Thyroid cancer articles. How to recognize thyroid cancer. Surgery using Gamma Knife

Cancer thyroid gland– 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, scientific works often contain 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).

However, the prevalence of thyroid cancer in last years in some regions increased not only due to increased diagnostic capabilities. It is well known that accidents at nuclear facilities (and above all, the 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, pediatric patients were registered. 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

Possible reasons for the development of thyroid cancer include: ionizing radiation, heredity, the presence of autoimmune diseases of the thyroid gland (primarily autoimmune thyroiditis). It should be noted that age is not a factor increasing the number of cases of thyroid cancer - the peak incidence of follicular cancer and papillary cancer falls on 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. There are no specific ultrasound signs 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 the dark color of the node (hypoechogenicity), the presence of fuzzy 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 those located next to the thyroid gland in the lymph nodes of the neck (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. It is this simple but very informative study that makes it possible to establish a diagnosis of thyroid cancer. A biopsy can reveal without any doubt papillary thyroid cancer, medullary thyroid cancer, anaplastic thyroid cancer, squamous cell carcinoma thyroid and lymphoma. 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 performed in specialized centers 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 and completely normal level 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), however, after removal of the thyroid gland, the patient remains a completely normal person, capable of leading a full-fledged life. 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 of diagnosis, although there are situations that require much faster 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. At the same time, 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 a specialized endocrine surgery clinic. 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 only be performed 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. 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, and ultrasound diagnostics, so 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-Western Endocrinology Center, 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 to include a thyroidectomy—the complete removal of the thyroid gland. In other cases (for small tumors, tumors of low aggressiveness), surgery may be performed to remove half of the thyroid gland. When lymph nodes are affected, various types of lymph node dissection are performed - 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 North-Western Endocrinology Center do not use drainage in 90% of cases postoperative wound and use absorbable cosmetic sutures or skin glue, which allows the patient to shower the day after surgery and eliminates the need for dressings and removing sutures 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 of thyroid cancer, another treatment step may be required: 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, some are still being tested final stages clinical trials. Specialists of the North-Western Center for Endocrinology 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, selecting the correct therapy, and monitoring treatment results begins. 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 an excessive number of diagnostic and therapeutic procedures that do not improve final results 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 Eventually, thyroid cancer is 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 of the second type (MEN type 2 syndrome) is a symptom complex that unites a group of pathological conditions characterized by the presence of a neoplasm or hyperplastic process from neuroectoderm cells affecting two or more organs 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 levels are 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

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

In the initial stages there are no symptoms, so regular preventive screening examinations are of utmost importance.

With their help, it is possible to detect thyroid cancer in the 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 type of cancer received this name due to the fact that when microscopic examination Multiple papillary projections were found on the tumor.
   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 the early appearance of 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, it is manifested by a rapid increase in the size of the thyroid gland, inflammation of the cervical lymph nodes, and 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 of malignant degeneration of 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 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 examination 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. Exactly these age categories are at risk for thyroid cancer.

If the patient already has a goiter, then you need to pay attention to atypical changes (rapid growth, the appearance of a large number of 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.

In 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 of the disease (dense nodule 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 differential diagnosis 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 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. Currently, the main treatment methods of 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, it is possible to resect only one lobe of the gland that is affected by cancer, so that the child does not develop serious hormonal disorders in the future.
2. Hormone 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. This technique does not have a negative effect on other organs and tissues. 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 sufficient quantity iodine, you need to give up junk food, introduce more fresh vegetables and fruits into the diet;
• timely treatment of pathologies of the thyroid gland and other organs that can provoke the development of oncology;
• refusal uncontrolled intake hormones, all medications must be prescribed by a doctor, who also determines their dosage and duration of treatment;
• use of funds personal protection when working in hazardous industries;
• strengthening immune defense, hardening the body;
• rejection of bad habits;
• avoiding stress and other types of nervous tension;
• giving up a sedentary lifestyle, which leads to the development of stagnation throughout the body, it is necessary to engage in physical exercise, spend more time on fresh air;
• regular sanitation of lesions chronic infection in organism;
• avoiding exposure to radioactive radiation on the body;
• periodic preventive examinations - this will help identify possible problems with health in the early stages.

Thyroid cancer is another form of cancerous malignancy. The disease itself is currently very rare - only about 1% of all malignant tumors. But in the last 10 years, the incidence of this particular disease has increased by 6%. But we hasten to reassure you that many medical minds attribute this growth to the development of early diagnostic tools.

As a rule, people suffer from a tumor of the thyroid gland at a much earlier age than with diseases of other organs. 65% of all patients are under the age of 55, and only 2% are children and adolescents. And the disease itself is not as aggressive as many others; cancer grows very slowly and can long time do not metastasize. At the same time, the mortality rate is one of the lowest in oncology – only 0.5%.

But you shouldn’t let the disease get worse – if you turn a blind eye to problems, the result can be disastrous.

Risk factors

Let us highlight the main factors influencing the transformation of cells into cancer cells and further DNA mutations.

• Age and gender– studies have shown that women still get sick more often than men, and even about 3 times, the risk age for women is 45-50 years, for men – 60-70 years. But after 65 years, men noticeably outperform women.
• Iodine deficiency– in places with iodine deficiency in food, people suffer noticeably more often.
• Increased radiation– several areas can be identified at once, but radiation significantly affects the risk of future cancer. Thus, children exposed to radiation in childhood (even on X-rays or computed tomography) suffer in the future more often than those who are not exposed to radiation. At the same time, the risk of occurrence when irradiating adults is noticeably lower. Note that after the Chernobyl explosion, an approximately 10-fold increase in thyroid cancer was recorded. Also in countries where the influence of radiation is noticeably lower (countries of Africa, Asia, South America), the incidence of this disease is much lower.
• Stress– prolonged stress, smoothly turning into prolonged depression, greatly reduces the immune system, which in turn must fight the emergence of “wrong” cells in the body.
• Heredity– sometimes they notice a predisposition in those who already have a patient in their family. Scientists have even found those same genes, and a mutated cell can be passed on to a child at the moment of conception.
• Bad habits– this is how smoking increases the content of carcinogens in the body, and alcohol again undermines our immunity.

Diseases also affect:

1. Female genital organs.
2. Mammary glands - not only malignant, but also benign.
3. Polyps in the gastrointestinal tract.
4. Endocrine neoplasia.
5. Multinodular goiter.
6. Various thyroid tumors.

Symptoms and signs

The thyroid gland has a butterfly shape and is located on the front surface of the skin, which greatly simplifies its diagnosis - because it can not only be seen, but also palpated well. A new formation on the neck is often visible only on one side, and it is not uncommon for the formation to grow rapidly. Any change in the thyroid gland is a sure signal to contact an endocrinologist.

Other visible signs and symptoms of thyroid cancer that may prompt you to see your doctor:

• Swelling of the neck.
• The appearance of a noticeable “nodule”. Note that if this is detected before the age of 20, it is immediately recommended to consult a doctor. In most cases, these nodules are benign.
• Unpleasant sensations, periodically giving a painful outbreak, in the neck area, can spread all the way to the ears.
• Voice disturbances, hoarseness. Difficulty swallowing. Pain when swallowing produces viscous mucus from the glands, which creates the effect of a “cotton ball in the throat.”
• Enlargement of the lymph nodes bordering the thyroid gland and located on the neck.
• Breathing problems.
• Enlarged veins in the neck area.
• Frequent cough without illness is due to metastases to the lungs.

It is worth remembering that not all of these signs directly indicate cancer. So, if you notice something like this, don’t panic. But it never hurts to see a doctor for prevention!

The development of the disease changes the structure of the gland, and therefore affects the formation of hormones, which can lead to hypothyroidism with symptoms:

• Apathy, lethargy, drowsiness.
• Periodic tingling sensations in the arms and legs.
• Hair loss.
• Breaking the voice into a roughened one.

With follicular cancer, on the contrary, hormones are produced above normal - hyperthyroidism:

• Convulsive processes.
• Increased temperature with a feeling of heat in the body.
• Increased sweating.
• Lack of desire for sleep.
• Accelerated fatigue.
• Weight loss, decreased desire to eat food.

Types

The first three tumors listed are differentiated.

Papillary carcinoma, papillary adenocarcinoma (sometimes confusedly called capillary carcinoma)– 80% of cases. Slow growth, damage to only one lobe. Often spreads to lymph nodes. Low mortality, favorable prognosis.

Follicular carcinoma– 10-15% of cases – In countries with low iodine levels higher – usually does not affect the lymphatic system, but may spread to other parts of the body. The lungs and bones are most often affected. But despite this, treatment also leads to a favorable outcome, although not as often as the previous one.

Medullary carcinoma– 5-8% – Develops from cells that produce the hormone “calcitonin” (controls the level of calcium in the blood). To diagnose this particular type of cancer, an increase in this calcitonin and a special protein of carcinoembryotic antigen can be used as one of the factors. Widespread metastases in the lymph, liver, and lungs. Often appear even before detection. Hence, due to current treatment problems, survival rate is greatly reduced.

Anaplastic cancer- less than 3% - the rarest form, undifferentiated, with this disease the cells completely lose their function, leaving only the ability to divide. Usually appears after 65 years, grows very quickly and metastasizes, the most unfavorable prognosis of all those mentioned above.

Diagnostics

In the early stages it can be detected by self-diagnosis. It is not difficult to detect the first signs - swelling in the neck - it could just be a goiter or any other benign tumor, but there is a risk that without further reaction a cancerous tumor may appear.

In modern medical examinations, ultrasound is often used to diagnose thyroid cancer. It can show the boundaries and presence of a tumor, nodules, but, unfortunately, it cannot diagnose whether the tumor is cancerous or not. Doctors pay special attention to tumors with uneven edges and excellent blood circulation within themselves.

In case of primary suspicion, another technology is used for further pinpoint diagnosis - FNAB - fine-needle aspiration puncture biopsy. The essence of the method is to insert a very thin needle into the tumor and take samples of its cells. Everything is done using ultrasound, and the method itself, despite its relative painlessness, gives accurate readings.

Most best method Diagnosis of this cancer is a biopsy.

But it happens that a biopsy does not give a 100% result, and then a small operation is performed to take cell samples.

Diagnosis can also be carried out by donating blood for tumor markers:

• Calcitonin– an increase indicates medullary cancer or developed distant metastasis in the body. Calcitonin norms are 0.07-12.97 pg/ml in women, 0.68-30.26 pg/ml in men.
• Thyroglobulin– an increased rate indicates the possibility of the formation of papillary or follicular thyroid cancer. The norm for this analysis lies in the range of 1.4-74.0 ng/ml.
• BRAF– under normal conditions this gene should be absent.
• EGFR– this indicator is measured after surgery to remove tumors, in case increased indicators there is a risk of the disease returning.
• Antithyroid blood antibodies- a sign of papillary cancer, an increase indicates that the immune system for some reason is fighting the thyroid organ itself, and this already indicates something abnormal in the processes of the thyroid gland.
• Proto-oncogene RET– a mutation of this gene indicates medullary cancer; often all relatives of the patient are tested for this gene.

General disturbances in the functioning of the gland are determined through hormone measurements:

• Thyroid-stimulating hormone (TSH).

Do not forget that in case of complications of the disease, research methods atypical for this cancer can also be used: for example, to examine the trachea and esophagus.

To accurately determine the stage of thyroid cancer and make a diagnosis, the following methods are used:

• X-ray.

Differentiated forms up to 45 years

The younger the patient, the lower the likelihood of death.

Stage 1– any size of the thyroid gland, the tumor does not disintegrate, there are no metastases. It may affect nearby lymph nodes.

Stage 2– in continuation of the previous one – gives metastases to distant organs.

Differentiated forms after 45 years

Stage 1– up to 2 cm, no metastases

Stage 2– 2-4 cm, located within the boundaries of the organ, no metastases

Stage 3– more than 4 cm, OR extends beyond the gland, but without metastases in the lymph nodes, OR there are metastases in the nearest lymph nodes without further spread

4 A– any size with distant foci, OR metastases in nearby lymph nodes without distant foci.

4 B– spread of tumor formations deep into the neck, as well as to the spine or into neighboring blood vessels. Metastasis may begin in the lymphatic system.

4 C– metastases in distant organs. The size and extension of the organ does not matter.

Anaplastic forms

The forms are classified as stage 4, the prognosis is unfavorable.

4 A– within the organ, likely to spread to the nearest lymph nodes, distant metastasis is not observed.

4 B– growth of the formation beyond the boundaries of the organ without the formation of distant metastases.

4 C– distant metastases.

Metastases

Finding out that metastases have appeared is not so difficult. Most often, metastases spread to nearby lymph nodes, noticeably increasing their size.

Metastases to the brain may be indicated by severe headaches; in addition, disturbances in coordination of movement, vision, and even the appearance of seizures are possible.

Jaundice, problems with digesting food, intolerance to fatty foods, blood in the stool are signs of a liver problem. Constant cough for no reason and a cold, problems with breathing problems in the form of shortness of breath, the appearance of blood in the sputum - indicate the lungs. The ribs, skull, spine are aching, and x-rays showed voids or strange dark growths in these areas - metastases have caught on the bones.

Treatment

The following methods are used in the treatment of thyroid cancer. In this case, both individual techniques and a set of therapies can be used in cascade application.

• Surgical intervention
• Radioactive iodine
• Radiation therapy
• Hormone therapy
• Targeted or selective therapy
• Less common chemotherapy

Malignant tumors of the thyroid gland are treated with an extremely low mortality rate, but if no metastases have been detected. The main methods are to remove or destroy most of the cancer cells to prevent possible growth and metastasis. In advanced cases, they resort to palliative treatment to reduce the symptoms of cancer - pain and other symptomatic problems.

Surgery

One of the main methods, with the exception of use for anaplastic forms.

Hemithyroidectomy– removal of one lobe of the gland. The method is used for early detection and the process is not very neglected. It can be used as a diagnostic if the biopsy did not give the desired result for taking cell samples. After the operation, there is no need to go on hormones - after all, the second part remains to work.

Thyroidectomy– surgery to remove the entire gland. Total or subtotal - in the latter case it is not carried out complete removal, due to tumor growth or the anatomy of the thyroid gland.

After removal, you need to take a hormone - levothyroxine.

When removing, they immediately take in the lymph nodes and tissue of the neck - especially with medullary cancer and anaplastic forms.

Stages of the operation

1. They begin to prepare the patient for the operation - they set a day, perform an ultrasound, collect tests, make sure that on the day of the operation the patient does not have any problems, be it chronic exacerbations and infections.
2. Consultations with the doctors involved in the operation - therapist, anesthesiologist, surgeon.
3. Conduct general anesthesia. No local anesthesia.
4. The operation is performed - usually within 1 hour. If there are metastases and it is necessary to remove lymph nodes, the operation can take up to 2-3 hours.
5. After the operation, the patient is transferred to a ward with strict bed rest. On the first day, a drainage is placed to drain the fluid; on subsequent days, a dressing is done. In just 2-3 days the patient can be discharged.

Consequences of the operation

1. Voice problems - from hoarseness to loss
2. Can affect and disrupt the functioning of the parathyroid glands
3. Bruising or bleeding in the neck
4. Infection

After surgery and discharge

The operation does not end everything; you need to continue to monitor the development of the disease and stop it.

After 6 weeks after removal, a study is carried out with Iodine-131 to identify residues, and, if necessary, they proceed to treatment with radioactive iodine.

In 6 months a repeat examination with ultrasound is performed.

According to the decision of the oncologist every six months you need to come for a re-examination.

Control checks also carried out 1 year and 3 years after surgery.

Radioactive iodine

When iodine-131 enters the body, it is deposited in the cells of the thyroid gland. Taking the drug even through the esophagus is subsequently absorbed by the thyroid gland. When gland cells consume radiation in this iodine, they completely disappear (both cancerous and healthy), without damaging other organs.

Used to completely destroy the remains of the removed gland after surgery. It is also effective in combating metastases in lymph nodes and organs. The method significantly increases survival at stage 4.

Iodine is absorbed by the gland with an increased concentration of TSH in the blood. To increase it, before introducing iodine, you can either limit the intake of medications after surgery for a couple of weeks, or introduce the drug Thyrogen - it is administered for 2 days, 1 time per day, and after that you can administer radioactive iodine.

Complications from the received dose are possible:

• Cervical swelling.
• Feeling of dryness in the oropharynx.
• Nausea and vomiting.
• Enlargement of salivary glands.
• The sense of taste changes.
• "Dry eye"

Hormone therapy

The method, as the name implies, involves taking hormonal drugs for the following purposes:

1. Maintaining body function after removal of the thyroid gland.
2. Preventing further growth of cancer cells after surgery.

Complications after taking hormones: arrhythmia, osteoporosis.

Radiation therapy

Spot radiation exposure cancerous tumors. Usually not used where radioactive iodine would be more effective. Therefore, for thyroid cancer, treatment is used only for anaplastic forms.

If the tumor grows beyond the organ, radiation therapy can help stop the formation of metastases and reduce the risk of cancer recurrence.

Irradiation is usually carried out for several weeks, 5 times a week. Before a course of treatment, doctors carefully make preliminary measurements, calculations for dosage and irradiation area. The session itself takes a few minutes and does not cause pain.

Side effects:

• Burns of adjacent tissues.
• Feeling of dry mouth.
• Change in skin color.

Selective therapy

The use of drugs that only affect cancer cells. With the development of medicine, the precision of drugs increases, and the need for full chemotherapy sometimes disappears.

Medullary cancer

Hormonal therapy and radioactive iodine are ineffective for this type of cancer. It is important to use drugs:

• Vandetanib – cessation of tumor growth within 6 months.
• Cabozantinib – 7 months.

Papillary and follicular cancer

For these types of cancer, other treatments are more effective, and drugs are used more to improve treatment.

List possible drugs for current use: Sorafenib, Sunitinib, Pazopanib, Vandetanib.

Nutrition

After surgery to remove the thyroid gland, you do not need to adhere to any special diets. We eat everything that is necessary to keep the body in healthy shape, maintaining a balance of proteins, fats and carbohydrates, as well as vitamins (you can drink multivitamin complexes). The most useful foods for preventing the return of cancer were:

• Vegetables: cabbage, radishes, turnips
• Beans: peas, beans, soybeans
• Carrots, parsley

But it is recommended to temporarily avoid eating animal fats, lard and margarine.

Traditional methods

Remember! Not a single folk method of “treatment” can replace a full visit to the doctor. Before using any advice from the Internet, we recommend that you consult a medical institution so as not to provoke the development of a tumor.

We will announce here what people are already using before and after surgery to enhance the healing effect, as well as simply to smooth out unpleasant symptoms.

Cleansing the body

The method is used to prepare for surgery. Recommended consumption more water and switch to plant-based foods. Drink a tablespoon before eating linseed oil. Cleansing will be facilitated by using an enema with apple cider vinegar (a tablespoon of vinegar to two glasses of plain water).

Enema schedule:

• Week 1 - every day.
• Week 2 – every other day.
• Week 3 – in 2 days.
• Week 4 – once a week.

Use before surgery

Use after surgery

Of the most frequent advice for use after surgery you can find:

• Nut tincture
• Poplar buds
• Tinctures of hemlock and celandine

Treatment without surgery

If you simply need to alleviate the condition of the body, but surgery is contraindicated, traditional healers recommend using tincture from the root of Aconite Dzungarian. Since this plant also contains poisons, be careful about the dosage and do not overdo it.

Survival prognosis

Depends on the type of tumor and the stage at which treatment begins. The forecast for five-year survival of patients is presented in the table below; please note that the table also gives forecasts after surgery.

Type of cancer	1 tbsp.	2 tbsp.	3 tbsp.	4 tbsp.
	~100%	~100%	93%	51%
	~100%	~100%	71%	50%
	~100%	98%	81%	28%

With anaplastic forms, survival rate drops sharply to 7%,

Disability

Treatment of such a complex disease cannot occur instantly, and the patient may be partially unable to work. Fortunately, this particular disease is not the most terrible among cancer ones, and the patient will sooner or later fully recover during the rehabilitation process. But the recovery process may take different time– from 3 months, and up to complete when using complex treatment methods (radiation or chemotherapy) and up to 5 years.

Thyroid cancer is diagnosed in women and men over the age of 40. It is quite rare and accounts for only 1% of the total number of cancers.

Reasons for origin

Among the predisposing factors that directly influence the occurrence pathological process, experts attribute:

Consequences of the Chernobyl accident;

Chronic inflammatory processes in the thyroid gland;

Long-term use of radiation therapy in the neck and head;

Professional activities related to ionizing radiation, heavy metals or performing professional duties in hot shops;

Smoking;

Constant stress, which reduces the body's immune response.

Hereditary predisposition

Long-term clinical studies have revealed that the human body contains a gene responsible for the development of thyroid pathology. It is inherited and the likelihood of developing cancer increases significantly in families where cases of low-quality thyroid tumors have already been identified. Hereditary forms of cancer occur in 20-30% of patients who seek help.

Classification of the international TNM system

Modern specialists use this classification to determine the stage of development of the pathological process:

T0 - at the time of surgery there are no signs of a tumor in the gland;

T1 - the diameter of the tumor does not exceed 2 cm and it does not grow into the capsule of the thyroid gland;

T2 - the size of the neoplasm is more than 2, but less than 4 cm and does not grow into the capsule of the thyroid gland;

T4 - when the diameter of the neoplasm is more than 4 cm, the tumor does not grow into the wall of the capsule, or when the size is less than 4 cm, areas of growth into the capsule of the thyroid gland are noted;

T4A - regardless of the diameter, specialists identify areas of germination of affected tissues into the capsule, subcutaneous tissue, larynx, recurrent laryngeal nerve, trachea or esophagus;

T4B is a tumor with invasion of the retrosternal vessels, as well as the carotid artery or prevertebral fascia.

Based on the presence of thyroid metastases in the regional lymph nodes, they are classified as:

Nx - it is impossible to differentiate the presence in the cervical lymph nodes;

N0 - absent in the study of regional lymph nodes;

N1 - identified during research in regional nodes.

Based on the presence of distant metastases, they are classified as:

Mх - it is impossible to assess their presence;

M0 - the study revealed their absence;

M1 - as a result of the examination, the presence of distant metastases was established.

Diagnostics

For the most complete diagnosis, specialists use high-precision equipment and modern research methods. These include:

Ultrasound of the thyroid gland, which reveals the heterogeneous structure of the organ and the presence of nodules;

Fine needle or open biopsy. With its help, specialists obtain material for histological examination;

Laboratory blood testing to evaluate its biochemical composition;

A blood test aimed at determining hormonal levels;

A blood test to conduct a study to determine tumor markers.

Treatment methods

After the examination, the specialist prescribes complex treatment, aimed at adjusting hormonal levels, slowing tumor growth or its surgical elimination. The choice directly depends on the stage of development of the disease, the activity of the pathological process, the presence of metastases, as well as the general condition of the patient.

The most common and effective techniques include surgical removal organ or part thereof, as well as the use of chemotherapy, radiation therapy and hormonal drugs to maintain the body.

Surgery using Gamma Knife

This modern method of performing operations is characterized by minimal tissue trauma and good results. This technique is based on the removal of the affected part of the thyroid gland without damaging healthy tissue, which characterizes this method of surgical intervention as minimally invasive and gentle.

Chemotherapy

It is based on the ability of thyroid tissue to absorb iodine. After degeneration, the cells of a low-quality tumor still actively absorb and accumulate iodine. The use of cytotoxic drugs allows for a targeted effect on the affected cells and does not harm healthy tissues. Individual selection of dosage allows you to reduce Negative consequences chemotherapy for the body and get maximum effect from the treatment performed.

Radiation therapy

It is based on a violation of the DNA structure of the degenerated cell, which leads to its destruction. Experts have also proven that radiation therapy not only helps to reduce the manifestation of the disease and alleviate the patient’s condition, but also prevents further division of pathological tissue.

Based on the examination results, the doctor makes a choice either in favor of external irradiation or gives preference to radioiodine therapy. The first method is used in the presence of metastases, as well as aggressive forms of the disease. And the second is used to treat the initial stages of thyroid cancer and as part of complex therapy.

Hormone therapy

Individual selection of the dosage of medications helps maintain hormone balance and ensures a normal lifestyle for patients suffering from thyroid cancer. The main objective of the method is to maintain the optimal level thyroid-stimulating hormone(TSH), which helps prevent the development concomitant diseases, complications after treatment and various abnormalities in the functioning of internal organs.

Radiosurgery

Allows you to suppress the development of metastases localized in the brain and spinal cord using modern treatment methods called Cyber ​​Knife. The technique belongs to the category of minimally invasive and is characterized by lasting results and high efficiency.

Rehabilitation

The opportunity to spend the rehabilitation period in a modern clinic equipped with high-precision equipment and qualified personnel significantly speeds up the body’s recovery process. Experts will help you overcome unpleasant consequences treatment, and will also select medications for further use. Diet, moderate physical activity and procedures will strengthen the body’s immune system and normalize hormonal background, and a psychologist will help you cope with the emotional side of the problem.

Thyroid cancer is a malignant tumor that develops from the cells of this organ. The disease is considered relatively rare. It accounts for 1% of all malignant tumors and less than 0.5% of deaths. But after the accident at the Chernobyl nuclear power plant, everything more people notice in themselves warning signs diseases.

The peak incidence is between 45 and 60 years of age, but a malignant thyroid tumor can appear at any age. This form of cancer is also sometimes found in children and adolescents. Moreover, at an early age the tumor behaves more aggressively than in adults.

Women are 2-3 times more likely to become victims of thyroid cancer. But in old age (over 65) men are at greater risk of getting sick than their peers.

The disease most often occurs in regions that have been exposed to radiation and where there is an insufficient amount of iodine in nature. This form of cancer is most common among Caucasians. Residents of Asian, African and South American countries are less likely to suffer from thyroid problems.

Thyroid cancer is a non-aggressive tumor. This tumor may not increase in size for years and not metastasize to other organs. But that's no reason to ignore serious illness. Modern methods diagnostics make it possible to detect cancer in the early stages and begin treatment on time. This approach allows you to completely defeat the disease and provide a person with a healthy, full life.

Causes of thyroid cancer

The causes that cause thyroid cancer are not fully established. But doctors name many factors, which can increase the risk of developing the disease tenfold.

1. Radioactive exposure. Studies conducted in areas affected by the Chernobyl accident have proven that after the explosion, the number of cases of thyroid cancer increased 15 times. Also dangerous are radioactive rains that fall after nuclear weapons tests.
2. Radiation therapy to the head and neck area. Long-term exposure to X-rays can cause tumors to appear decades later. Cells of the human body become prone to mutations, active growth and division. These processes ensure the appearance of papillary and follicular forms of tumors.
3. Age over 40 years. Although malignant tumors can appear in children, the risk increases greatly with age. During the aging process, thyroid cells are more likely to experience gene failures.
4. Family predisposition. Scientists have identified a special gene that is inherited and is responsible for the development of thyroid cancer. If it is present in a person, then the probability of a tumor appearing is almost 100%. When doctors discover such a gene, they may suggest preventive surgery to remove the thyroid gland.
5. Occupational hazards. Working with ionizing radiation is considered dangerous medical personnel, workers in hot shops or activities associated with heavy metals.
6. Stressful situations . Severe stress, after which a person cannot recover for a long time and depression undermines the immune system. But exactly immune cells responsible for destruction cancerous tumor.
7. Bad habits. Tobacco smoke contains carcinogens, and alcohol weakens the body's natural defenses against abnormal cells.

The following chronic diseases can contribute to the appearance of thyroid cancer:

1. Diseases of the female genital organs. Chronic diseases uterus and ovaries, especially if they are accompanied hormonal disorder.
2. Tumors of the mammary glands. Benign and malignant neoplasms in the breasts of women (especially hormone-dependent).
3. Rectal polyps and colon cancer.
4. Multiple endocrine neoplasia.
5. Multinodular goiter.
6. Benign tumors and nodules of the thyroid gland.

Symptoms and signs of thyroid cancer

The thyroid gland is similar in structure to a butterfly. It lies on the front surface of the neck under the thyroid cartilage and is covered with skin. Thanks to this location, it is clearly visible and can be felt. This makes the examination much easier.

Let's figure out what symptoms should lead you to believe that some changes are happening to the thyroid gland and you need to consult an endocrinologist.

The first sign is the appearance of a small nodule on the thyroid gland. It is noticeable under the skin and looks like a small elevation on one side. At the initial stages, the nodule may be elastic and painless, its mobility is limited. It does not grow into the skin, but rolls under it. Over time, the node becomes denser and increases in size.

Do not panic if you find such a lump on your neck. Many people have nodules, and only 5% of them are cancerous tumors. But if such a lump appears in a child, then the doctor must be immediately informed about it, since there should be no lumps on the thyroid gland until the age of 20.

Another early symptom of thyroid cancer is an enlarged lymph node in the neck. Sometimes this is the only sign of illness.

In the later stages, when the tumor becomes larger, other symptoms appear:

• pain in the neck, which may radiate to the ear;
• difficulty swallowing;
• feeling of a lump in the throat;
• hoarseness of voice;
• cough that is not associated with a cold or allergy;
• shortness of breath and difficulty breathing;
• swelling of the neck veins.

These symptoms are caused by the fact that the tumor has reached a large size and began to compress the surrounding organs: the esophagus, trachea. Metastases in the vocal cords and the recurrent laryngeal nerve, which runs next to the gland, are the cause of voice changes.

Types of thyroid cancer

The thyroid gland is a unique organ. It produces many hormones that regulate metabolic processes in the human body. A variety of cells become the basis for different forms thyroid cancer.

Papillary thyroid cancer

Such cancerous tumors have many protrusions on their surface that resemble papillae. Because of this, the new growth becomes similar to a fern leaf. Papillary cancer is a highly differentiated tumor. This means that its cells at first glance look like normal thyroid cells.
Papillary cancer is the most common form of the disease - 80% of all cases. This tumor is the most “peaceful” and is characterized by slow growth. It is not prone to metastasize and responds well to treatment.

If you examine the thyroid gland of healthy people under a microscope, then in 10% you can find tiny papillary tumors that do not grow and do not manifest themselves in any way. But in some cases they reach quite large sizes, then treatment is required.

Papillary tumors occur 3 times more often in women than in men. They appear at the age of 30-50 years.
99% of people who undergo therapy live longer than 25 years. Therefore, papillary thyroid cancer is considered to have a favorable prognosis.

Follicular thyroid cancer

In this case, the tumor looks like round vesicles - follicles. Its share in thyroid cancer is 10-15%. It appears more often in older people, especially women.

In one third of cases, the tumor does not grow into blood vessels and surrounding tissues and does not metastasize, which is why it is called minimally invasive. But the remaining 70% of follicular tumors are more aggressive. Cancer spreads not only to blood vessels and lymph nodes, but also to distant organs: bones and lungs. but such metastases respond well to treatment with radioactive iodine.

The prognosis for the course of the disease is favorable, especially in patients under 50 years of age. In older people, the disease can be complicated by numerous metastases.

Medullary thyroid cancer

This is a fairly rare form of cancer. It arises in 5-8% of cases from paraphyllicular cells that produce the hormone calcitonin. It regulates phosphorus and calcium levels, as well as bone growth.

Medullary tumor is more dangerous than previous forms. It can grow through the capsule into the trachea and muscles. The disease is accompanied by hot flashes, a feeling of heat, redness of the face and diarrhea.

Medullary cancer is detected in people over 40-50 years of age. It affects men and women equally. The tendency to such tumors is inherited. But medullary cancer can also appear in a person whose ancestors never suffered from such a disease. This is called the sporadic form.

Medullary thyroid cancer is often accompanied by other gland disorders internal secretion- multiple endocrine neoplasia. The cells of this tumor do not absorb iodine, unlike other forms of cancer. Therefore, radioactive iodine therapy does not help in this case.

Only surgery can help get rid of medullary cancer. The thyroid gland and cervical lymph nodes will need to be completely removed. Patients over 50 years of age have a poor prognosis.

Anaplastic thyroid cancer

This is the rarest form of the disease, in which atypical cells develop in the gland. They have lost all their functions and can only actively share. The proportion of aplastic tumors is less than 3%.

The tumor appears in people over 65 years of age, and in women more often than in men. The disease is characterized by rapid growth and spread of metastases. Difficult to treat. It has the worst prognosis of all forms of thyroid cancer.

Diagnosis of thyroid cancer

Devices are used to examine the condition of the thyroid gland. Ultrasound. This one is inexpensive and painless procedure allows you to determine whether the gland is enlarged, whether there are nodules and tumors in it, to find out their size and exact location. But, unfortunately, ultrasound cannot determine whether a nodule is a cancerous tumor. Doctors are most concerned about nodes that poorly reflect the ultrasound wave, have unclear and uneven edges, a heterogeneous structure, and in which blood circulation is well developed.

Fine-needle aspiration puncture biopsy (FNA) helps determine what cells the tumor consists of. Under ultrasound guidance, a thin needle is inserted into the tumor. With its help, the doctor takes a sample of cells for research. This is a very accurate and low-traumatic method.

If the result of a fine-needle biopsy is doubtful, then an open biopsy of the suspicious node is performed. This is a small operation during which the doctor excises a small area of ​​the tumor and does a quick examination of it.

Blood tests

A person needs to donate blood from a vein. In the laboratory with the help enzyme immunoassay determine whether it contains tumor markers. These are special protein-based chemicals. Elevated levels may indicate a certain form of thyroid cancer.

• Calcitonin . An elevated level indicates that a person has medullary thyroid cancer. In people who have already undergone treatment, high concentrations indicate distant metastases. But it is necessary to remember that the amount of the hormone increases during pregnancy, taking hormonal contraceptives, calcium supplements and diseases of the pancreas. The following indicators are considered normal: women - 0.07-12.97 pg/ml, men - 0.68-30.26 pg/ml.
• Thyroglobulin. This is a protein secreted by thyroid cells. The normal level of its content in the blood is 1.4-74.0 ng/ml. An increased level may indicate papillary and follicular thyroid cancer and the presence of metastases.
• BRAF gene. Its level makes it possible to determine the prognosis of the course of the disease in papillary thyroid cancer. Normally it shouldn't be there.
• EGFR. This test detects epidermal growth factor. It is done after the tumor is removed. Increased quantity his blood shows that there is a high probability that the tumor will reappear.
• Antithyroid antibodies in blood serum. High levels of these proteins indicate that a person has an autoimmune thyroid disease (the immune system mistakenly attacks the organ). This often happens with papillary thyroid cancer.
• Proto-oncogene mutationsRET . Identification of changes in genes confirms medullary cancer. Such a study is carried out not only on the sick person, but also on his family members.

In each specific case, the doctor may order several tests to confirm suspicions about the tumor. But it must be remembered that tumor markers do not provide completely reliable information about the disease. There is always a percentage of people who have elevated levels of these substances, but do not have a tumor. There are also patients in whom a tumor is detected, but tumor markers are normal. Therefore, only a biopsy can give the most accurate result.

In order to find out how impaired the function of the thyroid gland is, hormone levels are determined:

• Thyroid-stimulating hormone (TSH). This is a hormone secreted by the pituitary gland that stimulates the development of thyroid cells. It is important to measure its level after cancer treatment. The concentration should not exceed 0.1 mIU/l, otherwise the disease will return.
• Thyroxine (T4). The level of this hormone shows how active the thyroid gland is.
• Triiodothyronine (T3). Biologically active hormone. Its concentration indicates how the gland works.
• Parathyroid hormone (PTG). A substance produced by the parathyroid glands. His high concentration indicates metastases in medullary cancer.

Stages of cancer

In any oncological disease, there are 4 stages of tumor development. When a doctor determines the stage of cancer, he takes into account: the size of the tumor, its prevalence, the presence of metastases in nearby and distant organs.

Metastasis is a secondary tumor, a new focus of growth. It is formed after cancer cells are carried through the blood or lymph into other organs.

Stage I. A tumor up to 2 cm in size is located in one lobe (half) of the thyroid gland. It does not deform the gland capsule and does not form metastases.
Stage II. A single large tumor that deforms the gland. Many small tumors belong to this stage. Tumors do not grow into the capsule. There may be metastases on the side of the neck where the cancer is located.
Stage III. The tumor grows into the capsule of the thyroid gland. It compresses the trachea and surrounding tissues and fuses with them. Metastases appear in the cervical lymph nodes on both sides of the gland.
Stage IV. The tumor grows deeply into the surrounding tissues, the thyroid gland becomes immobile and greatly increases in size. Metastases are detected in nearby and distant organs.

How do you know that metastases have appeared?

Metastases in thyroid cancer appear most often in lymph nodes neck. In this case, the lymph nodes become enlarged and inflamed. They become dense, less mobile and merge with the skin. This complication does not worsen the prognosis of the disease. In papillary and follicular cancer, metastases are well treated with radioactive iodine.

Metastases to the brain manifested by headaches that are not relieved by analgin. Possible loss of coordination and blurred vision, seizures similar to epileptic ones.

Metastases in bones cause pain and fractures. More often than others, the ribs, bones of the skull, pelvis and spine are affected, and less often the limbs. On X-ray, metastases appear as voids or dark growths.

Liver metastases can cause jaundice, heaviness in the right hypochondrium and digestive disorders. The person can't stand fatty foods, meat. IN severe cases Internal bleeding may occur in the form of bloody stools and coffee-ground vomiting.

Metastases to the lungs cause dry cough, difficulty breathing, blood in sputum. There is a feeling of tightness and pain in the chest, severe fatigue.

Metastases to the adrenal glands practically do not show themselves in any way. With severe damage to these glands, the level of sex hormones decreases. Acute adrenal insufficiency may occur. It causes a sharp drop in blood pressure and a blood clotting disorder.

To determine the stage of thyroid cancer and detect metastases, ultrasound, radiography and magnetic resonance imaging, positron emission tomography are used.

Surgery for thyroid cancer

The indication for surgery is suspicion of cancer. If the biopsy confirms that there are cancer cells in the thyroid nodule, then it definitely needs to be removed.

If the tumor is very small, the doctor will suggest removing half of the thyroid gland with the isthmus. This operation is called hemithyroidectomy. The remaining share takes over the production of hormones.

But most doctors believe that the best option There will be a complete removal of the thyroid gland - a thyroidectomy. Only in this case can you be sure that no tumor, even the smallest one, will be missed and cancer will not recur. After all, a second operation on the thyroid gland can cause complications, for example, paresis vocal cords.

If the tumor has grown into the surrounding tissue and lymph nodes, they are also removed. This operation is called thyroidectomy and lymph node dissection. The surgeon excises the gland itself, the affected lymph nodes and fatty tissue in this area of ​​the neck.

Operation stages

1. Patient preparation. The operation is scheduled for a specific date. At this point, the person should not have acute infectious diseases or exacerbation of chronic ones. Before the operation, an ultrasound of the thyroid gland is performed. You will also need to take tests: a clinical and biochemical blood test, a general urine test, a blood group, and a “coagulogram”.
2. Consultations with a therapist, surgeon and anesthesiologist. Doctors will determine the scope of the operation and answer all your questions.
3. The patient is given general anesthesia. He is in medicated sleep and does not feel pain. Thyroid operations are not performed under local anesthesia.
4. Carrying out the operation. The procedure lasts about an hour, and if it is necessary to remove lymph nodes, then 2-3 hours. The surgeon removes the gland, restores blood circulation to healthy organs and applies stitches.
5. Postoperative period. The patient is transferred to the ward. The first day they are not allowed to get out of bed - strict bed rest is required. On the first day, a drainage is installed to drain fluid from the operation site. This is a thin silicone tube through which the ichor comes out. The next day it is removed and bandaged. The person is discharged from the department 2-3 days after the operation.

It is very important that the operation is performed by an endocrinologist surgeon who specializes in the treatment of glands. In this case, you can be confident in the successful outcome of the operation and the absence of recurrent tumors and complications.

After surgery, patients are prescribed radionuclide therapy with iodine-131 to ensure the destruction of all malignant cells. Radiation therapy with X-rays is of little help in this case.

After thyroid surgery

Many people are interested in how life changes after removal of thyroid cancer and whether disability occurs. Many studies have shown that almost all patients tolerate surgery well and continue to lead a normal life and work. Women after treatment can become pregnant and give birth to a healthy child.

During the first weeks after surgery, a person may experience neck pain and swelling. These phenomena happen to everyone and go away on their own after 1-2 months. It is enough to properly handle the seams. During the first 3-4 days while the patient is in the hospital, he is given dressings by a nurse. dressing room. Before discharge, the doctor tells you in detail how to treat the wound yourself, what medications to take and when to come back to continue treatment.

After tumor removal the following is prescribed:

• Administration of radioactive iodine to destroy possible metastases. Treatment begins 4-5 weeks after surgery.
• Thyroid hormones, which are normally produced in the thyroid gland. You may have to take them for life.
• L-Thyroxine (Levothyroxine) to reduce the production of thyroid-stimulating hormone by the pituitary gland. This hormone stimulates thyroid cells that may have remained after surgery, which means it increases the risk of tumor regrowth. The doctor prescribes the dose of this drug individually, based on the level of titeotropic hormone.
• Mineral supplements with vitamin D and calcium. They are necessary for rapid recovery and proper functioning of organs.

Medical supervision after thyroid surgery

Communication with doctors does not end after surgery to remove the tumor. People are registered at the oncology clinic.

In 3 weeks After the operation, the doctor evaluates its results and prescribes levothyroxine (TSH suppressive therapy).
After 6 weeks A whole body scan is performed with iodine-131. This is necessary to detect residual thyroid cells in the neck or other organs. If such metastases are detected, radioactive iodine is prescribed, which quickly destroys the remaining cancer cells.

In 6 months After the operation, you must come to the clinic for a re-examination. The doctor feels the neck and does an ultrasound.

Every 6 months It is necessary to visit a doctor for a routine examination. The doctor may set a different schedule, depending on the level of hormones and tumor markers.

After 1 year and after 3 years After surgery, all patients undergo a body scan.
Regularly monitor the level of thyroglobulin hormone and antibodies to thyroglobulin. It increases if metastases appear in the body. In this case, the doctor prescribes additional examination and treatment.

Postoperative complications

There is a small percentage of postoperative complications. If the operation was performed in a specialized endocrinology department, then the probability is 1-2%, and if in general, then it increases to 5-10%.
Nonspecific complications, which can occur after any operation. It's bleeding severe swelling or wound suppuration. Doctors can easily treat them with antibiotics. In addition, the probability of their occurrence is less than 1%. These complications arise on the first day after surgery. Therefore, if this did not happen in the hospital, then the danger has passed.

Specific complications occur only after surgery on the thyroid gland. This is damage to the nerves that control the vocal cords and disruption of the parathyroid glands.

The laryngeal recurrent nerves pass very close to the thyroid gland. To avoid damaging them, doctors use high-precision electric instruments. But in some cases, injury cannot be avoided. Hoarseness or loss of voice, coughing occurs. Often this phenomenon is temporary, but sometimes the consequences can last a lifetime.

Hypoparathyroidism occurs when the parathyroid glands malfunction. This condition is associated with a lack of calcium in the body. It manifests itself in muscle pain and muscle cramps in the limbs and face, burning and tingling in the lips and fingertips. To correct the situation you need to take calcium supplements.

Nutrition after thyroid surgery

After surgery to remove a thyroid tumor, you do not need to follow a strict diet. The menu should be varied and satisfy all the needs of the body. Remember, there are many foods that inhibit the growth of tumor cells. Scientists have named the healthiest food for tumor prevention. These are vegetables: different varieties of cabbage, turnips, radishes, radishes. Legumes: soybeans, peas, beans, lentils. And plants of the umbrella family: carrots, parsley, celery, parsnips.

If you include these and other “right” foods in your diet, you can prevent a relapse (recurrence) of the disease.

Squirrels - construction material for body cells and the basis of immunity. It is best to get proteins from fish and seafood, cottage cheese, eggs, legumes and soybeans, buckwheat and oatmeal. Can be consumed several times a week low-fat varieties meat.

Carbohydrates is a source of energy. After surgery, it is better to limit the amount of sugar and confectionery products. It is better to get carbohydrates from honey, fruits, fresh juices, marshmallows, marmalade, jam. Complex carbohydrates- pectins and fiber are found in vegetables, grain bread, and cereals.

Fats- a necessary component for hormones and cell membranes. The source of the necessary unsaturated fatty acids Vegetable oils can become: olive and rapeseed. It is better to avoid lard, margarine and other animal fats.

The diet should contain a wide variety of vitamins. Most of them are antioxidants and help fight tumors. It is better to get vitamins from fresh fruits and greens. But if this is not possible, then you need to take a vitamin-mineral complex.

Traditional methods of treating thyroid cancer

Traditional methods of treating thyroid cancer are used in two cases.

1. Tinctures and decoctions are drunk before and after surgery, as an addition to the treatment prescribed by the oncologist. During surgical treatment and chemotherapy, you should not take concentrated infusions that contain plant poisons.
2. In the event that official medicine is unable to help a person. For example, surgery cannot be performed. The patient may not survive it due to advanced age, diseases of the cardiovascular or respiratory systems, or because the tumor has grown into the vital area. important organs. Then traditional methods help improve the condition and reduce the tumor.

Treatment with herbs is more gentle than with drugs, but takes longer. Therefore, you need to take herbal medicines from 6 months to 5 years. Every six months they take a break for 2 weeks. You should not stop treatment if you notice improvement. Only a full course will ensure health and prevent the disease from returning.

Treatment with traditional methods before surgery

Cleansing the body
To prepare the body for surgery, it is necessary to do a cleansing. Enemas with apple cider vinegar: a tablespoon of vinegar per 2 cups of water. The first week of enemas is done daily, the second week - every other day, the third - every 2 days, the fourth - once a week. During this period, you need to drink more water and eat plant foods. Drink one tablespoon of flaxseed oil 3 times a day before meals.

Three-ingredient recipe
Wash and dry 1.8 kg lemons, remove the seeds and grind together with the peel in a meat grinder. Prepare a glass of aloe juice. Do not water the plant for a week, then pick it, wash and dry the leaves. Grind and squeeze the juice through cheesecloth. Mix with lemons and add half a glass of honey. Mix the components thoroughly. Store the product in the refrigerator, take 1 tsp. 3 times a day before meals. The course of treatment is 1 month.

Traditional medicine traditionally uses plants that contain a lot of iodine and other useful substances to treat thyroid cancer: common cocklebur, chickweed, common chickweed, tenacious bedstraw, and lesser duckweed. They are used in the form of decoctions prepared in a water bath.

Traditional treatment after surgery

Nut tincture
At the beginning of July, collect 30 walnuts. They need to be chopped together with the green peel. Pour 0.5 liters of vodka and add a glass of honey. Mix the product in a glass container and place in a dark place. Leave for 15-20 days at room temperature. Drink 1 tablespoon of the tincture in the morning on an empty stomach. During one course of treatment you need to drink all the medicine.

Black poplar buds
This remedy helps reduce the production of thyroid-stimulating hormone. 2 tbsp. pour a glass of boiling water over the kidneys, cover and leave for 2 hours. Strain the infusion. Take 1 tbsp. 3-4 times a day before meals.

Plant poisons
Hemlock and celandine contain toxic substances. These substances destroy malignant cells that may remain in the body after surgery. Do not forget that these tinctures should not be taken during radiation therapy or radioactive iodine treatment.

Hemlock tincture You can make it yourself or buy it ready-made at the pharmacy. Scheme for taking the tincture: on the first day, drink 3 drops 3 times a day, on the second day, 6 drops 3 times a day, and on the third day, 9 drops 3 times a day. Gradually increase the dose to 75 drops per day. This treatment lasts 3 months. Then the dose is gradually reduced to 3 drops per day.

Tincture of celandine you'll have to cook it yourself. To do this, the roots of the plant are collected during flowering in May. The roots are dug up, washed and dried on a towel. Grind in a meat grinder and squeeze out the juice through cheesecloth. The resulting liquid is half diluted with vodka. The product must be infused for 2 weeks in a dark place. Take 1 teaspoon 3 times a day.

Treatment of thyroid cancer without surgery

In the event that surgery is contraindicated and only supportive treatment is carried out, it is possible to help a person cope with cancer and improve their general condition.

Djungarian aconite root

You can buy a tincture of this plant or prepare it yourself. To do this, pour 20 grams of root into 200 ml of high-quality vodka. Infuse in a glass container in a dark place.

Take the medicine according to the schedule. The first day, 1 drop 3 times a day before meals. The second day, two drops, the third, three. So by the tenth day the single dose increases to 10 drops or 30 drops throughout the day. From day 11, the dose is reduced by 1 drop. Thus, the course takes 20 days. After this, take a break for 2 weeks and repeat the treatment. You need to take 3 courses in a row.

Remember that the plant contains poisons and strong bioactive substances. Do not exceed the dose! In order to cleanse the body of toxins during treatment, it is recommended to drink an oncological herbal mixture, which can be bought in pharmacies.

What determines the prognosis for thyroid cancer?

The prognosis for thyroid cancer is much more optimistic than for other malignant tumors. For example, in people under 45 years of age with a tumor size of up to 3 cm, there is a complete guarantee of recovery. Older patients with advanced forms of cancer have a less favorable prognosis.

But much depends on the shape of the cancer and the stage of the cancer.

• In people with papillary cancer The five-year survival rate is 95-100%. This means that after treatment all patients remained alive for at least 5 years.
• In people with follicular cancer Stage IV five-year survival rate is 55%. But in less advanced cases this figure also reaches 100%.
• In people with medullary cancer Stage IV, the five-year survival rate is lower - 30%, but in stages I and II, doctors guarantee recovery for 98% of patients.
• At aplastic cancer, the prognosis is worse. Most patients live 6-12 months after diagnosis.

This is due to the rapid growth of such a tumor and the formation of metastases. In addition, such cancer cells are not sensitive to treatment with iodine-131.

But no matter what diagnosis the doctors make, remember that human possibilities are limitless. If you combine your desire to live, the forces of nature and the help of a doctor, then you will cope with even the most severe illness.