Carcinoma of thyroid gland types causes diagnosis and treatment
Introduction
Thyroid gland is that gland which present in front of the neck which has two lobes one on each side connected together by an isthmus taken butter fly appearance
Thyroid gland is responsible for release of thyroid hormones such as tri-iodothyronine T3 tetra-iodiothyronine T4 and thyroid stimulating hormones TSH ,these hormones are responsible for the process of metabolism in the body if there is any disorders affect the release of these hormones are associated with diseases either in the form of increased secretion of thyroid hormones causing hyperthyroidism or decreased secretion of thyroid hormones causing hypothyroidism
Thyroid cancer is a malignant tumor or neoplasm which arise from either follicular or parafollicular cells of the thyroid gland it is uncommon cancer which affect women more than men ,there are several types of thyroid cancer and different methods of treatment
There are certain factors which may associated with cancer thyroid such as
- Exposure to irradiation head and neck exposure to irradiation such as X rays during childhood for treated other diseases such as tuberculosis or TB of the lymph nodes which was done in the past these patients are more liable for development of cancer thyroid
- Endemic cancer such as the incidence of follicular carcinoma is high in endemic areas possibly due to TSH stimulation
- Presence of benign thyroid lesions which may transformed to malignancy such as adenoma of the thyroid gland especially in male ,nodular goitre and Hashimotos thyroiditis
- Cancer thyroid may occur alone without previous causes DE Novo such as anaplastic carcinoma
- Hereditary causes may be found
There are several types of thyroid cancer as follow
- Papillary:it is the most common type of thyroid cancer account for more than 60% which can occur in young age begins in the follicular cells characterized by localized slowly growing nodule,can spread through lymphatic vessels to lymph nodes which is the main route of spread it is hormonal dependency tumor and if diagnosed early and treated give good result and best prognosis
- Follicular : it is the second most common causes account for about 17% which also begins in the follicular cell of the thyroid gland can occur in young and old age characterized by slow rate of growth but more than papillary type ,can spread to through the blood to the lung and bones which is the main route of spread it is Iodine uptake tumor and if diagnosed early and treated can give better result but less than papillary type
- Anaplastic :it is least common type account for about 13% of thyroid cancer common in old age patient above 60 years ,begins also in follicular cells of thyroid gland , characterized by large rapid growing highly infiltrating mass ,can spread either by direct spread to surrounding organs which is the main route of spread or to the lymph nodes through lymphatic spread or to the lung bones liver and brain through blood spread,give temporary response to external irradiation has poor prognosis
- Medullary :less common type of thyroid cancer which arise from parafollicular cells called C- cells of thyroid gland which secreted calcitonin characterized by some tumors are familial runs in family and form part on multiple endocrine syndrome type II MEN type II or Sipples syndrome which has two forms MEN type IIa which consists of medullary carcinoma pheochromocytoma and hyerparathyyroidism ,MEN type IIb when the familial form is associated with prominent mucosal neuromas involving lips , tongue and eyelids can spread through lymphatic to the lymph nodes or through the blood to the lungs bone brain and liver which is the main route of spread the disease common associated with diarrhea due to 5 -hydroxy traptophan 5HT or prostaglandins produced by the tumor cells,calcitonin is a biomarker it is non hormonal dependent can give good result after treatment without blood spread or metastases
What are the symptoms and signs of thyroid cancer
- The patient may complaining from mass or swelling in front of the neck
- The patient may not complaining and the thyroid mass or swelling is discovered incidentally by the physician during routine examination
- The patient may complaining from thyroid swelling of recent onset with rapid increased in size
- The patient may complaining from pain either in front of the neck or in the ear earache due to Arnolds nerve infiltration by cancer cells this nerve is the auricular branch of the vagus nerve
- The patient may complaining from difficulty in swallowing dysphagia due to swelling compression on the esophagus
- The patient may complaining from change in his voice in the form hoarseness of voice due to recurrent laryngeal nerve infiltration by cancer cells
- The patient may complaining from shortening or difficulty in breathing dypsnea and cough either due to swelling compression effect or due to spread of cancer cells to the lungs
- The doctor may showing by examination thyroid swelling which it is hard ,tender,irregular and fixed
- The doctor may show enlarged lymph nodes which hard and mobile then become fixed
- The doctor may showing other signs of distant metastases or cancer spread such as loos of weight and jaundice in case of liver affection
Thyroid cancer can be suspected to be malignant in the following cases
- When there is thyroid swelling or goitre with previous history of head and neck exposure to irradiation
- When thyroid swelling present either in young or very old ages
- When thyroid swelling become increased in size and rapid growth
- When thyroid swelling associated with pain
- When thyroid swelling become hard ,irregular and fixed or with limitation of it is mobility
- When there is blood or lymphatic metastases
What are the investigations of cancer thyroid
Laboratory
Complete blood count
For anemia and fitness
Liver function test
For elevation of liver enzymes in case of liver metasteses
Tumor markers
For detection of of thyrogobulin for differentiated carcinoma or calcitonin for medullary carcinoma
Thyroid function test
For T3,T4,TSH hormones of thyroid gland either elevated or decreased
Other according to the case
Radiological
Thyroid ultrasound
To differentiated between cystic from solid swelling
Thyroid scanning
By radioactive iodine to show the thyroid nodule which appear as
Cold nodule (inactive nodule) a cold nodule it is the nodule which takes up no isotope such as in case of cancer thyroid or common in cystic nodule
Hot nodule or overactive nodule which takes up isotope while the surrounding thyroid tissue is inactive because the nodule is producing such high levels of thyroid hormones that TSH secretion is suppressed such as in case of hyperthyroidism
Warm nodule or active nodule in which the warm nodule take isotope like normal thyroid tissue
X rays
For the neck ,chest,skull,spine and pelvis for detection cancer metastases
Laryngoscopy and bronchoscopy
For detection of recurrent laryngeal nerve or tracheal invasion by cancer cells
CT scanning of the head neck and chest and brain
MRI scanning of the head neck chest and brain
Whole body scanning
By using radioactive iodine which go through circulation to different body organs to detect cancer metastases
Other according to the case
Thyroid biopsy
Biopsy of thyroid gland it is essential for diagnosis of thyroid cancer which may be done by an open operation by surgical removal of the swelling or by needle fine needle aspiration cytology FNAC or by true cut needle biopsy which taken for histological examination under microscope for detection of cancer cells
If an enlarged lymph node is present it may be removed through a small incision directly over it and taken for microscopic examination for detection of cancer cells
What are the treatment of thyroid cancer
Treatment of thyroid cancer depend on many factors such as the type of the cancer the size of the cancer ,the age of the patient , there is distant metastases to other organs such as to the liver lungs bone brain lymph nodes or no the patient fit for operation or no
Treatment of thyroid cancer can be done by the following methods
Surgical
Surgical removal of thyroid gland by an operation called thyroidectomy
Radiotherapy
External irradiation indicated in case of some thyroid cancer which can not be treated by surgery or for recurrent cancer after it is removal or as palliative treatment to relieve pain or ulceration can be used in anaplastic cancer
Hormonal therapy
Some thyroid cancers are hormonal dependent and can respond to thyroid hormones like L-thyroxine such as papillary and follicular carcinoma
Chemotherapy
Can be used in some thyroid cancer such as medullary carcinoma and analpastic cancer can be used also to relieve pain
Can be used in some thyroid cancer which its can uptake iodine such as follicular carcinoma by using sodium Iodide 131 which given by oral route then absorbed into the body and reach thyroid gland which trapped inside it which causes irradiation to the thyroid tissue and causing its damage so reduced secretion of thyroid hormones from thyroid gland the half life of sodium Iodide 131 is eight days and can be retained in the body for several week and the excess Sodium Iodide are eliminated from the body through the kidney passing to the urine
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