Follicular thyroid cancer

As the modern statistics show, oncological pathology of the thyroid gland worldwide accounts for up to two percent of cases of the total number of cancer diseases. In this article, we will try to find out as much as possible about the pathology, which takes the second place in the frequency of the diagnosed malignant manifestations in this area of the human body. This is a disease called follicular thyroid cancer.

[1], [2], [3], [4]

Causes of Follicular Thyroid Cancer

Approximately 15% of all cases of malignant neoplasm, localized in the area of the human body considered in this article, refers specifically to follicular tumors. But in order to conduct therapy as effectively as possible, you should get the most accurate picture of pathological changes and identify the source of the "failure".

The causes of follicular thyroid cancer to date, establish, so far, fails. But a role in its development is assigned to physicians:

• Iodine deficiency in the patient's body.
• The fall of the immune status of a person, the inconsistency of his body in opposing the negative impact.
• To the effect of ionizing radiation. It can be either external in nature or intrinsic in nature (for example, entering into the protocol for the treatment of radioactive iodine). The bottom line is that this element has the property of accumulating in the thyroid gland, provoking the subsequent development of cancer. Exposure to such influence the child can even in utero. In an adult, the probability of provoking a failure and the development of a neoplasm in such a situation is less, since a higher dose of radiation is required.
• The heredity factor is not excluded.
• As specialists established, often the predecessors of the disease in question were neoplasms of a benign nature.
• Prolonged irradiation with X-rays of the head and neck region, which provokes the cells of this zone to mutation.
• Although this pathology was diagnosed in very young children, the main age of patients exceeds the age of forty.
• There are a number of specialties that fall into the list of the most dangerous in the light of the problem under consideration.
• Physicians suggest that the cause of follicular thyroid cancer may be long-term stress, in which the patient's body resides. Stresses lead to a decrease in the body's defenses, which "opens the way" to various pathologies.
• The presence of bad habits only aggravates the situation, making the risk of developing a tumor much higher. Carcinogens, found in tobacco and alcohol, adversely affect the immune status of a person, reducing counteraction to the appearance of atypical cells.
• Multinodular goiter.

But the sources listed above, and far from being a complete list, are only medical assumptions about the etiology of the disease. Symptoms of follicular thyroid cancer

This pathology is more marked in people who have crossed the forty-year line, but children are not insured against it. Although the percentage of such patients is rather small, but the tendencies of the defeat are alarming.

The considered pathology is marked by a low rate of progression, therefore the symptoms of follicular thyroid cancer begin to appear quite late:

• From the front side of the neck, nodal neoplasms gradually appear.
• Seldom, but nevertheless it is possible to observe growth of dimensional parameters of lymph nodes.
• The person begins to feel the emerging obstacle when swallowing.
• There are difficulties in inspiration and exhalation.
• There is chronic fatigue.
• Gradually, there is pain in the affected area.
• These metamorphoses lead to a breakdown in the voice.
• There are problems with sleep.
• Tingling in the limbs, convulsions may appear.
• The production of viscous mucus is produced.
• There is a development of hyperthyroidism.
• Man becomes apathetic.
• There is increased sweating.
• Decreased appetite, which leads to weight loss.
• Metastasis begins to be recognized at late stages of the disease.

[5], [6], [7], [8]

Stages of follicular thyroid cancer TNM

The International Association of Physicians adopted a cancer cancers ranking system that details the clinical picture of the disease and the severity of the manifesting symptoms at different levels of pathology. Stages of follicular thyroid cancer tnm are made up of three main parameters: T (Latin tumor - tumor), N (Latin nodus node) and M (Latin metastasis - metastasis). It is the condition, as well as the presence or absence of abnormalities in these elements, and forms the stages of disease progression.

Scale of the tumor:

• T0 - neoplasm is not determined.
• T1 - the formation has a size of less than 2 cm. In some cases, a more fractional division is carried out: T1a - dimensional parameters up to one centimeter and T1b - from one to two centimeters.
• T2 - the tumor is larger than 2 cm, but does not exceed the parameters of 4 cm.
• T3 - the size of the tumor is more than 4 cm. Neoplasm does not go beyond the thyroid gland. Also in this category include any neoplasm that has a minimum of presence overseas capsules.
• T4 - this category is divided into:
  • T4a - formation of any size, with penetration into surrounding tissues: the laryngeal nerve, trachea, esophagus, larynx, other tissues.
  • T4b - the formation invading the carotid artery, the fascia of the pre-invertebral region, the vessels of the chest zone.

It should be noted that if the carcinoma remains undifferentiated, then the stage T4 is automatically assigned to it, regardless of its dimensional parameters.

The presence of metastases in neighboring lymph nodes:

• NX - lack of opportunities to determine the metastases.
• N0 - there is no invasion.
• N1 - there is local metastasis:
  • N1a - invasion found in the VI zone of the lymph drainage.
  • N1b - invasion differentiates in cervical or retrosternal lymph nodes. In this case, both a one-sided invasion and a two-sided lesion can be observed.

Detection of metastases in more remote areas of the body:

• MX - there is no way to assess the presence of such an invasion.
• M0 - there is no such invasion.
• M1 - such an invasion is diagnosed.

Having determined the foregoing, the oncologist can classify the picture of the pathology in question into one of four stages:

• The first is a neoplasm of up to 2 cm in size, the absence of metastases, while non-picephic cells do not undergo decay. The most favorable stage in the prognosis is cancer.
• The second - the size of the tumor from 2 to 4 cm (the tumor does not cross the capsule boundary), there are no metastases.
• The third is a new growth of more than 4 cm, going beyond the limits of the capsule (without metastases), or a tumor of any size with local metastases to the neighboring cervical lymph nodes. Without disintegration and invasion of more distant organs.
• Fourth A - any new growth, but the presence of invasion beyond the capsule boundaries, differentiated metastases in the cervical and / or thoracic lymph nodes. But there is no damage to other organs.
• The fourth B-any new growth, the presence of invasion beyond the boundaries of the capsule with germination in the direction of the cervical spine and adjacent large blood vessels and lymph nodes. Metastasis of other organs is not observed.
• The fourth C - invasion shows a wide scale of damage, affecting other organs. The most severe prognosis for the development of the pathology in question.

Based on the TNM system, the stage of the disease is determined, which makes it possible to be estimated with a prognosis for its reduction.

Follicular thyroid cancer 1 degree

Normally, the tissues of the gland under consideration consist of structural components of a spherical configuration called follicles. If malignant neoplasms include follicles, the disease is also called follicular cancer.

Follicular thyroid cancer of the 1st degree is distinguished by the diagnosis of a low level of iodine in the patient's body. There is an acute shortage of this element. The tumor shows "medium aggressiveness". The prognosis for its diagnosis is generally favorable. But this result is somewhat more difficult than with the papillary type of pathology. In this case, the removal of the affected gland occurs completely.

The first degree of the disease is manifested by small nodules of tumors. After their sizes grow, the symptoms begin to gradually appear. At the same time, the intensity of symptoms increases slowly. This can take many years. Metastases are completely absent.

[9],

Follicular thyroid cancer of the 2nd degree

Each type of malignant lesion of the thyroid gland has its own individual characteristics. Follicular cancer of the thyroid gland of the 2nd degree is caused by the appearance of metastases. At the same time, the size parameters of the neoplasm and the state in which the nearby lymph nodes are located do not play a significant role in determining the degree of the disease.

[10], [11]

Follicular thyroid cancer 3 degrees

With worsening of the patient's condition, the disease passes into the next stage of pathological manifestations. Follicular thyroid cancer of the third degree has such characteristics:

• Tumor size characteristics can be any size.
• Neoplasm is not limited by the boundaries of the capsule, but goes beyond it.
• The size of the nearby lymph nodes is normal.
• Regional metastasis is diagnosed.
• Remote invasion is absent.

But another option is possible, when there is no metastasis, but lymph nodes are significantly enlarged.

But the most unfavorable in the forecast is the fourth stage, which indicates the lost time and late timing of the diagnosis. This stage is ascertained when the metastasis scales cover quite extensive areas, affecting both distant organs. The size of the tumor itself does not matter.

[12], [13], [14],

Follicular papillary thyroid cancer

In their practice, oncologists, based on the results of histological examination, subdivide the pathology of the character in question into:

• Papillary adenocarcinoma, which is characterized by a low rate of progression with possible limited regional metastasis.
• Follicular adenocarcinoma, which also has a slow development rate.
• Follicular papillary thyroid cancer is referred to a highly differentiated type of cancer. This category of diseases occurs more often (up to 80% of all cases of thyroid cancer) than the two following. At the same time they show a good susceptibility to stopping therapy.
• Medullary carcinoma is rarely diagnosed. Presumably has a hereditary character.
• Anaplastic (undifferentiated) category of tumors is a low percentage of diagnoses. It is characterized by a high rate of progression. The highest percentage of deaths.

The follicular type of development has a more aggressive character of leakage compared to papillary carcinoma. Papillary type of cancer education is diagnosed more often, especially in children and patients of pre-retirement and retirement age.

Metastasis of lymph nodes with papillary carcinoma is detected much more often than in the other case. Whereas follicular carcinoma is characterized by a higher probability of tumor germination into the vascular components. It is from the degree of invasion that the mortality prognosis directly depends.

Follicular carcinoma is characterized by damage to nearby tissues and distant organs of the human body. It can be light, bone tissue, epidermis, brain and others.

[15], [16], [17], [18]

Low-differentiated follicular thyroid cancer

In addition to the follicular and papillary malignant type of the pathology under consideration, which relate to the highly differentiated course of the disease, oncologists are diagnosed with cell - follicular low - grade thyroid cancer.

Cases of its definition are rare. The frequency of this form of the disease does not exceed 4-7% of all malignant tumors of the thyroid gland.

This type of pathology is characterized by a high rate of progression. The patient begins to complain about the acceleration of growth in the volumes of tumors that are already visible to the naked eye. He has problems with swallowing and breathing. Gradually, there is a change in voice.

Already after two to four months from the onset of the disease, a person begins to feel pathological symptoms and consults with a qualified specialist.

When visually examining the facial region of the neck, one can observe the asymmetry of its shape. With palpation, the outline of the formation is dense, not clear and blurred. With pressure, the patient feels growing pain.

To the low-grade type of malignant thyroid formations include medullary carcinomas and anaplastic tumors.

The prognosis of this type of disease is much worse than in the case of highly differentiated cancers, since the rate of progression is so high that after the diagnosis the oncologists sometimes give the patient only a few months, or even weeks, of life.

Diagnosis of follicular thyroid cancer

If a person has a negative symptomatology or a deviation from the norm in the state of health is revealed during the next preventive examination, the patient receives a referral to a specialized oncological institution where the oncologist doctor will appoint a general package of measures necessary for a complete examination of the patient's health condition.

In general, the diagnosis of follicular thyroid cancer includes:

• Consultation of the otolaryngologist and oncologist, with their examination of the patient, screening his anamnesis.
• Ultrasound allows you to visualize the area of interest, which makes it possible, without causing special harm to the human body, to identify nodules of neoplasms that were not found during palpation.
• X-ray computed tomography - a method that does not violate the integrity of tissues, makes it possible to layer-by-layer investigation of the internal structure of the thyroid gland.
• Magnetic resonance imaging is a method of medical examination that allows to obtain images of the organ under investigation in a 3D image and a number of X-ray images. Thanks to the recording of this information on the hard disk of the computer, the survey information can be used more than once, during the whole period of examination and treatment of the patient.
• Taking a targeted puncture biopsy of the tumor to determine its benign or malignant nature. After receiving the material, a histological and immunochemical examination is carried out. This technique gives the oncologist a response to the question of the need for an operative intervention.
• A radioisotope survey will make it possible to determine the isotopic sites manifested as a defect in their accumulation. But this despite the fact that the tumor is diagnosed. Differentiate with the help of this method its character (benign or malignant) does not work out. This technique is very effective in determining the presence of metastases, their scale and localization. But this fact is justified only if the modified cells have the ability to accumulate iodine-containing chemical compounds, as well as in the absence of thyroid tissue cells, which was excised earlier.
• A wide range of different biochemical studies is being carried out. The result of the analysis is obtaining a quantitative indicator of the level of a hormone participating in the normalization of the thyroid gland. The level of TSH, T3, T4 - hormones is determined.
• Laryngoscopy - examination of the larynx, including the vocal cords, produced with the introduction of a rigid laryngoscope. The procedure is performed under general anesthesia during surgery.

Modern medicine is equipped with a sufficient number of different diagnostic methods, which make it possible to recognize pathology early in its development, which greatly facilitates the work of the oncologist and preserves the patient's health.

[19], [20], [21], [22]

Treatment of follicular thyroid cancer

The protocol for the therapy of this type of pathology remains controversial to this day. A number of oncologists are quite sure that if the neoplasm is small in size, and there are no metastases (which is mostly noted in most cases), it is quite enough simply to excise the affected portion of the gland together with the formation and tissues of the isthmus. This intervention shows good results, leading to a complete cure. This statement is based on the fact that the percentage of relapses of the disease under consideration is quite low.

But they also have opponents who claim that treatment for follicular thyroid cancer should be done by taking as a base, subtotal or total thyroectomy, which means complete removal of the thyroid gland. Thyroidectomy is a fairly radical method of coping a problem.

To date, a typical treatment protocol for the disease in question looks approximately this way (follicular carcinoma is perfectly limited, small in size, without metastasis):

• The oncologist is a hemothyreectomy (organ-preserving surgery - surgical removal of one lobe of the thyroid gland with an isthmus) or thyreectomy (complete excision of the thyroid gland together with pathological neoplasms).
• In the postoperative period, the patient begins to receive radioactive iodine (50-150 mCi I-131). If there is a relapse of the disease, the dosage of irradiation is increased. There are several types of radioactive iodine, but there is only one, which causes cellular toxicity. Modified cells absorb this chemical element well, which provokes their destruction by radioisotope iodine-131.
• In parallel, the patient begins to receive drugs related to thyroid hormone drugs. The pharmacodynamic characteristics of these drugs can inhibit the secretion of TSH and inhibit the single remaining mutated cells. To this end, actively used antistrum - darnitsa, bagotiroks and thyrecomb.

Tablet thyreocom are appointed orally, orally, for half an hour before a morning meal. The drug must be swallowed completely, without crushing, together with the necessary amount of liquid. The drug is administered once a day.

The daily dosage of the drug is assigned to the patient by the treating doctor individually. This parameter follows from the analysis of the clinical picture of the pathology and the results of laboratory tests. Primarily the starting daily dose is prescribed in the volume of half a tablet.

If the necessary therapeutic effectiveness is not observed, the attending physician gradually increases the dose, bringing up to one - two tablets. The dosage is increased after one to two weeks of admission.

If there is a cardiovascular pathology in the patient's anamnesis, a tendency to epileptic seizures, insufficiency of the adrenal cortex, then the adaptation period of the next dose increase is longer and can range from four to six weeks, or even more.

The medication should be administered continuously, without interruptions. The duration of treatment is determined by the attending physician. Patients are not advised to adjust the dosage or schedule of the given drug.

To contra-indications of appointment in the protocol of treatment of follicular thyroid cancer thyreocomb refers to increased individual sensitivity to one or several components of the composition, herpetiform dermatitis, acute myocarditis, thyrotoxicosis, noncurable adrenocortical insufficiency, severe angina pectoris, acute myocardial infarction. There are a number of diseases that require more careful administration of thyroid hormone.

After the restorative postoperative period has passed, such a patient remains under the supervision of specialists for the rest of her life and must undergo a periodic examination, which includes a study determining the level of hormones (including thyroglobulin). A high level of this hormone (more than 10 ng / ml) during the postoperative period may indicate a relapse of the disease.

Prevention of follicular thyroid cancer

To reduce the risk of the onset and development of a disease as a rule is possible if a number of simple rules and recommendations of the oncologist are followed. Prevention of follicular thyroid cancer is based on the conduct of a healthy lifestyle.

The recommendations of a specialist include:

• Refusal from bad habits: smoking, alcohol, drugs ...
• Maintain your weight within acceptable limits.
• To reconsider the relation to meal. Minimize the consumption of fatty foods, fast food dishes and supermarket products burdened with a large number of "Yeshok": various stabilizers, emulsifiers, dyes, flavor enhancers and so on. The daily diet should be balanced and rich in vitamins and minerals. Especially the focus in this situation is on iodine-containing products.
• To maintain the level of vitamins and minerals, including iodine, is normal, you can use and pharmacological drugs, regularly drinking their courses.
• It is necessary to avoid the long-term presence of open areas of skin, and the whole body, under direct sunlight. Do not get involved in frequent visits to the solarium.
• It is necessary to protect oneself from radiation. This is especially true when buying a house or apartment. It is worth to choose a more environmentally friendly place.
• It should be regularly consulted by specialized doctors. If the patient has already had cancer, he needs to undergo an X-ray examination and tests every year to monitor the level of hormones in the blood.

Forecast of follicular thyroid cancer

Getting on reception to the expert, the patient, after an establishment of the diagnosis, is interested in the chances of recovery. The prognosis of follicular thyroid cancer, in most cases, is quite favorable. But it nevertheless largely depends on the stage of development of cancer, on which the disease was established and the relief was started.

Poor medical statistics say that the five-year survival rate of patients who have undergone the necessary treatment shows:

• When diagnosing the first stage of the disease - 100% survival rate.
• In the case of the second stage of follicular thyroid cancer - 100% survival rate.
• At the third stage of malignant neoplasm - 71% of five-year survival.
• At the fourth stage of pathology, 50% of the five-year survival rate.

How unfortunate it sounds, but in recent years, cancer patients are becoming increasingly affected by all layers and age categories of human society. Hearing the diagnosis - follicular cancer of the thyroid gland, almost all patients, at first, fall into a stupor, perceiving the diagnosis as a verdict. But this is far from the case. If a patient is "lucky" and a malignant tumor was found at an early stage of development, then, after receiving effective treatment, the patient can later return to his habitual way of life (of course, with some glance at the disease and the possibility of relapses). But to reduce the risk of such a pathology is still human, and a healthy way of life that is able to "protect" the body from many diverse health problems, including reducing the likelihood of both benign and malignant tumors. So take care of yourself and be well!

[23], [24], [25], [26], [27], [28]