Papillary thyroid cancer

The most common form of thyroid carcinoma is papillary thyroid cancer.

This tumor occurs, as a rule, from the usual tissue of the gland and is found in the form of a heterogeneous significant or cyst-like formation. This kind of oncology is very treatable. The indicative 10-year survival of patients reaches almost 90%. And yet the disease is quite serious, like all oncological pathologies, so let's take a closer look at it.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of papillary thyroid cancer

Fertilization of healthy thyroid cells can occur due to genetic abnormalities, which are often provoked by the unfavorable influence of the surrounding environment (radioactive zone, harmful production nearby, etc.). In more rare cases, such anomalies are congenital in nature.

Mutations in genes give rise to excessive growth and division of cellular structures. Several gene modifications associated with the formation of papillary thyroid cancer have been discovered:

• RET / PTC - mutation of this gene occurs in 20% of all registered diseases with papillary thyroid cancer. It is often found in childhood and in regions with an unfavorable radioactive environment;
• BRAF - mutation of this gene can be detected in 40-70% of diseases of papillary thyroid cancer. Oncopathology, associated with the mutation of this gene, is more aggressive with an abundance of metastases to other organs.

NTRK1 and MET genes are also thought to be involved in the formation of cancer. However, the involvement of these genes is still at the stage of study.

In addition, there are factors that contribute to the development of papillary cancer:

• the age range from 30 to 50 years;
• female sex (in men, the disease occurs less often);
• adverse radioactive conditions, frequent radiographic studies, radiation therapy;
• hereditary predisposition.

[10], [11], [12], [13]

Symptoms of papillary thyroid cancer

In most cases, the development of papillary cancer occurs gradually. Patients at first do not make any complaints about poor health: the thyroid gland does not bother them.

Often the reason for the patient's treatment to the doctor is the detection of a painless nodular formation in the thyroid gland. Usually it is felt on the neck when it reaches a pronounced size, or when the node is located close to the neck surface. A large-sized formation can have an effect on nearby organs, for example, pressure on the larynx or esophageal tube.

In the future, the clinical picture expands. There may be hoarseness, difficulty in swallowing food, shortness of breath, perspiration and soreness of the throat.

In some cases, the neoplasm is located in such a way that it becomes almost impossible to probe it. In this situation, the disease produces enlarged lymph nodes in the neck. Lymph nodes act as filters in the lymphatic system. They catch and hold in themselves malignant cells, not allowing their further distribution. If such cells get into the lymph node, it grows and becomes denser. However, this sign does not always indicate the formation of a cancerous tumor: the lymph nodes may increase and if they get into an infection, for example, with colds, flu, etc. As a rule, such lymph nodes come back to normal after curing the infection.

Stages of papillary thyroid cancer

The development of papillary thyroid cancer goes through four stages. The earlier the treatment has been treated, the better the disease prognosis will be.

• I st .: node is located separately, thyroid capsule is not modified, metastases are not found.
• IIa st .: single unit, which affects the shape of the thyroid gland, but does not cause metastasis.
• IIb st: single unit with the detection of unilateral metastases.
• III: a neoplasm that extends beyond the capsule, or exerts pressure on the nearest organs and tissue structures; while metastases are formed in the lymph nodes in a bilateral order.
• IV century: the neoplasm grows into nearby tissues, metastasis is observed both in the nearest and in the remote parts of the body.

Papillary cancer can occur directly in the thyroid gland, or enter the gland as a metastasis from other organs.

Metastases of papillary thyroid cancer

Metastases of papillary thyroid cancer can spread through the lymphatic system located inside the gland, and also often go to the lymph nodes from the affected side. The distant (distal) metastases are not found very often and are formed to a greater extent from the follicular tissues of malignant formation.

Papillary cancer and metastases with papillary tissue construction are considered inactive with respect to hormones and are not capable of retaining radioactive iodine. Metastases with follicular construction show activity to hormones and keep radioactive iodine.

Classification of metastases of papillary thyroid cancer is carried out as follows:

• N - whether there are regional metastases of papillary thyroid cancer.
  • NX - it is not possible to assess the presence of metastases in the cervical lymph nodes.
  • N0 - absence of regional metastasis.
  • N1 - detection of regional metastases.
• M - whether distant metastases are present.
  • MX - it is not possible to assess the presence of distant metastases.
  • M0 - no distant metastasis.
  • M1 - detection of distant metastasis.

This classification is used to clarify the diagnosis of papillary thyroid cancer and the prognosis of the disease.

Diagnosis of papillary thyroid cancer

As a diagnosis of papillary thyroid cancer, the following methods are used:

1. The method of fine needle aspiration biopsy is the main procedure that the doctor prescribes for suspected oncology of the thyroid gland. Often a positive biopsy result can make this method unique in the diagnosis of the disease. The biopsy is performed in this way: the doctor, controlling the process on the ultrasound screen, conducts the introduction of a thin needle inside the suspicious node. Next, a syringe joins, and the tissue of the knot is as if sucked through the needle. After this, the taken tissues are sent for examination for their malignancy.
2. The ultrasound method of thyroid examination - provides an opportunity to examine the boundaries of the organ, the structure and structure of the gland tissues. This is the safest and inexpensive procedure for diagnosing papillary cancer, and also quite informative. Ultrasound can be used as an independent method, or in combination with a biopsy. Unfortunately, the procedure is not performed on its own because the ultrasound can inform about the presence of a tumor in the gland, but can not accurately determine the degree of its malignancy.
3. CT, MRI - tomography methods of research are used, basically, if the malignant lesion is spreading to the nearest tissues and organs.
4. Laboratory tests - a blood test for the content of thyroid hormones and the pituitary gland. The results of such analyzes give an idea of the insufficient, excessive or normal function of the gland.
5. The method of radioisotope scanning is usually performed if the blood test indicated excessive thyroid function.

Without a doubt, a competent diagnosis of papillary thyroid cancer is the key to further successful treatment of the disease.

[14], [15], [16]

Treatment of papillary thyroid cancer

Treatment of papillary thyroid cancer is operational. The operation is called thyrotectomy.

1. Total removal of the gland is complete removal, when the surgeon removes the left and right share of the thyroid gland along with the isthmus. If necessary, simultaneously performs excision of enlarged lymph nodes. The operation for total thyroectomy on average lasts about 3 or 4 hours. In the projection of the gland, the doctor makes an autopsy and conducts the removal of the gland, gently tracing it between the recurrent nerves. After total operative intervention, substitution therapy is performed, which provides for the replenishment of hormones in the body of the now defunct thyroid gland.
2. Partial removal of the gland - is used with a relatively small size of the tumor, which is located separately in one lobe of the gland and does not germinate in the nearest organs and tissues. As a rule, the tumor size in such cases is not more than 10 mm. The duration of such an operation is from one and a half to two hours. In most cases, replacement therapy is not required.

Despite the fact that surgery on the thyroid gland is a rather complicated operation, recovery after it passes quickly and does not cause much discomfort to the patients.

Return to the usual way of life can almost immediately. Diet after surgery is not required. The patient is discharged most often the next day.

Additionally, at the doctor's discretion, hormone therapy and radioactive iodine therapy may be prescribed.

Prophylaxis of papillary thyroid cancer

Since the final cause of papillary thyroid cancer has not yet been established, there are no specific preventive measures for the disease. But there are activities that generally help reduce the risk of cancer.

• Try to avoid irradiation of the head and neck area, including X-rays.
• If possible, change the area of residence, away from nuclear power plants and environmentally unfavorable areas.
• Periodically examine thyroid gland, donate blood to the level of hormones, undergo prophylactic ultrasound, especially if you are at risk.

Of course, such a disease as cancer, is still difficult to prevent. However, early detection of pathology in most cases guarantees a favorable prognosis.

Prognosis for papillary thyroid cancer

The prognosis for papillary thyroid cancer can be called favorable. If metastases are not detected, or found in the immediate vicinity of the gland, then the duration of quality life of patients after surgery is high. Most of the operated patients live after the intervention of 10-15 years or more.

If metastases have been found in bone tissue and the respiratory system, the percentage of optimistic prognosis is somewhat deteriorating. Although in this case, a positive outcome is possible. In this case, the younger the patient, the more likely that he will better and more favorably transfer the treatment.

Fatal outcome in patients who underwent thyroectomy, can be observed only with the repeated formation of a tumor in the preserved element of the thyroid gland.

In patients who have been removed part or all of the gland, the quality of life, as a rule, is not violated. Sometimes after the operation, it is possible to change the voice, a slight hoarseness. The appearance of such symptoms depends on the degree of damage to nerve fibers during the operation, as well as on the swelling of the vocal cords. Most often, such changes are transient.

Patients who underwent papillary thyroid cancer should be periodically examined by the doctor, first once every 6 months, and then every year, in order to prevent the occurrence of a relapse of a malignant tumor.