Medullary thyroid cancer

Thyroid cancer occurs when cells in the organ grow abnormally. The main function of the organ is to produce hormones for the normal functioning of the entire body. There are several forms of thyroid cancer, among which medullary thyroid cancer is the least common (diagnosed in 5% of patients). With this form of cancer, abnormal growth of C-cells occurs, the characteristic symptoms of the disease are facial flushing, bowel disorder. Also, medullary cancer is more aggressive, compared to other forms, metastasizes to nearby lymph nodes, can affect the trachea, muscles, and less often metastases are found in internal organs.

ICD-10 code

Medullary thyroid cancer in ICD 10 belongs to class II (neoplasms) and is listed under code C73.

Causes of medullary thyroid cancer

The main reason for the development of this form of cancer is considered to be gene modifications. It is in the genes that the information that is controlled by our body is embedded. Experts believe that the development of a tumor in some cases is genetically determined.

Medullary thyroid cancer can be caused by organ dysfunction (excessive hormone production, autoimmune diseases), as well as previous radiation therapy.

Women are more susceptible to this form of cancer.

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Pathogenesis

The development of medullary cancer is caused by C-cells, which make up the thyroid gland. These cells produce calcitonin, which is essential for metabolic processes in the body.

When the tissue structure changes and the gland enlarges, abnormal growth of C-cells and increased production of calcitonin begins, resulting in medullary thyroid cancer being diagnosed.

Symptoms of medullary thyroid cancer

All forms of thyroid cancer have similar symptoms - a palpable mass in the front of the neck. At the first stages, the tumor does not bother a person, but after a while, pain appears, the voice becomes hoarse, breathing and swallowing become difficult, and the lymph nodes enlarge.

In approximately half of the cases, metastases are detected in adjacent lymph nodes; in 20% of cases, cancer cells affect distant organs, most often bones, liver, and lungs.

First signs

The first sign of pathology is a tumor in the neck (front); medullary thyroid cancer is characterized by early metastasis, and enlarged cervical lymph nodes can often indicate it.

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Consequences

Medullary thyroid cancer is an extremely aggressive form of cancer, the tumor develops too quickly, in the early stages the cancer already spreads to adjacent lymph nodes, over time the cancer affects distant organs (most often bones).

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Complications

Medullary thyroid cancer is dangerous, first of all, because of its rapid development – in the initial stages, the cancer already metastasizes and can affect the cervical lymph nodes. If the cancerous tumor and metastases are detected early, and complex treatment is prescribed correctly, the patient’s life is not in danger.

If the disease is detected at a late stage, treatment is aimed primarily at improving the patient’s quality of life.

As the medullary tumor grows, metastases can also spread to the lungs, liver, and bones.

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Diagnosis of medullary thyroid cancer

To examine the vocal cords of a patient with suspected medullary carcinoma, a laryngoscope is used, blood tests, ultrasound or CT of the thyroid gland are prescribed, and during the examination by palpation, the doctor determines the neoplasm and determines further diagnostics.

Medullary thyroid cancer is caused by abnormal growth of C-cells that produce calcitonin, and it is the high level of this hormone that can be associated with the development of a pathological process in the thyroid. High levels of calcitonin in the blood are associated with the fact that C-cells continue to produce it, and it is this hormone that is a kind of tumor marker that indicates the development of a medullary tumor.

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Tests

If medullary thyroid cancer is suspected, a blood test is prescribed to help identify tumor markers.

Elevated calcitonin levels may indicate the development of medullary carcinoma. If the level of this hormone is elevated after a course of treatment, there are most likely distant metastases.

Elevated levels of parathyroid hormone may also indicate metastases.

It is worth noting that a blood test does not always reliably indicate cancer; sometimes, during cancer processes, hormone levels are normal and, vice versa, in a healthy person. Hormonal levels can increase due to various factors.

If the patient's relatives had medullary cancer, genetic analysis for RET gene mutations is prescribed.

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Instrumental diagnostics

After examination, the specialist prescribes a blood test and instrumental diagnostics to confirm the diagnosis.

It is absolutely necessary to undergo an ultrasound scan, which will help determine the size of the neoplasm, its location, prevalence, and also identify hidden (non-palpable) small lesions.

Since medullary thyroid cancer is characterized by early metastasis, X-ray or tomography of the esophagus, skeleton, lungs, etc. is prescribed to identify foci of probable tumor spread.

To identify the cells that formed the tumor, invasive diagnostic methods are used - fine-needle aspiration biopsy, which is performed under the control of an ultrasound machine. Biopsy allows you to take a small area of the tumor for laboratory testing. The method is quite accurate and minimally invasive.

If the biopsy results are questionable, an open biopsy is used. This method is a minor surgical intervention in which a small part of the tumor is excised and sent for examination.

Differential diagnostics

In differential diagnostics, the results of laboratory testing of tumor tissues taken by biopsy are of primary importance. This test allows us to determine the type of cancer and its histological variety.

If medullary thyroid cancer is a hereditary disease, blood tests are ordered to check hormone levels and RET mutations.

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Treatment of medullary thyroid cancer

Medullary thyroid cancer is not sensitive to radiation and chemotherapy. C-cells are not susceptible to radioactive iodine, so this treatment is ineffective. Radiation therapy is aimed solely at alleviating the patient's condition, but it does not help to overcome cancer. Treatment of medullary cancer is mainly surgical, which in most cases helps to avoid relapses. During surgery, the thyroid gland and affected lymph nodes are removed. After surgery, a blood test for calcitonin levels is mandatory (if the levels are high, diagnostics are needed to find new cancer foci).

Medicines

In addition to surgical treatment, medullary thyroid cancer may include medication. Among the drugs used are targeted ones that block the growth of atypical cells.

Common drugs include Caprelsa and Pazopanib.

Pazopanib is taken orally at 400-800 mg per day, depending on individual tolerance of the drug. During treatment, headaches, transient ischemic attack, dizziness, increased pressure, cough, nosebleeds, chest pain, increased fatigue, weight loss often occur.

The drug is not prescribed to pregnant women, children and adolescents under 18 years of age, or those with renal or hepatic insufficiency.

Caprelsa is prescribed at 300 mg per day, usually until patients no longer receive significant benefit from the drug.

During treatment, diarrhea, vomiting, abdominal pain, inflammation of the pancreas, fatigue, swelling, weight loss, increased hemoglobin levels, and insomnia are often observed. Contraindicated in cases of QT interval disorders, renal and hepatic insufficiency, pregnant women, children and adolescents under 18 years of age, and hypersensitivity to the components of the drug.

Folk remedies

In folk medicine, poisonous plants that kill cancer cells are used to treat cancer. There are remedies for both oral administration and compresses. The course of treatment can last from several months to several years (depending on the type and stage of cancer).

Metastatic tumors require intensive treatment, sometimes requiring the use of several drugs.

An effective remedy is considered to be an ointment from cyclamen: grate 50 g of the root (preferably fine), put it in a jar, add unsalted lard and simmer in a water bath for 2 hours. The ointment should be applied to the thyroid gland every evening, covered with gauze on top (keep the compress until the morning). The course of treatment is not less than a month.

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Herbal treatment

Medullary thyroid cancer, as already noted, develops quickly and metastasizes, so treatment in this case should be intensified.

In folk medicine, for serious diseases, potent herbs are used, for example, hemlock. For treatment, you will need fresh leaves, which are washed and applied to the thyroid gland for half an hour (it is better to carry out the procedure in the evening).

Herbal preparations for internal use are also widely used to treat cancer patients.

The following remedy is considered the most effective:

• - 100 g each of sage, birthwort, burnet root, mugwort, 50 g each of poplar buds, hemlock (flowering parts), and mistletoe.
• Brew 3 tablespoons of the mixture in 1 liter of boiling water (it is better to do this in a thermos) and leave for 12 hours.

The dosage is calculated for 1 day of intake - 1 glass at equal intervals. The course of treatment is 14 days, if necessary, the course can be repeated after 2 months.

Another remedy that is a little weaker than the previous one, but no less effective (it can be taken for a long time).

• 75 g each of viburnum shoots, celandine, elderberry flowers, 50 g of wormwood.
• Brew 1 teaspoon of the mixture in 250 ml of boiling water, drink in small sips after 10 minutes.

After a few weeks, the condition improves and the symptoms disappear.

Homeopathy

Homeopathic medicines have recently been used for various diseases, and medullary thyroid cancer is no exception.

Among homeopaths, the most common remedies are pokeweed and hemlock.

Phytolacca contains bitter substances, starch, saponin, essential oils, phytolaccin, vitamin C. It is produced in the form of dragees. The dosage and course of treatment are prescribed by a specialist, taking into account the severity of the patient's condition.

Hemlock is considered a powerful anti-cancer agent, and also has an immunostimulating effect. According to some data, hemlock helps in the last stages of cancer with multiple metastases and can even replace narcotic substances used for pain relief. Experts' opinions on this herb differ - some consider hemlock ineffective, others believe that this remedy should be included in the list of anti-tumor drugs.

The tincture should be taken warm for better absorption. The dosage and duration of treatment is determined by the doctor in each individual case.

Surgical treatment

Medullary thyroid cancer is treated primarily by surgery.

The surgeon removes all affected tissue, including adjacent lymph nodes.

Removal of lymph nodes is associated with the fact that in palpable tumors, metastases are detected in them in 90% of cases.

Prevention

Medullary thyroid cancer develops mainly due to genetic mutations. Thyroid diseases can also affect the abnormal growth of C-cells. In this case, it is necessary to promptly treat diseases of this organ, undergo preventive examinations (especially for people at risk).

Forecast

Medullary thyroid cancer comes in several forms and the prognosis in each case will be different. In hereditary diseases, the prognosis is more favorable, since the development of pathology is easier to prevent. 5-year survival is observed in patients with metastases in the cervical lymph nodes (in about 80% of cases), if metastases in distant organs, the chances of survival are sharply reduced.

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