Treatment of Thyroid Cancer

About the disease

Until recently, thyroid cancer had not been researched enough. However, thanks to impressive advancements in this field, doctors are now able to treat this type of cancer effectively. Thyroid cancer develops in the thyroid, also known as the epithelium. This disease is also known as papillary carcinoma. Techniques for treatment of thyroid cancer have been invented and implemented into use over the last 50 years.

Thyroid cancer is considered to be a rare disease. Its incident rate is about 1.6% of all malignant tumors. Thyroid cancer is more common in women aged 45-65 years (4 times more often than men). Sometimes thyroid cancer is caused by a radioactive environment, when people get exposed to radioactive iodine. Even if there is no radiation exposure, risk of thyroid cancer can significantly increase with age.

Although this is a rare disease, doctors have reported that the rate of mortality has diminished dramatically over recent years. But in order to recover, it is necessary to undergo a specialized course of treatment and to be diagnosed in time. Today, approximately 80% of malignant tumors are detected at the stage of microinvasive carcinoma, the size of which is less than 0.9 mm without lymph node involvement. This is good news. According to medical journal HealthDay, there is steady progress in curing cancer. For instance, there is a drop in the number of deaths by 1.2% each year. Although this seems to be a relatively small number, it represents thousands of people who have fully recovered from cancer.

A number of high risk factors contribute to the growth of thyroid cancer:

• Presence of chronic inflammation of the thyroid gland
• Lasting inflammation or neoplastic process of the breasts
• Genetic predisposition to tumors of the endocrine glands
• General or local ionizing radiation - this cause of thyroid cancer can develop if a person lives in a harmful environment
• Thyroid adenoma
• A number of inherited genetic conditions
• Conditions associated with a change in hormonal balance during papillary carcinoma
• Physical changes specific to the female body (menopause, pregnancy, lactation)
• Most often, the combination of several factors plays a vital role in the growth of papillary carcinoma
• Deficiency of an iodine element
• Retirement age
• Hormonal imbalance
• Chronic diseases of the thyroid glands

However, it is believed that the swelling of the thyroid glands is a hereditary disease, as cancer cells are incorporated in the body at the genetic level and they progress further under the negative influence of predisposing factors mentioned above.

Symptoms

It is not easy to detect signs of thyroid cancer at an early stage because cancers do not manifest themselves for a long period of time. Soon, however, the patients begin to notice negative changes in their own state of health. Symptoms can include:

• A sensation of a foreign body in the throat
• Difficulty swallowing
• Sweating
• Compression in the throat
• Nausea
• Enlarged cervical lymph glands

Along with the growth of the tumor, thyroid cancer symptoms include shortness of breath, choking, loss of appetite and weight loss.

For children, thyroid cancer growth is relatively slow. Older patients have more severe common symptoms, and the progression of the disease is very rapid. Rare signs of thyroid cancer are anemia and high levels of some hormones.

Diagnosis

• During a Palpation examination, the doctor can find single or multiple swollen lymph nodes.
• A Radioactive iodine scan can diagnose metastatic thyroid cancer and determine if cancer was caused by exposure to radioactive substances.
• Ultrasound reveals the size and the number of special nodes in the gland. However, benign thyroid cancer is difficult to distinguish during the ultrasound, so the diagnosis requires the use of additional breast imaging techniques.
• With the help of Magnetic Resonance Imaging, doctors can diagnose even benign nodules.
• Computed tomography of the thyroid also presents an opportunity to clarify the stage of disease.
• Needle biopsy of the thyroid gland, with subsequent histological examination of the biopsy, is the basic verification method.

Overall, diagnosis is made by ultrasound, MRI and scintigraphy of the thyroid gland. However, the main criterion is the detection of cancer cells in the material obtained during the needle biopsy.

Treatment

Today, endocrinological science has a number of effective methods at its disposal to deal with thyroid cancer. Thyroid cancer treatment may involve thyroid cancer surgery, radioactive therapy with iodines or hormonal therapy, chemotherapy and irradiation. Using a combination of two or more methods, the doctor can achieve high cure rates for thyroid gland cancer.

• The most radical method is a surgical thyroid gland removal. This method is called thyroidectomy. Extended thyroidectomy includes the removal of the muscle along the side of the neck. After surgery, if there are new signs of thyroid cancer, it is absolutely necessary to conduct regular re-examinations to avoid any further recurrence and tumor metastasis, including a chest X-ray, ultrasound thyroid scintigraphy and examinations of thyroglobulin in the blood and others. After the partial or total procedure of thyroidectomy, the patient requires an intake of thyroid hormones (thyroxine) to maintain the high concentration of TSH hormone and reduce thyroid cancer recurrence.
• Lymphadenectomy is required if a patient has metastases in the lymphs that need to be eliminated.
• Radioiodine therapy as thyroid cancer treatment is most effective when metastases of thyroid cancer are located only in the lungs and this treatment can lead to their extinction. The recurrence rate of the tumor depends on the level of thyroglobulin in the blood, for example, during the presence of papillary carcinoma.
• For cases of progressive metastatic thyroid cancer, doctors treat the patient using an external beam. Radiation and chemotherapy are also used for the palliative treatment of incurable cancer.
• Treatment of thyroid cancer following surgery often involves radioactive iodine isotope 131. This isotope improves survival rates and minimizes the likelihood of relapse.

Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko