Papillary thyroid cancer.

The most common type of thyroid carcinoma is papillary thyroid cancer.

This tumor usually originates from normal gland tissue and is detected as a heterogeneous, significant or cyst-like formation. This type of oncology is easily treated. The indicative 10-year survival rate of patients reaches almost 90%. However, the disease is quite serious, like all oncopathologies, so we will dwell on it in more detail.

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Causes of Papillary Thyroid Cancer

Malignancy of healthy thyroid cells can occur as a result of genetic abnormalities, which are often provoked by adverse environmental influences (radioactive zone, hazardous industries nearby, etc.). In rarer cases, such abnormalities are congenital.

Mutations in genes trigger excessive growth and division of cellular structures. Several gene modifications associated with the formation of papillary thyroid cancer have been identified:

• RET/PTC – mutation of this gene occurs in 20% of all registered cases of papillary thyroid cancer. It is often detected in childhood and in regions with unfavorable radioactive conditions;
• BRAF – mutation of this gene can be found in 40-70% of papillary thyroid cancer cases. Oncopathology associated with mutation of this gene is more aggressive with an abundance of metastases to other organs.

The involvement of altered genes NTRK1 and MET in the formation of cancer is also assumed. However, the involvement of these genes is still under study.

In addition, factors that contribute to the development of papillary cancer have been identified:

• age period from 30 to 50 years;
• female gender (the disease occurs less frequently in men);
• unfavorable radioactive environment, frequent X-ray examinations, radiation therapy;
• hereditary predisposition.

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Symptoms of Papillary Thyroid Cancer

In most cases, papillary cancer develops gradually. At first, patients do not complain of feeling unwell: their thyroid gland does not bother them.

Often the reason for a patient to see a doctor is the discovery of a painless nodular formation in the thyroid area. It is usually felt on the neck when it reaches a significant size, or when the node is located close to the surface of the neck. A large formation can affect nearby organs, for example, press on the larynx or esophagus.

Later, the clinical picture expands. Hoarseness, difficulty swallowing food, difficulty breathing, sore throat and pain in the throat may appear.

In some cases, the neoplasm is located in such a way that it becomes almost impossible to palpate it. In such a situation, the disease is given away by enlarged lymph nodes in the neck area. Lymph nodes act as filters in the lymphatic system. They catch and hold malignant cells, preventing their further spread. If such cells get into a lymph node, it enlarges and thickens. However, this sign does not always indicate the formation of a cancerous tumor: lymph nodes can also enlarge when an infection gets into them, for example, with a cold, flu, etc. As a rule, such lymph nodes return to normal after the infection is cured.

Stages of Papillary Thyroid Cancer

Papillary thyroid cancer develops in four stages. The earlier the stage is treated, the more favorable the prognosis for the disease.

• Stage I: the node is located separately, the thyroid capsule is not modified, metastases are not detected.
• Stage IIa: a single node that affects the shape of the thyroid gland, but does not cause metastasis.
• Stage IIb: single node with detection of unilateral metastases.
• Stage III: a neoplasm that extends beyond the capsule or exerts pressure on nearby organs and tissue structures; in this case, metastases form in the lymph nodes bilaterally.
• Stage IV: the neoplasm grows into nearby tissues, metastasis is observed in both nearby and distant parts of the body.

Papillary cancer can occur directly in the thyroid gland or enter the gland as a metastasis from other organs.

Metastasis of papillary thyroid cancer

Metastases from papillary thyroid cancer can spread through the lymphatic system located inside the gland and often move to the lymph nodes on the affected side. Distal metastases are rare and are formed to a greater extent from the follicular tissues of the malignant tumor.

Papillary cancer and metastases with papillary tissue structure are considered inactive with respect to hormones and are not capable of retaining radioactive iodine. Metastases with follicular structure exhibit activity with respect to hormones and retain radioactive iodine.

The classification of papillary thyroid cancer metastases is as follows:

• N – whether there are regional metastases of papillary thyroid cancer.
  • NX – it is not possible to assess the presence of metastases in the cervical lymph nodes.
  • N0 – no regional metastasis.
  • N1 – detection of regional metastases.
• M – are there distant metastases?
  • MX – it is not possible to assess the presence of distant metastases.
  • M0 – no distant metastasis.
  • M1 – detection of distant metastasis.

This classification is used to clarify the diagnosis of papillary thyroid cancer and to prognosticate the disease.

Diagnosis of papillary thyroid cancer

The following methods are used to diagnose papillary thyroid cancer:

1. Fine needle aspiration biopsy is the main procedure that a doctor prescribes when thyroid cancer is suspected. Often, a positive biopsy result can make this method the only one in diagnosing the disease. The biopsy is performed as follows: the doctor, monitoring the process on the ultrasound screen, inserts a thin needle into the suspicious node. Then a syringe is attached, and the node tissue is sucked through the needle. After this, the tissue taken is sent for examination to determine whether it is malignant.
2. Ultrasound examination of the thyroid gland – provides an opportunity to examine the boundaries of the organ, the structure and structure of the gland tissue. This is the safest and most inexpensive procedure for diagnosing papillary cancer, and is also quite informative. Ultrasound can be used as an independent method, or in combination with a biopsy. Unfortunately, the procedure is rarely performed independently, since ultrasound can inform about the presence of a neoplasm in the gland, but cannot accurately determine the degree of its malignancy.
3. CT, MRI – tomographic research methods are used mainly if the malignant lesion spreads to nearby tissues and organs.
4. Laboratory tests – blood tests for thyroid and pituitary hormone levels. The results of such tests provide information about insufficient, excessive or normal function of the gland.
5. The radioisotope scanning method is usually performed if a blood test indicates excessive thyroid function.

Without a doubt, proper diagnosis of papillary thyroid cancer is the key to further successful treatment of the disease.

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Treatment of papillary thyroid cancer

Treatment of papillary thyroid cancer is surgical. The operation is called thyroidectomy.

1. Total thyroidectomy is a complete removal, when the surgeon removes the left and right lobes of the thyroid gland together with the isthmus. If necessary, the enlarged lymph nodes are simultaneously excised. Total thyroidectomy surgery lasts about 3 or 4 hours on average. The doctor makes an incision in the projection of the gland and removes the gland, carefully guiding it between the recurrent nerves. After total surgery, replacement therapy is performed, which involves replenishing the hormones of the now missing thyroid gland in the body.
2. Partial removal of the gland is used when the tumor is relatively small, located separately in one lobe of the gland and does not grow into nearby organs and tissues. As a rule, the tumor size in such cases does not exceed 10 mm. The duration of such surgical intervention is from one and a half to two hours. In most cases, replacement therapy is not required.

Despite the fact that thyroid surgery is a rather complicated operation, recovery from it is quick and does not cause much discomfort to patients.

You can return to your normal lifestyle almost immediately. No diet is required after the operation. The patient is usually discharged the next day.

Additionally, at the discretion of the physician, hormonal therapy and radioactive iodine therapy may be prescribed.

Prevention of papillary thyroid cancer

Since the final cause of papillary thyroid cancer has not yet been established, there are no specific measures to prevent the disease. However, there are measures that can generally help reduce the risk of developing a cancerous tumor.

• Try to avoid exposure of the head and neck area to radiation, including X-rays.
• If possible, change your area of residence, away from nuclear power plants and ecologically unfavorable areas.
• Periodically examine your thyroid gland, have your blood tested for hormone levels, undergo preventive ultrasound, especially if you are at risk.

Of course, a disease like cancer is still difficult to prevent. However, early detection of the pathology in most cases guarantees a favorable prognosis.

Prognosis for papillary thyroid cancer

The prognosis for papillary thyroid cancer can be called favorable. If metastases are not detected, or are detected in close proximity to the gland, then the duration of quality life of patients after surgery is high. Most patients who have undergone surgery live 10-15 years or more after the intervention.

If metastases were detected in bone tissue and the respiratory system, the percentage of an optimistic prognosis is somewhat worse. Although in this case a positive outcome is possible. At the same time, the younger the patient, the greater the chance that he will tolerate treatment better and more favorably.

Fatal outcome in patients who have undergone thyroidectomy can only be observed if the tumor re-forms in the remaining element of the thyroid gland.

Patients who have had part or all of the gland removed usually do not experience any quality of life problems. Sometimes, voice changes and slight hoarseness may occur after surgery. The appearance of such symptoms depends on the degree of damage to nerve fibers during surgery, as well as on the swelling of the vocal cords. Most often, such changes are transient.

Patients who have had papillary thyroid cancer should be examined periodically by a doctor, initially every 6 months, and then every year, in order to prevent the recurrence of a malignant tumor.