cancer than 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.

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

• chronic inflammatory processes in the thyroid gland;
• long-term diseases of the 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 production of thyroid hormones, which leads 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, a tendency to allergic reactions, the state of health 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 a neoplasm is malignant, therefore, in case of suspected cancer, additional diagnostic methods are used.

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.

The most informative diagnostic method 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 undergoes an 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 is determined in the blood.
• In the general blood test, anemia and accelerated ESR are detected.

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, a 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 inhibit 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 performed 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. Then the patient can lead a normal 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.
The hormonal drug Levotherokine is used for suppressive therapy, that is, to suppress the pituitary hormone that stimulates the thyroid gland.
Radiation therapy is 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 the cancerous tumor, you do not need to follow a 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, radishes, parsley, parsnips, radishes, carrots, celery, green peas, 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. The percentage of the probability of a complete cure with early diagnosis of the disease is quite high - 85–90%. Lymphoma and anaplastic cancer have the most disappointing prognosis - death occurs within 6–12 months from 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.