Thyroid cancer: types of treatment

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Papillary thyroid cancer, which is the most common type of thyroid cancer, makes up about 80% of all cases of thyroid cancer. It is one of the fastest growing cancer types with over 20,000 new cases a year. In fact, it is the 8th most common cancer among women overall và the most common cancer in women younger than 25. Although a person can get papillary thyroid cancer at any age, most patients will present before the age of 40. Although risk factors for papillary thyroid cancer include radiation exposure and a family history of thyroid cancer, it is important to chú ý that the majority of patients have no risk factors at all. Fortunately, papillary thyroid cancer is also the thyroid cancer with the best prognosis and most patients can be cured if treated appropriately and early enough. Up to lớn 20% of patients will have involved lymph nodes at the time of diagnosis. However, unlike other cancers where involved lymph nodes means a very poor prognosis, in thyroid cancer involved lymph nodes usually have almost no impact on survival. Involved lymph nodes may increase the chance of recurrence (i.e. Cancer coming back), but they vì not change the prognosis. Most patients with papillary thyroid cancer will not die of this disease.

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Signs & Symptoms

Most papillary thyroid cancers bởi vì not cause symptoms (i.e. They are asymptomatic). In fact, many patients will not know that they are there. Patients with large nodules may notice a palpable mass (i.e. A mass they can feel) or a visible mass (i.e. A mass they can see). Very large nodules may cause compressive symptoms which include difficulty swallowing, food or pills getting "stuck" when they swallow, và pressure or shortness of breath when lying flat. In cases of advanced cancer that are growing (i.e. Invading) into surrounding structures, patients may develop hoarseness or difficulty swallowing. Enlarged neck lymph nodes that are concerning for cancer include those that are non-tender, firm, growing, and/or do not shrink over time. Patients with compressive symptoms, enlarged lymph nodes, hoarseness, and/or a rapidly growing nodule should seek medical evaluation right away.

Diagnosis

When a thyroid nodule is discovered, a complete history and physical examination should be performed. In particular, the doctor is looking for risk factors for cancer that include: a family history of thyroid cancer, a history of radiation exposure khổng lồ the head, neck, and/or chest, age less than 20, age greater than 70, male gender, very hard nodules, enlarged lymph nodes, and/or hoarseness. After the history & physical exam, a TSH cấp độ should be checked lớn see if the patient is euthyroid (i.e. Normal thyroid function), hyperthyroid (i.e. Hyperactive or overactive thyroid), or hypothyroid (i.e. Underactive thyroid). In general, it is unusual for hyperthyroid patients lớn have cancer while patients who are hypothyroid may have a slightly higher rate of cancer. Most patients with thyroid cancer are euthyroid.

The next step in the work-up of a thyroid cancer is an ultrasound (USG) of the neck. There is no radiation associated with an USG. An USG is the best thử nghiệm to look at the thyroid & will allow the doctor to see the size of the thyroid & specific features of the nodule(s) including: size, number of nodules, if there are calcifications (calcium deposits), echotexture (i.e. How bright or dark it looks on USG), borders, shape, and if it is solid or cystic (i.e. Fluid-filled). In general, USG findings that are concerning for thyroid cancer include microcalcifications (i.e. Microcalcifications), hypoechoic nodules, hypervascularity (i.e. More blood vessels than normal), irregular borders, and enlarged suspicious lymph nodes.

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The best kiểm tra to determine if a thyroid nodule is benign or cancer is a fine-needle aspiration biopsy (FNAB). In this test, a small needle (like the needles used for drawing blood) is placed into the nodule either by USG or feeling the nodule with the fingers. Cells are removed from the nodule into the needle (i.e. Aspirated) and looked at under the microscope by a specially trained doctor called a cytologist. There are a number of different guidelines as to which nodules should be biopsied, but in general, nodules over 1 centimet should be biopsied. If a patient has risk factors for thyroid cancer (especially a family history of thyroid cancer or exposure to radiation therapy) or suspicious findings on USG, then nodules over 0.5 centimet should be biopsied. The FNAB may give one of 4 results:

Non-diagnostic:

This means that not enough cells were removed to lớn make a diagnosis. Even in the best of hands, this happens in 5 lớn 10% of FNAB. Typically the FNAB will be repeated. If the nodule grows, then a repeat biopsy will usually be performed. In certain cases, a patient may go straight to lớn an operation to make a diagnosis, especially if the risk of cancer is high or if the patient has had two or more non-diagnostic FNAB in the past.

Benign:

This means that there is a 97% chance that the nodule is not cancer. In most cases, patients with a benign biopsy are watched with an USG và physical exam 6 months later, and then at regularly scheduled times. A patient with a benign nodule may still have an operation if the nodule is large, causing symptoms, or cosmetically unappealing.

Malignant:

This means that there is a 97% chance that the nodule is cancer, usually a papillary thyroid cancer. Much less commonly, the FNAB can show a medullary or anaplastic thyroid cancer. Sometimes the cytologist reports that the nodule is "suspicious for thyroid cancer" which means that there is an 80 lớn 90% chance of cancer, again usually papillary thyroid cancer. Most patients with a FNAB of cancer will have a total thyroidectomy (i.e. Removal of the entire thyroid) with or without removal of certain lymph nodes.