THYROID CANCER

Thyroid is an elastic formation consisting of two lobes and the isthmus. Located at the lower third of the
larynx and primary rings of the trachea. It shares borders with the esophagus, the recurrent nerve and
trachea. Outside it is covered with a capsule.

It is the most common form of cancer of the endocrine organs. Among women 15%, men 0,5% of all
malignant neoplasms. 1,1-3,7 per 100000 population are affected. Women are twice more vulnerable than
men.The most common group of incidence is 40 to 60 years of age. However, thyroid cancer may occurs in
young people and children.

Risk factors:
1. Hormonal imbalance.
2. Ionizing radiation
3. Endemic goiter.
4. Genetic predisposition.
5. Chronic thyroiditis
Most often thyroid cancer appears as a node of variable size, dense, white or grayish in color.

Primary multiple cancer is found in 20% of patients.

Histological structure:

1. Follicular carcinoma-differentiated form of cancer - 20% of all thyroid cancers. Made of atypical
follicular cells, mainly in older women. Characterized by slow growth. Grows into blood vessels and
metastasizes hematologically to the bone and lungs. Regional metastases are rare.
2. Papillary carcinoma - differentiated form, up to 70% of all thyroid cancers. Also arises from the follicular
cells. Metastasizes mainly to regional lymph nodes. Slow progression.
3. Undifferentiated carcinoma - the most malignant tumor with infiltration of almost all the gland and
metastasizes quickly with progression. Poor prognosis.
4. Medullary carcinoma - develops from parafollicular cells producing calcitonin. The tumor tissue
contains calcitonin in hundreds of times more than in normal tissue.. Elevated blood levels of calcitonin is a
marker of medullary cancer. Often medullary cancer has family predisposition.

TNM classification

T1-tumor 1 cm without invasion of the capsule

T2 - from 1 to 4 cm or two or more small tumors in one lobe
T3 - more than 4 cm or multiple tumors in both lobes or swelling of the neck.
T4 - tumor of any size with invasion capsules and moving beyond the thyroid gland.

N1 - metastatic lymph nodes in the neck on the affected side

STAGES :

Stage I - T1N0M0
Stage II - T2-4 N0M0
Stage III - T1-4N1M0, T1-4N1M0
Stage IV - T1-4N0-1M1
CLINICAL PICTURE

1. The presence of nodules in the thyroid gland with a dense consistency, lumpy and painless.
2. Secondary symptoms associated with invasion of tumor into adjacent organs or structures: voice
hoarseness, pain and difficulty swallowing, shortness of breath, limited mobility of the gland.
3. Symptoms of intoxication in advanced process.
4. If medullary carcinoma - diarrhea-as a reaction to the secretion of excess hormones (calictonin,
serotonin).
"Latent form of thyroid cancer - is not determined by palpation of the gland, but there is lesion on the lymph
node of the neck.

Diagnosis of thyroid cancer

Ultrasound examination:
Currently, the main method of screening and diagnosis of thyroid nodules. To diagnose nodules smaller
than 1 cm in diameter, and changes in lymph nodes of the neck.

Computed tomography and angiography: methods to verify diagnosis.

Morphological verification by means of needle biopsy - allows to establish the correct diagnosis in 95% of
patients. Using ultrasound imaging can correctly verify morphologically tumors with nodules up to 0.5 cm
Radioisotope scan- a method of identifying tumor formations in retrosternal location of the thyroid gland.

TREATMENT OF THYROID CANCER

SURGICAL -Stage I- hemithyroidectomy.

Stage II- thyroidectomy or subtotal resection
Stage III-combined treatment. Preoperative therapy (SOD-40Gr.) and then thyroidectomy.

When performing radical operation,cervical lymph node dissection on the affected side is mandatory.

In inoperable cases - radical radiotherapy (SOD -60-66 Gy).

In differentiated carcinoma , 5 - year survival rate is upto 80%. The best results is seen in the treatment of
papillary carcinoma.

When there is distant metastases in the skeleton, intravenous radiation therapy with liquid iodine isotopes
-131 is used.
The patients who have undergone thyroidectomy ,need replacement therapy with thyroidin.