Thyroid cancer: how long do they live? Consultation with an oncologist. Thyroid cancer

For quotation: Podvyaznikov S.O. THYROID CANCER // Breast cancer. 1998. No. 10. P. 8

Cancer thyroid gland constitutes on average 1 - 1.5% of all malignant neoplasms, however, there is a tendency to increase the frequency of this disease, especially in areas of multifactorial environmental pollution. The disease often affects people of young, working age. In most cases, the thyroid gland is affected by differentiated forms of the tumor, with proper treatment which doctors can achieve quite satisfactory results. However, patients with thyroid cancer often turn to doctors of various specialties (surgeons, endocrinologists, therapists, otorhinolaryngologists, radiologists) who do not know the peculiarities and originality of clinical course this pathology, which has special biological properties. In this regard, various, and sometimes inadequate, diagnostic and treatment methods are used for this disease.

P understanding the problem of the development of thyroid tumors, their clinical manifestations and diagnosis, depends on knowledge of the functional characteristics and morphogenesis of this organ.
The main thyroid hormone, thyroxine, discovered by Kendal in 1915, primarily functions as a regulator of the oxidation process in cells. It is produced, accumulated and released in accordance with the needs of tissues and supplies the body with iodine. IN 1952 A. Pitt-Rivers and J. Gross discovered triiodothyronine, a hormone that acts stronger and faster than thyroxine. These hormones in the lumen of the follicle are associated with thyroglobulin and stimulate all types of metabolism.
Concepts about the morphogenesis of the thyroid gland have also undergone evolution. Before 1962 thyroid gland considered as an organ with monomorphic cellular structure, represented only by follicular cells (later called A-cells), the function of which is associated with the synthesis of thyroxine. In the period from 1962 to 1968, parafollicular cells producing the polypeptide hormone calcitonin (C-cells) were discovered and described in the thyroid gland. These cells are neuroectodermal in nature. They produce polypeptide hormones that are capable of active accumulation of monoamine precursors and their decarboxylation (amine precursos uptake and decarboxylation), and therefore they are classified as the APUD system. In 1970 - 1972 in the thyroid gland a powerful cellular system, accumulating the biogenic monoamine - serotonin, which is currently called B-cells.
Table 1. Histogenetic classification of thyroid tumors

Taking into account the presented data and based on clinical and histogenetic principles, a classification of tumors that can develop in thyroid tissue has been developed (Table 1).
Thus, the histological forms of tumors are associated with various cellular representatives of the thyroid gland, forming clear groups that can be differentiated by microscopic examination and differ in clinical course.
Thyroid cancer occupies a modest place in the structure of the incidence of malignant tumors. It accounts for 0.4 - 2% of all malignant neoplasms. Incidence of thyroid cancer in Russian Federation(1996) was 1.1 per 100 thousand among the male population and 3.8 per 100 thousand among the female population. However, the incidence of thyroid cancer across Russian regions is heterogeneous. Thus, among the male population, the highest incidence was noted in the Ivanovo (2.5% ooo), Bryansk (2.7% ooo), Oryol (3.1% ooo) regions, among the female population - in Bryansk (7.2% ooo), Sverdlovsk (8.2%oooo), Arkhangelsk (9.4%ooo) regions.
Table 2. Frequency of factors contributing to the development of thyroid diseases, %

An increase in incidence occurs in the 4th decade in both men and women, but the incidence ratio remains 1:3, respectively. The incidence of thyroid cancer in all countries has two peaks: the smaller one in age period from 7 to 20 years, the largest - at 40 - 65 years.
Etiology of thyroid cancer. A detailed study of patients with thyroid diseases allows us to make certain judgments about the causes of thyroid cancer.
Hormonal influences. The experiment convincingly shows that the increased content thyroid-stimulating hormone pituitary gland (TSH) in the blood is an important etiological and pathogenetic factor in the development of thyroid tumors. At the same time, suppression of TSH secretion by thyroid hormones causes a therapeutic effect in differentiated thyroid cancer. It is noted that baseline TSH in thyroid cancer is significantly higher than in the absence of pathology in the organ.
Ionizing radiation. IN lately More and more observations point to ionizing radiation as a cause of the development of cancer in the thyroid gland. In 1978, I. Cerlethy et al. showed that in persons exposed to X-ray irradiation of the head and neck area in childhood (for lymphadenitis, enlarged tonsils, adenoids, etc.), thyroid cancer was detected in 19.6% of cases. Among Japanese people exposed to radiation from the atomic bombs in Herashima and Nagasaki, thyroid cancer was observed 10 times more often than among the rest of the Japanese population (R. Sempson et al., 1974). In this regard, it should be noted that there is an increase in the incidence of thyroid cancer in people exposed to ionizing radiation after the accident at Chernobyl nuclear power plant. In Russia (Bryansk, Tula, Ryazan and Orel regions), according to V.V. Dvoirina and E.A. Axel (1993), the incidence of thyroid cancer in children aged 5 - 9 years after the accident increased by 4.6 - 15.7 times compared to the national average.
Table 3. Frequency of early thyroid cancer in the presence of other diseases

However, the results of studies conducted recently to determine the risk of developing thyroid pathology in children living in conditions of multifactorial environmental pollution (V.G. Polyakov et al., 1997) showed that such children have a hereditary predisposition on the maternal side to goiter formation. There was no direct correlation between the enlargement of the thyroid gland in children and the fact of the father’s participation in the liquidation of the Chernobyl nuclear power plant accident.
Other factors contributing to the development of thyroid diseases. The study of the problem of thyroid cancer has recently made it possible to establish a number of factors that are directly related to the development of the disease (Table 2) .
It was noted that in patients with papillary and follicular thyroid cancer, predisposing factors were identified in 84 - 86% of cases, while a combination of several factors occurs in the majority of patients (60.5%).
The issue of the relationship between cancer and “background” processes is one of the main ones in oncology, since it concerns cause-and-effect relationships in carcinogenesis. It has been established that iodine deficiency in the body is the main cause of thyroid hyperplasia. Usually such hyperplasia is compensatory, but sometimes it becomes irreversible. This process can also be facilitated by factors that block the synthesis of thyroid hormones. Thus, the development of malignant New growths in the gland are often preceded by nodular goiter, diffuse and nodular hyperplasia, and benign tumors (adenoma).
Currently, the features of the clinical manifestations of thyroid cancer and the possibility of preoperative diagnosis of “early” cancer, i.e. tumors up to 1.0 cm in size against the background of an unchanged or goitrous gland, are widely discussed(Table 3) . There is a thyroiditis-like form, the clinical course is very similar to Hashimoto's thyroiditis or Riedel's goiter.
The highest percentage of detection of early cancer was observed against the background of adenomas and adenomatosis of the thyroid gland, however, hyperplastic diseases can also be background for the development of thyroid cancer in 23.6% of cases. This once again proves the need for morphological verification of any nodular formation in the thyroid gland.
Taking into account the available data regarding the etiopathogenesis of thyroid cancer, it should be noted that the following should be included in the high-risk group:
. women, long time those suffering from inflammatory or tumor diseases of the genitals and mammary glands;
. persons with a hereditary predisposition to tumors and dysfunction of the endocrine glands;
. patients suffering from adenoma or adenomatosis of the thyroid gland;
. recurrent euthyroid goiter in epidemic areas;
. persons who have received general or local exposure to ionizing radiation on the head and neck area, especially in childhood.
Clinic and diagnosis of thyroid cancer. Clinical manifestations of thyroid cancer are very diverse and depend on the morphological form of the tumor. Differentiated thyroid cancer may not differ from the clinical course of nodular goiter for a long time. This form is called “latent” cancer or local clinical variant. The absence of obvious changes in the thyroid gland leads many specialists to erroneous observation tactics, unreasonable prescription of hormone therapy, non-radical surgical interventions, etc. Often, the first clinical manifestation of differentiated adenocarcinomas (especially papillary cancer) may be cancer metastases to the lymph nodes of the neck. At the same time, cancer metastases increase in size 10 times faster than the primary focus in the gland. In this regard, papillary thyroid cancer can occur as a metastatic clinical variant, often defined in the specialized literature as “hidden cancer” of the thyroid gland. It should be noted that papillary adenocarcinoma is characterized by a high percentage of metastatic lesions of the lymph nodes of the neck, amounting to 40 - 81.3%. Distant metastases are observed in 40 - 44% of cases.
Follicular cancers are less common than the papillary form. Clinically, the only manifestation of the disease is a slowly enlarging tumor in the thyroid gland, which develops over years and does not cause any other complaints in patients. And taking into account the rare metastasis to regional lymph nodes (2 - 10%), follicular forms of thyroid cancer have a local clinical variant.
Undifferentiated forms of thyroid cancer are rare, in 4 - 5% of cases. The tumor consists of several nodes that have merged into a single conglomerate without clear boundaries. The process proceeds quickly, the tumor infiltrates the surrounding anatomical structures and often (up to 70%) metastasizes to regional lymph nodes. Clinically undifferentiated cancers have a locally metastatic course.
Medullary thyroid cancer is classified as an “apudoma”, given the fact that C cells, producing catecholamines, they are representatives of the APUD system. In patients suffering from medullary thyroid cancer, adrenal pheochromocytomas, hyperplastic parathyroid glands, multiple mucosal neuromas, and ganglioneuromatosis may be detected. gastrointestinal tract, diverticulosis and megacolon, marfanoid type of face. The combination of medullary cancer with this pathology is defined as Sipple's syndrome, which should be considered a family disease transmitted by an autosomal dominant inheritance pattern.
Medullary thyroid cancer can be multihormonal and, in addition to catecholamines (adrenaline, norepinephrine, DOPA decarboxylase), produce calciotonin, serotonin and prostaglandin, an excess of which sometimes leads to diarrhea. It is noted in 25 - 32% of patients with medullary thyroid cancer.
This form of cancer is characterized by a high frequency of regional metastasis (40 - 55%), and often there is bilateral damage to lymph node metastases.
Squamous cell carcinoma of the thyroid gland is histologically associated with the remains of embryonic cells of the elements of the thyroid-lingual duct and is extremely rare. More often it can be noted due to the growth of a tumor process into the gland from the larynx, esophagus and other organs of the upper respiratory-digestive tract. In this regard, it is important differential diagnosis a primary tumor developing in the thyroid gland itself, and a secondary one, i.e. a malignant neoplasm of another organ that has spread beyond its boundaries and invaded the thyroid gland.
Thyroid sarcomas are also not a characteristic morphological form of the thyroid gland, like squamous cell carcinoma. At the same time, in the specialized literature there are descriptions of isolated observations of fibrosarcomas, leiomyosarcomas, and tumors of vascular origin. There are known cases of lymphosarcoma developing against the background of Hashimoto's thyroiditis and lymphogranulomatosis.
Variety of clinical manifestations of thyroid cancer indicates the variability of the course of this disease and requires oncological vigilance for all patients suffering from any pathology in the thyroid gland.
Assessing the main complaints of patients with differentiated forms of thyroid cancer (papillary and follicular adenocarcinoma), patients often complain about the presence of a tumor in the gland area (50 - 63%), for anaplastic cancer in to a greater extent inherent complaints associated with the prevalence of the process affecting neighboring anatomical structures (changes in voice timbre, choking, swallowing disorders), as well as general clinical symptoms(rapid tumor growth, increased body temperature, weight loss, general weakness, sweating, etc.).
Clinical diagnosis thyroid cancer is based on medical history (time of tumor appearance in the gland), changes in the rate of tumor growth, asymmetry of the lesion, changes in the sphericity of the contours of the gland, and tumor density. Thyroid adenoma is usually characterized by a spherical shape of the tumor, malignant neoplasm grows into the gland tissue and loses its sphericity. The appearance of a tumor node in healthy gland tissue makes one suspect its malignant nature, especially in people over 40 years of age. At the same time important role plays a role in the rapid growth rate of the tumor, which is initially asymmetrically located in one lobe of the gland. The neoplasm has a dense elastic consistency.
Instrumental diagnostics is based on data from ultrasound tomography and/or radioisotope method. In both cases, as a rule, a topical diagnosis is established, i.e., the exact localization of the tumor is determined, as well as its true size and relationship to surrounding tissues. With the radioisotope method, the “functional” activity of the neoplasm can be determined, i.e., the degree of accumulation of the radionuclide is determined gland tissue and tumor. With neoplastic processes, “cold” nodes are detected, with hyperplastic processes, “warm” or “hot” ones. The likelihood of diagnosing cancer when examining punctate from a so-called cold node is much higher, however It should be emphasized that any nodular formation detected in the thyroid tissue should be subjected to a puncture aspiration biopsy. It is most advisable to puncture a tumor that is at least 0.8 cm in size. Accuracy cytological examination is 96%, while the cellular origin of the tumor is determined in 78% of cases.
Thyroid cancer and thyrotoxicosis. Even 20 years ago, such a combination was rare; moreover, thyrotoxicosis was considered a kind of guarantee against the occurrence of malignant tumor, expressing the opinion that excess thyroid hormones prevent the occurrence of cancer in the gland. Recently, quite a lot of publications have appeared regarding the combination of thyroid cancer with thyrotoxicosis. The latter can be caused by both diffuse or adenomatous hyperplasia and the functional activity of the tumor itself. Proof of this is the recurrence of thyrotoxicosis in patients operated on for thyroid cancer when they develop a relapse or metastasis of cancer.

Mistakes in diagnosing thyroid cancer

Doctors often pay attention to pronounced signs thyroid cancer: rapid growth of the tumor, immobility of the tumor, the presence of metastatic lesions. Meanwhile initial symptoms escape attention medical workers, which delays the process of examining the patient and can lead to unreasonable conservative or inadequate surgical treatment.
Conservative treatment of patients with thyroid cancer with iodides and hormonal drugs helps in some cases to improve general condition patient, and in some even leads to a reduction in tumor size (usually due to the elimination of perifocal inflammation). This misleads doctors and patients with thyroid cancer receive conservative treatment for a long time.
Thyroid pathology among residents of the Russian Federation has become more common, and has doubled over the past 10 years. In this regard, patients suffering from this pathology began to receive treatment more often in surgical hospitals general profile. In specialized oncological institutions, the group of patients with thyroid cancer after non-radical primary operations began to increase, since 90.8% of such patients are operated on in general surgical departments and only 9.2% in oncological institutions of the country. Preoperative diagnostic errors inevitably lead to tactical errors. In particular, an analysis of the treatment tactics for patients with thyroid cancer in general surgical departments of hospitals in the Moscow region showed that in 84.9% of cases non-radical operations were performed, i.e. surgical interventions including enucleation of the node, resection of the gland lobe, hemithyroidectomy without resection of the isthmus, Nikolaev surgery (A.I. Paches et al., 1990).

Treatment of thyroid cancer

Nodular formations of the thyroid gland of a neoplastic nature, as well as hyperplastic processes in the absence of obvious positive dynamics from conservative therapy, they must undergo surgery. At the same time, taking into account enough high risk If thyroid cancer is detected against this background, extracapsular surgery should be performed in the amount of hemithyroidectomy with resection of the isthmus. The remaining portion of the gland fully compensates for the body's need for thyroid hormones, and if a malignant tumor is detected in a remote specimen, this volume surgical intervention can be considered radical.
The leading method of treatment for thyroid cancer is surgical, and the extent of its implementation depends on the extent of the process and the morphological form of the tumor. All surgical interventions are performed extracapsularly. Despite the high percentage of metastatic lesions of regional lymph nodes, preventive operations on the neck are not performed and the question of surgical treatment solved in case of realized metastases. The presence of metastases of thyroid cancer in regional areas in differentiated forms of the tumor (papillary and follicular adenocarcinoma) does not worsen the prognosis for the patient.
Radiation therapy for differentiated forms of thyroid cancer is not effective and does not improve long-term results of treatment of patients, and therefore its use in the treatment of papillary and follicular adenocarcinoma is inappropriate. Radiation therapy is indicated for patients with undifferentiated thyroid cancer and is used in combination with surgical method in the treatment of medullary thyroid cancer.
Hormone therapy is prescribed for replacement purposes. It is advisable to use it in the treatment of inoperable differentiated thyroid tumors or their metastases. When prescribing hormone therapy, it is necessary to know the level of thyroid hormones in the blood of the operated patient; drug doses are selected individually and under the supervision of an endocrinologist.
Radioactive iodine (131I) can be used in the treatment of distant metastases of differentiated thyroid tumors after thyroidectomy in such patients.
The possibilities of chemotherapy for thyroid cancer are limited, and its use is most appropriate for inoperable cancer, the treatment of disseminated forms of the tumor and undifferentiated thyroid cancer.

Literature:

Paches A.I., Propp R.M. Thyroid cancer. - M., 1995.
Paches A.I. Tumors of the head and neck. - 3rd ed., 1997.
Cobin RH, Sirota DK. Malignant tumors of the thyroid. Clinical concepts and controversies. Springer-Verlag, New York, 1992.

As you know, the thyroid gland is located on the front of the neck and plays huge role in the metabolic processes of the body, being the most important part endocrine system.

A malignant neoplasm that develops from thyroid cells is called thyroid cancer. Most often, the pathology is diagnosed in people 45-60 years old, but the disease can appear at any age (even in children and adolescents). The younger the patient, the more aggressive the cancer behaves.

On initial stages There are no symptoms, so regular preventive screening examinations are of utmost importance.

With their help, you can detect thyroid cancer on early stages, which significantly facilitates subsequent treatment and improves the prognosis, allowing a person with thyroid cancer to live a full life.

Most often, thyroid tumors occur in women, but in old age (65 years and older), the risk of developing thyroid cancer is higher in men. This type of cancer is classified as a non-aggressive form; the tumor may not grow or metastasize for many years. But this does not mean that the disease should be ignored.

Classification of thyroid cancer

The following are the main types of thyroid cancer:

1. Papillary cancer (carcinoma) of the thyroid gland. It occurs most often (in approximately 70% of cases). This is the name this type received cancer because a microscopic examination of the tumor revealed multiple papillary projections.
   The tumor usually occurs in only one lobe and develops rather slowly. However, this type of cancer can metastasize to the cervical lymph nodes.
   The prognosis is relatively favorable. With timely treatment, patients live 25 years or more. The chances of recovery are significantly worsened by cancer metastasis, large (more than four centimeters) tumor size, age younger than 25 and older than 50 years.
2. Anaplastic cancer. It is quite rare, the tumor grows quickly, affects the cervical lymph nodes and gives distant metastases. The prognosis for this form of cancer is unfavorable. The disease usually develops in old age, against the background of long-term nodular goiter.
   During the rapid growth of the tumor, the patient experiences problems with breathing, swallowing, possible loss of voice, and attacks of suffocation. Death occurs quickly, within a year.
3. Follicular thyroid cancer. Occurs in approximately 7-10% of cases. One of the reasons for its development is iodine deficiency. Most often, the tumor does not extend beyond the thyroid gland; metastases to the lungs, bones and nearby lymph nodes are rare. With timely treatment, the prognosis is favorable, most patients recover.
4. Medullary thyroid cancer. Occurs in approximately 5% of cases. This is a moderately differentiated form of oncology. The course of the disease is aggressive, with early appearance metastases.
5. Lymphoma of the thyroid gland. This type of cancer develops independently or is a complication of autoimmune thyroiditis. The tumor develops from lymphocytes. Clinically manifested by a rapid increase in thyroid gland size, inflammation cervical lymph nodes, compression of the mediastinum. Metastases are rare, and the tumor responds well to radiation therapy.

Stages of thyroid cancer

There are four stages of development of thyroid cancer:

1. The size of the neoplasm is less than two centimeters, it does not grow into neighboring organs and does not metastasize.
2. The tumor begins to increase in size, grows over the entire lobe, does not invade neighboring organs, and single metastases may appear.
3. The tumor continues to grow, can become multiple, and metastasizes to the cervical lymph nodes.
4. The tumor is large in size and strongly compresses nearby organs, which causes the appearance of a vivid clinical picture. Multiple metastases appear.

Causes of thyroid cancer

The exact causes of the disease are unknown, but there are a number of factors that can trigger the development of cancer.

These include:

• exposure to radiation - in people who have received large doses of ionizing radiation, the risk of developing thyroid cancer increases sharply; this fact was confirmed after the accident at the Chernobyl nuclear power plant, when many people who took part in the liquidation of the consequences of the accident began to develop cancer several years later;
• some chronic diseases- pathologies such as goiter can lead to the development of thyroid cancer, benign neoplasms thyroid glands, breast tumors, intestinal polyps, pathologies of female reproductive organs;
• radiation therapy— the development of cancer can occur even several decades after irradiation, as a result of mutation of one’s own healthy cells, which gradually form a malignant tumor;
• constant stress and emotional overstrain - these conditions of the body cause depression, which leads to a decrease in immunity and can trigger the mechanism malignant degeneration thyroid cells;
• bad habits - alcohol and tobacco are recognized carcinogens and can cause the development of many forms of cancer;
• working in hazardous work significantly increases the likelihood of developing thyroid cancer;
• hereditary predisposition - if thyroid cancer was diagnosed in close relatives, this sharply increases the likelihood of developing the disease in their descendants;
• age 40 years and older - as the body ages, the risk of a genetic failure that leads to the development of cancer increases.

Symptoms of thyroid cancer

The main danger and insidiousness of almost any type of cancer is that in the initial stages, when it can be quite easily cured, it is asymptomatic. The first noticeable signs of the disease usually appear when the tumor has already grown sufficiently and begins to compress the surrounding tissue.

One of the first visible symptoms of thyroid cancer is the appearance of a nodule on the gland. In some types, the first signs appear only after the tumor has metastasized to the cervical lymph nodes.

Most often, the development of a tumor is provoked by nodular goiter, so all patients with thyroid diseases should undergo regular preventive examinations for early detection cancer.

The main signs of the disease include:

• the presence of a palpable nodule in the thyroid gland;
• change in voice, difficulty swallowing, periodic feeling of asphyxia;
• pain in the neck (sometimes the pain radiates to the ear).

The main symptom is the appearance of a lump on the thyroid gland. If it is single, isolated, and growing rapidly, then this gives the endocrinologist reason to suspect that we are talking about cancer. Particular attention should be paid to the formation of such nodes in children and adolescents, as well as in the elderly. It is these age categories that are at risk for thyroid cancer.

If the patient already has a goiter, then you need to pay attention to atypical changes (rapid growth, occurrence of large quantity new nodules on the thyroid gland and so on).

Symptoms of thyroid cancer, such as loss of voice, difficulty swallowing and breathing, occur if the tumor is large and puts pressure on the surrounding tissue so much that it closes the lumen of the esophagus, larynx, trachea, as well as the recurrent nerve that leads to the vocal cords .

As the tumor grows, compression and damage to the tissues and organs of the neck and vascular bundle occurs, blood circulation is impaired, and, as a result, local metabolic processes are disrupted. With further progression, tumor cells enter the lymph nodes of the neck and then spread throughout the body through the flow of lymph and blood.

Clinical manifestations also depend on the type of cancer. Thus, with the papillary form, the tumor grows slowly, over several years or even decades, metastases in the cervical lymph nodes are observed in only 20% of patients.

The follicular form of the disease is more aggressive and can give rapid metastases to nearby lymph nodes and to the lungs. Medullary cancer is manifested not only by the appearance of a tumor in the thyroid gland, but also by high blood pressure, carbohydrate metabolism disorders, diarrhea, facial hyperemia, and a feeling of heat.

Considering that a tumor can develop asymptomatically over a long period of time, it is necessary to consult a doctor for examination if the following risk factors are present:

• age under 20 and over 60 years;
• presence of thyroid cancer in close relatives;
• the appearance of a dense nodule in the thyroid gland, which begins to grow quite quickly, limiting the mobility of the gland;
• causeless enlargement of cervical lymph nodes, change in voice;
• suffered exposure to radioactive radiation.

Children often the only symptom developing cancer is an enlargement of the cervical lymph nodes, so if such a symptom appears, you must consult a doctor to find out the causes of this phenomenon.

Diagnosis of thyroid cancer

If one or more of the above symptoms appear, you should consult a specialist and undergo an examination. If necessary, the endocrinologist can send the patient to an oncologist for additional examinations.

The diagnosis of thyroid cancer is made based on the results of the following studies:

1. Collecting anamnesis, interviewing the patient.
2. Clinical picture diseases (dense node in the thyroid gland, changes in voice, swallowing, periodic asphyxia, enlarged cervical lymph nodes).
3. Ultrasound of the thyroid gland. They are carried out to determine the size of the gland, identify the presence of a neoplasm and its location.
4. Blood test for thyroid hormones.
5. Scintigraphy of the thyroid gland. When conducting this study use special radioactive iodine. Scintigraphy is used to differentiate a benign thyroid tumor from cancer.
6. MRI, CT. Carry out to determine residual tumor tissue and detect relapse of thyroid cancer during postoperative examination of patients.
7. Aspiration biopsy followed by examination of the sample taken biological material under a microscope. Using this study, the type of neoplasm, type of cancer, and its stage are accurately determined.
8. If thyroid cancer is suspected, consultation with an oncologist is also necessary.

Treatment of thyroid cancer

The choice of treatment method depends on the type and size of the tumor, general condition, age of the patient, and the presence of metastases. Today, the main methods of treating this disease are:

1. Thyroidectomy. The essence of the method is to remove the thyroid gland and nearby lymph nodes. If surgery for thyroid cancer is performed on a child, then resection of only one lobe of the gland that is affected by cancer is possible so that the child does not develop serious hormonal disorders in the future.
2. Hormonal therapy. It is prescribed after surgery and helps the body function normally in the absence of the thyroid gland. In addition, hormones are used to stop the growth of pathologically altered cells that could remain in the body after surgery.
3. Chemotherapy. The essence of the technique is to use radioactive iodine for the treatment of thyroid cancer, which has the ability to accumulate in the tissues of the gland and destroy its cells (both cancerous and healthy).
   Once in the intestines, iodine is absorbed into the blood and is delivered by its current to the thyroid gland, where it is completely absorbed by its cells. For other organs and tissues this technique negative impact does not provide. Most often, such treatment is carried out after surgery to remove the thyroid gland if not all tumor cells were removed. In addition, this technique is used when metastases appear.
4. Targeted therapy. If it is not practical to use the previous treatment method (for example, with medullary cancer), the patient may be prescribed targeted therapy drugs, which have a selective effect and destroy only tumor cells. For other types of thyroid cancer, targeted drugs are rarely used, since good effect thyroidectomy gives.
5. Radiation therapy. The use of highly targeted radiation is another method of treating thyroid cancer. Radiation is used to treat anaplastic thyroid cancer. In addition, such therapy is indicated to prevent metastases if the tumor has already spread beyond the gland.
   The course of treatment takes several weeks. The irradiation procedure is absolutely painless. After completing therapy, the patient needs several months to recover, since his body is greatly weakened.

Thyroid cancer prognosis

The outcome largely depends on the stage at which the disease was diagnosed. In addition, the histological structure of the tumor is of great importance.

For example, with anaplastic cancer and lymphoma, mortality from thyroid cancer is almost absolute.

Follicular cancer is less aggressive and the likelihood that the patient will live more than 5 years is quite high. A medullary tumor is extremely aggressive, it grows quickly and begins to metastasize to both nearby and distant organs, which significantly worsens the prognosis of the disease. The survival rate for this type of thyroid cancer is extremely low.

Prevention of thyroid cancer

The main measures to prevent the disease are:

• proper nutrition - food should contain a sufficient amount of iodine, you must avoid junk food, introduce more fresh vegetables and fruits into the diet;
• timely treatment pathologies of the thyroid gland and other organs that can provoke the development of oncology;
• refusal of uncontrolled use of hormones; all medications must be prescribed by a doctor, who also determines their dosage and duration of treatment;
• use of personal protective equipment when working in hazardous industries;
• strengthening immune defense, hardening the body;
• refusal bad habits;
• avoidance of stress and other types nervous overstrain;
• refusal of a sedentary lifestyle, which leads to the development of stagnation throughout the body, it is necessary to engage in physical exercise, spend more time in the fresh air;
• regular sanitation of lesions chronic infection in the body;
• avoiding exposure to radioactive radiation on the body;
• periodic preventive examinations - this will help identify possible problems with health in the early stages.

Our region, including Chelyabinsk, is considered an endemic area for goiter, since in Southern Urals There is a lack of iodine in food, water, environment. That is why thyroid diseases are widespread in our country. Thyroid cancer is not a widespread disease, but recently it has been observed somewhat more often, including among children.

The head of the Department of Oncology at South Ural State Medical University, Doctor of Medical Sciences, Professor Sergei Yaitsev, talks today about the features of the occurrence, treatment and prevention of thyroid cancer.

— Sergey Vasilyevich, many patients with thyroid problems are concerned about the question: can hyperthyroidism or goiter turn into thyroid cancer?

- That's two absolutely. various diseases. Hyperthyroidism, or diffuse toxic goiter, is a consequence of increased function of the thyroid gland, when the gland increases diffusely, that is, both of its lobes increase. There are nodular forms of toxic goiter, but they are benign tumors. Thyroid cancer can develop either against this background or as an independent disease. Previously, there was an opinion that goiter turns into cancer, but our research has proven that nodular goiter never turns into cancer. There are forms of thyroid cancer that grow for a long time, over several years, which gives reason to assume that it is a goiter, but the condition must be monitored by an oncologist. We believe that any nodular formation in the thyroid gland requires observation by both an endocrinologist and an endocrinologist surgeon or oncologist, who treat these diseases.

In Chelyabinsk, on the basis of City Clinical Hospital No. 1, there is a regional center for endocrine surgery, where consultations are conducted and where patients with thyroid tumors from all over the region can go. There are only a few such centers in Russia. Experienced doctors at the center either provide indications for surgery or recommend further drug treatment and observation. Moreover, if there is a suspicion of malignancy, the patient must undergo fine-needle aspiration biopsy to determine which cells the tumor consists of - typical thyroid cells or atypical ones. Such a study is mandatory and is included in the gold standard for examining thyroid nodules.

— How does the disease manifest itself?

— The most common sign of thyroid cancer is a node in the front of the neck, on one of its sides. The doctor may notice this during an examination, or the patient himself may see in the mirror some strange lump or ball when swallowing. When examined by an endocrinologist, palpation examination is sometimes sufficient to suspect a tumor. Therefore, if a person takes care of his health and undergoes regular preventive examinations, then identifying this disease at an early stage is not so difficult. Physicians should also exercise appropriate caution. A nodule is one of the symptoms of thyroid cancer; most often, a nodule is benign and not cancerous.

Other clinical signs include neck pain, shortness of breath, difficulty swallowing, cough that is not associated with a cold, hoarseness or changes in voice. If these signs appear, you should definitely consult a doctor. Initially, like any nodular formation, cancer can be asymptomatic.

- Obviously, what earlier illness revealed, the more favorable the prognosis?

— With thyroid cancer, 95 percent of patients with stages 1–2 of the disease have at least a five-year or more survival rate. This is one of the most curable cancer diseases.

— The main way of treatment is surgery?

- Yes, but we have many other methods in our arsenal. This includes radiation therapy, radioactive iodine, drug treatment or a combination necessary with surgical treatment. Recently, a unique opportunity has appeared in Chelyabinsk to conduct treatment with radioactive iodine, and we are making extensive use of it. Indications for the treatment method are individual for each individual case.

— Who can be classified as at risk for this pathology, what are the risk factors?

— More often women suffer from thyroid cancer; in the Chelyabinsk region this ratio is 1 to 12, that is, for every man there are 12 sick women. This is due to the characteristics of hormonal activity female body, because hormones are interconnected. And one more relationship can be noted: according to some data, in 5–20 percent of cases, thyroid cancer is combined with breast cancer, that is, this is also a risk factor. If we talk about the reasons, we must take into account that our region is considered endemic for goiter, which in a certain way influences the increase in the incidence of thyroid cancer.

There is a theory that in cities with increased technogenic pollution, the number of cancer cases is higher; in our case, these are Chelyabinsk, Magnitogorsk, Zlatoust. Heredity has a certain influence when there is a family predisposition to medullary thyroid cancer. Therefore, for some forms of cancer, we recommend that all blood relatives be examined in order to detect the disease in the early stages.

- In some popular medical literature There is a statement that it is impossible to prevent thyroid cancer. Is this really true?

“If a person has a predisposition to this disease, then sooner or later it will manifest itself. Actually, just like a predisposition to cancer of any other location. There is an expression among oncologists: everyone has their own cancer, but not everyone lives to see it. It may be somewhat cynical, but fair. There are such forms of thyroid cancer that, when good immunity can exist for a long time, practically without manifesting themselves in any way.

In America, the following studies were once carried out: all those who died from various reasons They began to examine the thyroid gland, and 10 percent of the dead were found to have signs of thyroid cancer. Thanks to high immunity, this tumor is, as it were, squeezed into a capsule and does not grow. And a person may not even suspect its existence.

- From this we can conclude about the prevention of this disease: the main thing is to increase immunity...

— Yes, as with the prevention of any other disease. healthy eating, healthy image life, periodic examinations, maintaining a good mood in life and, of course, eliminating iodine deficiency. This means that you should eat iodized salt and other iodized products; now they produce iodized eggs, iodized bread... This is the prevention of goiter and partly thyroid cancer.

However, in everything you need to know when to stop. Going to buy a few cans of seaweed and forcefully eating it is stupid, especially if the thyroid gland is already sick and excess iodine consumption may, on the contrary, be contraindicated. In this case, the doctor will make appointments, as well as give advice for the prevention of nodule formation.

— Is it necessary to strictly maintain normal weight bodies?

- This should always be done overweight and obesity is the cause of many health problems. But in endocrinology this is not so simple. With diseases of the thyroid gland, excess weight sometimes occurs precisely because of insufficient function of the thyroid gland, with hypothyroidism.

There is such a disease - autoimmune thyroiditis. It is accompanied, to put it simply, by replacement of glandular tissue connective tissue, and the thyroid gland stops producing necessary for the body amount of hormones. Violated metabolic processes, excess weight appears and obesity develops. For this disease, the patient is prescribed replacement therapy, and if the cause is determined correctly, then weight loss occurs.

— Where is thyroid cancer in terms of prevalence among cancer diseases in our region?

“It is not among the leaders, but in our region it accounts for 20 percent of all thyroid diseases that have undergone surgical treatment. For example, about 500 people get sick with diffuse toxic goiter every year. In general, the incidence rate of thyroid cancer is 4 - 5 cases per 100 thousand population. Among children, the incidence is up to 1 in 100 thousand.

— Does childhood morbidity have its own causes?

“Children have a slightly different situation. When we conducted a survey of the adult population living as children in the area of ​​the East Ural radioactive trace, specifically the city of Ozersk, we found that people exposed to atmospheric radiation in childhood are almost four times more likely to develop thyroid cancer, then One of the risk factors in childhood is radiation.

People who suffered in childhood or young adulthood radiation treatment on the head and neck area due to any diseases, they get sick more often. In general, it is advisable to avoid frequent X-ray exposure to the head and neck area. Parents should also know that iodine prophylaxis is especially necessary in childhood.

— Sergey Vasilyevich, today in our healthcare there is such a procedure when a patient must first contact a local physician with any problem. Doesn't this lengthen the path to the right specialist, in particular, to an endocrinologist?

— We have long worked out the so-called routing, that is, every therapist knows with what treatment to send whom and where. If, for example, there is no endocrinologist in the hospital, then the therapist gives a referral to a medical facility, provided for in the route map, where such a specialist is available. The endocrinologist, examining the patient, decides on further examination. All endocrinologists have professional oncology awareness and understand perfectly how to act.

I repeat once again that every day in the city clinical hospital No. 1 a consultation with an endocrinologist surgeon is held. Patients from the region can also be sent to the oncology clinic, where specialists examine them and make the appropriate decision. So the main thing is for the person himself to pay attention to himself and not neglect his health.

The frequency of thyroid cancer, according to various authors, varies widely from 1 to 23% of all diseases of this organ. It is more often observed in women - 3.5:1 (9:1) at the age of 40-60 years. Improved diagnostics and greater familiarity of doctors with the clinical picture of the disease have led to a significant increase in the number of observations published in recent years.

Etiology and pathogenesis have not been clarified. It has been established that in 80-90% of cases, cancer develops against the background of an existing goiter. In goiter-endemic areas, the incidence of thyroid cancer is 10 times higher. Chr. contributes to the development of the disease. inflammatory processes in the gland, the presence of nodular and mixed goiter, TSH stimulation of hyperplastic processes in the gland, X-ray irradiation of the neck area and use therapeutic dose 131I in children and young people, as well as hormonal imbalance in the body (women - pregnancy, lactation, menopause).

There are thyroid cancers primary when the tumor has its starting point in the gland itself, and secondary when a tumor grows into a gland from a neighboring organ.

Depending on the morphological structure, thyroid cancers are divided into differentiated and undifferentiated.

To the first group include papillary, alveolar, follicular cancers and various combinations thereof. These tumors have a relatively favorable course. They occur in relatively young people. Emerging metastases usually develop in the cervical regional lymph nodes.

Differentiated tumors (except papillary) can be treated with radioactive iodine. The function of the gland is often increased. Long-term results are favorable in most patients.

To undifferentiated cancers include solid, squamous, round cell tumors, etc. These tumors are 2 times less common than differentiated ones and have a rapid unfavorable course. Distant metastases occur early in the lung, less often in the bones and liver. Radioactive iodine has no effect therapeutic effect. Even with combination therapy the outcomes are unsatisfactory.

Often there are crayfish with a mixed structure, with a predominance of certain cellular elements.

The stages of thyroid cancer are divided according to the TNM system:

T 1 N 0 M 0- the tumor node is located in one lobe of the thyroid gland, does not extend beyond the capsule, there are no metastases to the regional lymph nodes.

To stage T 2 N 0-1 M 0 included tumors that occupy the entire lobe of the gland, have infiltrating growth, grow into the capsule and, as a rule, give regional metastases. In the T3N2M0 stage, the tumor spreads to the entire gland, grows into the capsule and surrounding tissues, and compresses the trachea and recurrent nerves. It is immobile, there are metastases to regional and paratracheal lymph nodes.

IN T 4 N 1-2 M 1 stage, the tumor can be small in size, but give distant metastases (lung, bones, liver). More often a large tumor grows the most important organs neck: trachea, esophagus, neurovascular bundle, etc.

Clinical picture There are differences between differentiated and undifferentiated thyroid cancer. In patients with differentiated cancer, an almost constant, and sometimes the only complaint is an indication of availability of education on the neck. Most patients experience progressive growth of a previously long-existing goiter. Sometimes develop signs of compression of the neck organs: difficulty swallowing, shortness of breath due to compression of the trachea, attacks of suffocation and excruciating shooting pains in the back of the head, chin, shoulder. The trachea may become so compressed that the patient dies during one of these attacks of suffocation. As the tumor grows into the deep tissues, the recurrent (complete loss of voice) and sympathetic nerves ( Horner's sign- retraction of the eye, drooping of the upper eyelid and constriction of the pupil). General symptoms are also observed: weakness, weight loss, loss of appetite. Most patients in this group are characterized by a long course of the disease. Their cancer develops against the background of nodular goiter. During an objective examination, it is possible to detect larger or smaller single or multiple nodes in both lobes and a total change in the entire gland. Characteristic features are the adherence of the tumor to the surrounding tissues, limited mobility, dense consistency and lumpy surface. Along with very dense areas, soft elastic nodes can often be found. Availability regional metastases - reliable sign cancer. Often in these patients it is determined anemia, accelerated ESR, increased or normal gland function.

At undifferentiated cancer the tumor usually occupies the entire gland, the consistency is very dense, the surface is lumpy, and the mobility of the gland is sharply limited. Distant metastases in other organs are detected early. Often these patients experience anemia and accelerated ROE. Gland function is normal or reduced.

In children Thyroid cancer has a relatively favorable slow course. They often have highly differentiated tumors - papillary cancer. At the same time, regional cervical lymph nodes are widely involved in the tumor process. The latter can even come to the fore when the tumor is in the gland and is small.

A distinctive feature of thyroid cancer in patients at a young age is a predisposition to metastases through the lymphatic tract. In older patients, tumors acquire the ability to invade surrounding organs of the neck. The prognosis for thyroid cancer in children is relatively favorable.

In elderly patients, thyroid cancer is more common than in children. Characteristic severity common features, rapid progression of the disease. High-grade forms of cancer are common.

The diagnosis of thyroid cancer is established mainly on the basis of an analysis of the clinical course of the disease, data from a manual examination of the neck, examination histological structure tumors or secondary formations, gammatopographic data, among which of particular importance is the study of the nature of the distribution of I 131 in the gland, as well as x-ray examination of the larynx and the initial part of the trachea.

Differential diagnosis should be carried out with hr. thyroiditis, nodular goiter. In cancer, a tumor develops in one of the lobes. There is no uniform, diffuse enlargement of the gland, as with Hashimoto's thyroiditis. Cancer can grow into surrounding tissues and give regional metastases, which is not observed with autoimmune thyroiditis. The use of prednisolone for cancer, in contrast to autoimmune thyroiditis, not effective. Unlike a nodular goiter, a cancerous nodule is very dense, lumpy, quickly grows or invades surrounding tissue. In addition, tuberculosis and syphilitic lesions of the gland should be taken into account. Metastases of thyroid cancer to the lymph nodes should be differentiated from TVS of the cervical lymph glands and lymphogranulomatosis.

Treatment of thyroid cancer must be comprehensive. It includes radical surgery as the main method of treatment, radiation, hormonal therapy and cytostatic chemotherapy. The scope of the operation must be individual. For stage 1-2 thyroid cancer, when the infiltration does not spread beyond the capsule and is localized in one lobe, you can limit yourself to removing the latter, the isthmus and suspicious areas of the other lobe.

Extension of the operation with removal of the neck muscles, excision of the jugular vein (if it is involved in the tumor process) and all regional lymph nodes along with subcutaneous fat and thyroidectomy is indicated for stage 3-4 thyroid cancer.

Radiation therapy- valuable additional method treatment. X-ray and telegamma therapy 60 Co has become widespread. It is advisable to carry out radiotherapy (in a total dose of 2000-3000 rad per course) after surgery, especially in cases where there is no confidence in the ablasticity of the intervention performed. Follicular cancer usually responds to treatment with radioactive iodine. The absolute indication for the use of radioiodine is the presence of metastases that can concentrate I 131 if the thyroid gland is removed. Radioiodine therapy is especially indicated for sensitivity to I 131 metastases in the neck or paratracheal space, when radical surgery has failed. Relative indications include incurable tumors, cancer recurrences and cases of refusal of surgery. I 131 is also given to prevent tumor recurrence after radical surgery.

Inhibition of thyroid tumor growth under the influence of thyroidin has been established. This is explained by the inhibition of TSH secretion, as well as the possible inhibitory effect of the hormone on the tumor (up to 2-3 g per day).

It is especially advisable to prescribe hormones after surgery and subsequent massive doses of radiotherapy. When prescribing drugs, it is important to support the body on the verge of development signs of lung thyrotoxicosis.

In the complex treatment of thyroid cancer when the process has spread and there are distant metastases, chemotherapy is advisable, with regional infusion into the superior thyroid artery having a greater advantage.

Literature:

1. I.I. Neumark. Selected heads of private surgery. Atlas. Barnaul: Altai Regional Association "ANTIAIDS", 1992. - 368 p. Page 39-42.

2. A.T. Lidsky Symptomatic diagnosis of surgical diseases. M.: Medicine, 1973.- 228 p. Page 38.

3. Private surgery (a guide for doctors) ed. prof. A.A. Vishnevsky and prof. V.S. Levita. Volume 1. M., 1962.- 782 p. Page 484-486.

4. Encyclopedia of a family doctor (in two books). Book 2. K.: Health, 1993.- 670 p. Page 115-117.

5. Robert Hagglin Differential diagnosis of internal diseases. M.: Miklos, 1993.- 794 p. Page 478.

6. Big medical encyclopedia. Volume 27. M.: Soviet Encyclopedia, 1986.- 576 p. Page 527-529.

7. V.V. Potemkin Endocrinology.- M.: Medicine, 1987.- 432 p. pp. 168-174.

8. L.V. Ivanova, A.I. Strashinin. Radiation therapy of inoperable thyroid cancer. - M.: Medicine, 1977. - 28 p. Page 8-10.

9. R.M. Propp Clinic and treatment of malignant tumors of the thyroid gland. - M.: Medicine, 1966. - 164 p. Page 100-124, 17-24.

Thyroid cancer is a malignant tumor growing from the epithelium of the thyroid gland. There are three types of cells in the thyroid gland: A, B and C. From cells of type A and B, which normally produce the thyroid hormones thyroxine and triiodothyronine, differentiated forms of thyroid cancer most often develop: follicular and papillary, as well as rare and dangerous tumor– anaplastic thyroid cancer. Type C cells develop into medullary thyroid cancer (medullary thyroid carcinoma or C-cell carcinoma).

Prevalence of thyroid cancer

Currently in scientific works There are often statements about an increase in the incidence of thyroid cancer among the inhabitants of our planet. However, if we analyze the statistics, it becomes clear that we are not talking about a true increase in the incidence of thyroid cancer, but about an improvement in the detection of these tumors due to improved diagnostic capabilities (primarily due to the advent of very sensitive and accurate ultrasound machines that are used practically everywhere). Nowadays, the diagnosis of thyroid cancer is often made when the node size is 4 mm or more, and even such small thyroid tumors can cause the development of regional metastases (metastases in the lymph nodes) and distant metastases (in the lungs, bones, liver, brain).

At the same time, the prevalence of thyroid cancer has increased in recent years in some regions not only due to increased diagnostic capabilities. It is well known that accidents at nuclear facilities (and above all, Chernobyl disaster) led to a significant increase in the incidence of thyroid cancer in Ukraine, Belarus and some regions of Russia. After the accident at the Chernobyl nuclear power plant, for some time in Ukraine, a sharply increased number of patients with thyroid cancer and, above all, patients were registered childhood. Fortunately, by now this “wave” of morbidity has subsided, but thousands and thousands of patients were among the victims.

It is important to note that the regional structure of thyroid cancer incidence does not have a clear geographic location. Widespread fears in Russia that the sun and southern climate can cause thyroid cancer or worsen the lives of patients after surgery have no scientific basis. Southern countries are not characterized by an increased incidence of thyroid cancer. On the contrary, in the northern regions of our planet, autoimmune diseases of the thyroid gland are more common, which in some cases can lead to the development of thyroid cancer.

Causes of thyroid cancer

Among possible reasons, as a result of which thyroid cancer develops, one can indicate ionizing radiation, heredity, the presence autoimmune diseases thyroid gland (primarily autoimmune thyroiditis). It should be noted that age is not a factor that increases the incidence of thyroid cancer - the peak incidence of follicular cancer and papillary cancer occurs at 30-35 years. Only anaplastic thyroid cancer is directly related to age - it is extremely rare in patients under 60 years of age.

Diagnosis of thyroid cancer

Thyroid cancer is most often detected by ultrasound of the thyroid gland in the form of a nodular formation. Specific ultrasonic signs There are no methods that allow a diagnosis of thyroid cancer to be made with 100% accuracy. At the same time, a number of signs have been described that allow one to suspect the presence of thyroid cancer: these include dark color node (hypoechogenicity), the presence of unclear or uneven contours of the node, the appearance of microcalcifications in the node, the appearance of increased blood flow in the node, specific changes in the lymph nodes of the neck located next to the thyroid gland (rounding of the nodes, the appearance of cystic cavities in them).

Diagnosis of thyroid cancer is based on a fine-needle biopsy of thyroid nodules. This is exactly what is simple, but very informative research allows you to make a diagnosis of thyroid cancer. A biopsy can reveal papillary thyroid cancer, medullary thyroid cancer, anaplastic thyroid cancer, squamous cell thyroid cancer and lymphoma without any doubt. The diagnosis of follicular thyroid cancer cannot be established with a fine-needle biopsy - it can only be suspected and the diagnosis “Follicular tumor” established, i.e. a tumor with a 15-20 probability of malignancy.

There are no specific hormonal markers for differentiated forms of thyroid cancer (follicular cancer, papillary thyroid cancer), as well as for anaplastic cancer. For medullary thyroid cancer there is such a tumor marker - the hormone calcitonin, produced by the C-cells of the thyroid gland. When thyroid tumors arise from C-cells, the concentration of calcitonin in the blood increases significantly and usually exceeds 100 pg/ml. If a borderline increase in calcitonin levels is detected (from 20 to 100), a study of stimulated calcitonin levels may be recommended, i.e. study after intravenous administration of calcium gluconate (usually carried out in specialized centers for endocrine surgery and endocrinology).

Symptoms of thyroid cancer

It should be noted that in the vast majority of cases, thyroid cancer does not manifest itself with serious symptoms and causes almost no complaints. Most patients have completely normal levels of thyroid hormones. For many patients, the diagnosis of thyroid cancer comes as an unpleasant surprise against the background of complete health. Signs of thyroid cancer are completely absent in most patients - it is important to remember this.

However, there are symptoms of thyroid cancer that can be called very alarming. These include the appearance of hoarseness, a sharp thickening in the area of ​​the thyroid gland, visible to the eye and a rapidly growing tumor formation in the area of ​​the thyroid gland, problems with swallowing and breathing.

Thyroid cancer prognosis

It must be remembered that in the vast majority of cases, thyroid cancer is curable at the current level of medical development. Of course, if a patient is diagnosed with thyroid cancer, the patient will have to undergo surgery, and in most cases the thyroid gland will have to be completely removed (in some cases with the surrounding lymph nodes), but after removal of the thyroid gland the patient remains completely normal person able to lead a full life without any restrictions.

In case of thyroid cancer, the timeliness of the operation plays an important role. Currently, there is scientific evidence indicating that in some cases, anaplastic thyroid cancer - the most malignant human tumor - is formed from long-unoperated papillary thyroid cancer - the most “benign” human malignant tumor. That is why treatment should not be delayed for years. In the vast majority of cases, thyroid cancer requires surgery within 1-2 months after diagnosis, although there are situations that require much more quick treatment– for example, if anaplastic thyroid cancer or medullary thyroid cancer is detected.

Papillary thyroid cancer has the best prognosis. The mortality rate for papillary thyroid cancer can be very close to zero - of course, if the treatment of thyroid cancer is carried out by specialists with sufficient experience in this field of medicine, and also if the patient strictly follows the doctor’s recommendations. However, both follicular thyroid cancer and medullary thyroid cancer in the early stages are completely curable - early diagnosis allows to significantly improve treatment results.

Treatment of thyroid cancer

Treatment of thyroid cancer should be carried out by specialists - this is an unshakable rule that is not questioned. The best results are achieved when treatment is carried out in specialized clinic endocrine surgery. The concentration of patients with one diagnosis in such clinics leads to the fact that doctors at endocrine surgery clinics are well aware of all the features of treating patients with thyroid cancer. Surgeries for thyroid cancer should be performed only by endocrinology surgeons who are board certified as oncologists and who perform at least 100 thyroid surgeries per year.

The North-Western Center for Endocrinology is the Russian leader in the field of thyroid surgery - more than 5,000 operations are performed at the center every year. In Europe, there are only three centers that perform a similar volume of operations annually - in Pisa (Italy), in Munich (Germany) and in St. Petersburg. Thyroid cancer is operated on daily at the Endocrinology Center. Every year the center treats more than 700 patients with thyroid cancer. Most of the center's oncology patients have papillary thyroid cancer, and a slightly smaller number have follicular thyroid cancer. A rare form of thyroid cancer, medullary cancer, is also quite common in the practice of the center. In 2013, the center operated on 35 patients with medullary thyroid cancer. The leading surgeons of the Endocrinology Center perform up to 400 operations on the thyroid gland per year for a long time, so their qualifications are not questioned.

The Endocrinology Center adheres to the “one doctor” principle: optimal results in the treatment of thyroid cancer can be achieved if diagnosis, surgery, and further observation for one patient are carried out by one doctor who is well aware of the specifics of this type of tumor and individual characteristics specific patient. Endocrinologist surgeons at our center specialize in surgery, oncology, endocrinology, ultrasound diagnostics, therefore, they can perform all stages of diagnosis and treatment: ultrasound of the thyroid gland, fine-needle biopsy of the node, surgery, and the appointment of additional radiation methods treatment, and selection of the optimal dose of hormonal therapy.

Currently, at the Northwestern Center of Endocrinology, treatment of thyroid cancer is carried out by endocrinologist surgeons who have significant experience in performing these operations:

	Sleptsov Ilya Valerievich Surgeon-endocrinologist, Doctor of Medical Sciences, Professor of the Department of Surgery with a course in Surgical Endocrinology, Head of the Northwestern medical center, member of the European Thyroid Association, European Association of Endocrine Surgeons, Russian Association of Endocrinologists. 12 years of experience in the specialty
	Chernikov Roman Anatolievich Endocrinologist surgeon, candidate of medical sciences, head of the department of endocrine surgery, member of the European Thyroid Association. 12 years of experience in the specialty
	Chinchuk Igor Konstantinovich Endocrinologist surgeon, Candidate of Medical Sciences, employee of the North-West Center for Endocrinology, member of the European Thyroid Association. Work experience in specialty 9 years
	Uspenskaya Anna Alekseevna Endocrinologist surgeon, employee of the North-West Center for Endocrinology, member of the European Thyroid Association. Work experience in specialty 8 years
	Novokshonov Konstantin Yurievich Endocrinologist surgeon, employee of the North-West Center for Endocrinology, member of the European Thyroid Association. Work experience in specialty 8 years>
	Fedorov Elisey Alexandrovich Surgeon-endocrinologist, candidate of medical sciences. Work experience in the specialty is 12 years.
	Timofeeva Natalya Igorevna Endocrinologist surgeon, candidate of medical sciences, member of the European Thyroid Association. Work experience in the specialty is 10 years.
	Semenov Arseniy Andreevich Endocrinologist surgeon, Candidate of Medical Sciences, member of the European Thyroid Association, European Association of Endocrine Surgeons. Work experience in the specialty is 8 years.
	Makarin Viktor Alekseevich Endocrinologist surgeon, Candidate of Medical Sciences, member of the European Thyroid Association, European Association of Endocrine Surgeons. Work experience in specialty 5 years.
	Karelina Yulia Valerievna Surgeon-endocrinologist. Work experience in specialty 5 years

Surgery for thyroid cancer

If a patient is diagnosed with thyroid cancer, surgery is inevitable. In some cases, thyroid cancer requires surgery in the amount of thyroidectomy - complete removal thyroid gland. In other cases (for small tumors, tumors of low aggressiveness), surgery may be performed to remove half of the thyroid gland. If the lymph nodes are affected, various types lymph node dissection – central lymph node dissection (removal of lymph nodes of the paratracheal, pretracheal, prelarynx groups) and lateral lymph node dissection (removal of lymph nodes on the lateral surface of the neck).

If the patient has advanced thyroid cancer, the operation may be accompanied by significant technical difficulties. Often the tumor manages to surround the vocal nerves or grow into them. There are also cases of tumor growth into the trachea, esophagus, larynx, and muscles surrounding the thyroid gland. To perform surgery for advanced cancer, it is very important to have a full range of modern equipment: from high-quality operating lamps, microscopes for surgeons to a system for searching the vocal nerves and parathyroid glands.

At the Northwestern Endocrinology Center, patients with thyroid tumors undergo surgery using modern equipment:
- ultrasonic harmonic scalpel Ethicon Ultracision (USA),
- bipolar electrocoagulator with feedback ERBE VIO (Germany),
- coagulating clamp ERBE Bi-Clamp (Germany),
- binocular operating loupes Univet (Italy),
- neurostimulator NeuroSign (UK),
- endoscopic operating complex Karl Storz (Germany).

If you have proper experience in treating thyroid cancer and the necessary equipment, in 95% of cases the operation requires spending 2-3 days in the hospital. Qualified surgeons at the Northwestern Endocrinology Center in 90% of cases do not use postoperative wound drainage and use absorbable cosmetic sutures or skin glue, which allows the patient to take a shower the day after surgery and eliminates the need to bandage and remove the suture after surgery.

In the endocrine surgery department, where patients are treated, the most favorable and comfortable conditions for patients have been created: each room is equipped with a high-quality bathroom with shower, air conditioning, telephone, and TV. There is free Wi-Fi for patients throughout the center. You can get acquainted with the situation in the endocrinology center by viewing virtual tour, posted below.

Additional treatments

In some cases after surgical treatment Thyroid cancer may require another treatment step: radioactive iodine therapy. Radioiodine therapy is used only for differentiated forms of cancer: papillary thyroid cancer and follicular thyroid cancer. Other forms of thyroid cancer do not accumulate radioactive iodine, so its use in detecting them is useless.

External beam radiation therapy is used only in cases where it was not possible to completely remove the thyroid tumor due to its prevalence, and treatment with radioiodine cannot be carried out (the tumor does not accumulate radioactive iodine).

In some cases (for example, if a patient has advanced medullary thyroid cancer or papillary cancer with distant metastases that do not accumulate radioiodine), patients are prescribed chemotherapy treatment. Unfortunately, “classical” chemotherapy for thyroid cancer is practically useless. Treatment of cancer requires the use of the most modern chemotherapeutic drugs from the group of kinase inhibitors (vandetanib, sorafenib, etc.). Some of these drugs are registered in Russia, while others are still in the final stages of clinical trials. Specialists of the North-Western Endocrinology Center have a significant circle of scientific connections in the world, therefore, for patients with thyroid cancer and in need of the most modern chemotherapy, participation in treatment in Russia or abroad may be recommended, including treatment as part of clinical trials of the most modern drugs.

Treatment after surgery

After surgery and (if required) radioactive iodine therapy, the important stage of monitoring the patient begins, selecting proper therapy, monitoring treatment results. At this stage, a significant number of tactical errors are observed due to insufficient knowledge by doctors of the specifics of treating thyroid cancer. In the vast majority of cases, we have to deal with “overtreatment” of the patient, i.e. using excessive amounts of diagnostic and medical procedures that do not improve the final results of patient treatment. Only an experienced endocrinologist surgeon can determine that “golden mean” in the diagnosis and treatment of thyroid cancer, when, with a minimum number of therapeutic and diagnostic procedures used, thyroid cancer is ultimately completely cured.

• Anaplastic thyroid cancer

  In the tissue of the thyroid gland, the formation of several types of tumors is possible, while thyroid cells can be the source of the development of both one of the most benign tumors in humans - papillary carcinoma (papillary cancer), and the most malignant tumor - anaplastic cancer

• Medullary thyroid cancer

  Medullary thyroid cancer (medullary thyroid carcinoma) is a rare hormonally active neoplasm of a malignant nature, developing from parafollicular cells of the thyroid gland

• Multiple endocrine neoplasia syndrome type 2

  Multiple endocrine neoplasia type 2 (MEN type 2 syndrome) is a symptom complex that unites the group pathological conditions, which are characterized by the presence of a neoplasm or hyperplastic process from neuroectoderm cells, affecting two or more organs of the endocrine system

• Thyroid nodules

  A thyroid nodule is a section of its tissue that differs from the rest of the gland tissue during ultrasound or palpation (feeling). Palpation of the thyroid gland reveals nodes in 5-7% of the inhabitants of our planet. With the spread of thyroid ultrasound, nodes of this organ began to be detected in 20-30% of people. The prevalence of thyroid nodules increases with age, and by age 50, nodules can be found in 50% of women and approximately 20% of men. At the age of 60, the number of women with thyroid nodules begins to exceed the number of women without this pathology.

• Thyroglobulin

  Thyroglobulin is the most important protein contained in the thyroid tissue, from which the thyroid hormones T3 and T4 are produced. Thyroglobulin level is used as the main marker of relapse of differentiated thyroid cancer (follicular and papillary). At the same time, thyroglobulin is often given without indications - this increases the costs of patients. The article is devoted to the meaning of thyroglobulin, indications for taking a thyroglobulin test and evaluation of the results

• Attention! Calcitonin increased!

  What is calcitonin? Why do you need a blood test for calcitonin? What is the normal level of calcitonin? What to do if calcitonin is elevated? You will find the answer to all these questions in the article devoted to the hormone calcitonin and its clinical significance

• If your biopsy answer is “Follicular thyroid adenoma”...

  If, based on the results of a fine-needle biopsy, you were given a cytological diagnosis of “Follicular adenoma of the thyroid gland,” you should know that the diagnosis was made to you INCORRECTLY. Why it is impossible to establish a diagnosis of follicular adenoma with a fine-needle biopsy of a thyroid nodule is described in detail in this article