In the new millennium, thyroid cancer began to appear more often in children and the elderly; over 10 years, the incidence has increased by 10%. Benign and malignant tumors of the thyroid gland are more often diagnosed in women, which in turn can be inherited. In men, the appearance of thyroid nodules, which subsequently become malignant, is also confirmed.

The thyroid gland is the guardian that stands to protect all vital systems and organs within the body. Even the ancient Greeks called the thyroid gland a shield that controls the functional work of organs due to hormones containing iodine.

The thyroid gland belongs to the endocrine system, which stores iodine and produces iodothyronines, which regulate the growth of certain cells and metabolic processes in them.

If the level of hormones in the blood is not sufficient, a violation will occur throughout the body:

1. metabolic processes;
2. growth, maturation of soft and bone tissues, organs;
3. energy supply of cells.

It's important to know! Iodothyronines or thyroid hormones contribute to the optimal growth, development and functioning of all body cells. With a normal content of them in the blood, energy processes, the work of the cardiovascular system and the central nervous system are activated. With a deficiency of iodothyronines, the growth of children is delayed, especially up to 5 years, cretinism develops. With an excess of thyroid hormones in adults, thyrotoxicosis occurs - the function of the thyroid gland increases: there is constant thirst, diarrhea and profuse urination.

Informative video on the topic:

What is thyroid cancer and how does it develop?

Thyroid cancer is a malignant tumor of the thyroid gland that develops from follicular or C-cells.

A malignant tumor of the thyroid gland is variable in its structure, although cancer of epithelial forms is more common. Tumors, the malignancy of which is low, are referred to as papillary cystadenomas. They are distinguished by a benign course, but are able to recur again and grow into blood vessels.

The average degree of malignancy occurs in developing papillary adenocarcinomas and malignant adenomas. High-grade cancers include intercellular and anaplastic cancers, such as thyroid sarcoma of various structures, including lymphosarcoma.

The prevalence of thyroid cancer is about 1.5% of all malignant tumors of various localizations. The tumor affects in most cases women aged 40-60 years and occurs 3.5 times more often than men.

Distinctive features in the course of thyroid cancer are the erasure of the symptoms of the disease and the painlessness of palpable nodes. Also, in some forms of cancer, early metastasis to the lymph nodes and other organs can be noted. Benign thyroid tumors are much more common than malignant ones. Their ratio is 90% -95% and 5% -10%, which requires differential diagnosis.

Thyroid cancer: causes of the tumor

Cancer can occur when a benign goiter has existed for a long time. This can be seen by the rapid increase in the existing tumor, its compaction and tuberosity. Therefore, proliferating cystadenoma, especially papillary, also become causes of thyroid cancer.

It is worth noting! After the Chernobyl accident, the incidence of thyroid cancer increased significantly, especially among children, whose thyroid gland is much more sensitive to the accumulation of radioactive iodine. In the absence of radiation exposure, the incidence of thyroid cancer increases with age.

Predisposing risk factors for thyroid cancer include:

• diseases of the genitourinary system in women;
• diseases of the endocrine system (adenomas), including medullary thyroid carcinoma, in parents, brothers, sisters;
• familial polyposis, Gardner's or Cowden's syndrome,
• tumors or dyshormonal diseases of the mammary glands;
• occupational hazards: ionizing radiation, work with heavy metals or in hot shops;
• an altered state associated with hormonal balance during menopause, pregnancy and lactation;
• mental trauma.

Thyroid cancer: symptoms and signs

Early detection of thyroid cancer is difficult, and symptoms may be associated with a benign thyroid nodule. When probing it, you need to contact an endocrinologist for an examination. Symptoms of thyroid cancer will depend on the type of cancer: papillary, follicular, medullary, and anaplastic.

Symptoms and signs that indicate the development of thyroid cancer:

• the formation of nodules in the thyroid gland;
• enlargement of the cervical lymph nodes;
• hoarseness of voice;
• coughing fits;
• swallowing failure;
• dyspnea;
• suffocation;
• pain localized in the thyroid gland;

Common symptoms of thyroid cancer include:

• sweating;
• causeless weakness;
• lack of appetite
• weight loss.

Signs indicating tumor growth:

1. When an asymptomatic and progressive node in the thyroid gland appears, a malignant neoplasm should be suspected. It can occur at the bottom of one of the lobes of a healthy gland or in its isthmus, further spreading to the second lobe.
2. Initially, the tumor will have a rounded and smooth shape and a consistency denser than thyroid tissue. Growing, it turns into a bumpy bump without clear boundaries with a dislocation on one or both lobes.
3. When the tumor grows in the opposite direction through the capsule of the gland, it will compress the trachea and recurrent nerve, which is why hoarseness appears, shortness of breath and shortness of breath with the slightest physical exertion.
4. When squeezing the esophagus, dysphagia manifests itself - swallowing is disturbed. In the case of progression of the tumor process, the pathology appears on the muscles of the neck, fiber and neurovascular bundle. The skin is covered with a dense network of dilated venous vessels.

Classification of thyroid cancer

In accordance with the international classification system of tumor formations, there are:

1. epithelial tumors: benign and malignant;
2. nonepithelial.

Regarding histological forms, the following types of thyroid cancer are distinguished:

• papillary cancer, occurs in 60-70% of cases of malignant organ damage;
• follicular in 15-20%;
• medullary in 5%;
• anaplastic in 2-3% of cases;
• mixed - 5-10%;
• Hürthle cell carcinoma in 3%;
• lymphoma - 2-3%;
• adenocarcinoma.

Separate forms of cancer:

• primary cancer - when a tumor is detected only in the thyroid gland;
• secondary cancer - when the tumor grows into the thyroid gland from the surrounding organs.

It is worth noting! Thyroid carcinoma recedes with timely treatment with a favorable prognosis after rehabilitation. It can be inherited, but symptoms of thyroid carcinoma may not be recognized early on. Therefore, most patients begin to worry when probing enlarged lymph nodes with fingers and an increase in the size of the thyroid gland.

The classification of thyroid cancer relative to the international TNM system is based on the criterion of the extent of the tumor in the gland and the presence of metastases in the lymph nodes and distant organs, where:

T is a tumor that has spread to the thyroid gland:

• T0 - primary tumor was not detected during the operation;
• T1 - the largest diameter of the tumor is up to 2 cm, the tumor has not spread beyond the borders of the gland (does not grow into its capsule);
• T2 - tumor with a diameter >2 cm, but< 4 см, не распространена за границы железы;
• T3 - tumor with a diameter > 4 cm, not spread beyond the borders of the gland, with d< 4 см прорастает в ее капсулу;
• T4 - stage of thyroid cancer is divided into 2 substages:
• T4a - a tumor of any size, growing through the capsule, into the subcutaneous soft tissues, larynx, trachea, esophagus, recurrent laryngeal nerve;
• T4b - a tumor that grows into the prevertebral fascia, carotid artery, retrosternal vessels.

N - the state of the lymph nodes:

• NX - it is impossible to assess metastases in the cervical lymph nodes;
• N0 - no regional metastases;
• N1 - regional metastases in the lymph nodes were identified: paratracheal, pretracheal, prelaryngeal, lateral cervical, retrosternal.

M - distant metastases:

• MX - it is impossible to assess metastasis to distant organs;
• M0 - no metastases in distant organs;
• M1 - metastases in distant organs are identified.

Classification according to the TNM system is used to determine the stage of thyroid cancer, select a method of treatment and further prognosis.

Stages of thyroid cancer

• stage 1 thyroid cancer

Thyroid cancer at stage 1 is a small tumor that does not exceed 2 cm in diameter and is located inside the gland. The patient himself is able to identify a small induration.

• stage 2 thyroid cancer

Thyroid cancer at stage 2 is manifested by an increase in the tumor in diameter up to 4 cm, which does not go beyond the boundaries of the capsule. It is manifested by slight discomfort, the tumor can be palpated and seen visually. With timely treatment, a cure is possible in 95% of cases.

In turn, stage 2 is divided into substages, namely:

1. stage 2a - there is one tumor with a deformity of the gland or multiple nodes are identified, metastases and deformation of the capsule are absent;
2. Stage 2b - one tumor is identified, metastatic lymph nodes are unilateral.

• stage 3 thyroid cancer

At stage 3, thyroid cancer increases in size and reaches 4 cm or more in diameter. The symptoms are severe. The capsule is damaged or there is compression of adjacent organs and tissues with bilateral lymph node involvement. When squeezing nearby organs, in particular, the trachea, swallowing becomes difficult, shortness of breath also appears, and an asthma attack can be diagnosed. When the esophagus is compressed, dysphagia occurs, and when the recurrent nerve is damaged, the mobility of the vocal folds is disturbed, which leads to hoarseness or hoarseness.

• stage 4 thyroid cancer

Stage 4 thyroid cancer can be identified by a sharp deterioration in the condition. The tumor metastasizes, while affecting neighboring organs and tissues, metastases are found in the lungs, bones, esophagus, etc. The manifestations depend on which organ is affected by metastases.

When the lungs are affected, coughing fits interspersed with blood in the sputum are characteristic, with brain damage, severe headaches appear.

Common symptoms of stage 4:

• lack of appetite;
• weight loss;
• increase in body temperature.

In thyroid cancer, the stages indicate the size of the tumor, its spread, metastases near and far from it. That is, the symptoms of thyroid cancer at an early stage are manifested by a tumor up to 1 cm with no metastases, with enlarged or normal regional nodes.

Follicular, medullary and papillary cancer in stage 2 is characterized by:

• primary tumor size up to 4 cm;
• the absence of metastases and near and distant lesions of the lymph nodes.

Thyroid cancer stage 3 (follicular and papillary) is characterized by the fact that:

• the tumor has a different size and grows through the capsule of the thyroid gland;
• no distant metastases and enlarged lymph nodes;
• there are (rarely) enlarged regional lymph nodes in the absence of metastases.

Medullary cancer at stage 3 is diagnosed if there is a primary tumor of different sizes and regional lymph nodes are affected, but there are no metastases.

The most unfavorable symptomatic cancer is at stage 4, which indicates a late diagnosis. Distant metastases are already determined without taking into account the size of the tumor and the state of the lymph nodes. Any cancer can be referred to this stage if undifferentiated cells are found. They quickly divide and lead to early complications, so the prognosis will be disappointing for patients.

Types of thyroid cancer

Thyroid adenocarcinoma

Lymphoma (diffuse tumor) may be preceded by autoimmune thyroiditis, so it is difficult to differentiate the diagnosis of both diseases. Lymphoma can be an independent, transient disease of the thyroid gland that responds well to the use of ionizing radiation therapy.

Thyroid Cancer: Diagnosis and Detection

In the early stages of thyroid cancer, diagnosis is reduced to a visual determination of a growing tumor in one lobe of the gland against the background of an existing goiter. Its tuberosity and mobility are noted. The patient's complaints about tension in the thyroid gland and a feeling of suffocation are taken into account.

To determine how affected the recurrent nerves, examine the larynx, vocal cords, using laryngoscopy. If paralysis of the vocal cord is established, then the nerve is involved in the tumor process. Bronchoscopy is also used to examine the trachea and vocal cords.

Additionally, the signs of thyroid cancer on ultrasound are examined:

• an increase in the thyroid gland (size);
• the presence of nodules and tumors (size);
• precise location.

Fine-needle aspiration puncture (FNA) is used to determine the quality of cells. A thin needle is inserted into the tumor under ultrasound guidance and the tissue is removed. If after its study there are doubts about the correctness of the diagnosis, a suspicious node is diagnosed by an open biopsy: excision of a small area of ​​the tumor and an express study.

Determined by enzyme immunoassay of venous blood. Elevated levels of specific protein-based chemicals diagnose a specific form of cancer. Namely, when increasing:

• calcitonin is used to treat medullary thyroid cancer;

Important! If an elevated level is determined after treatment, this indicates the presence of distant metastases. At the same time, it is taken into account that the hormone can increase in pregnant women, in women taking hormonal contraceptives, calcium supplements, in patients with pancreatic disease. The norm for women is 0.07-12.97 ng / ml, for men - 0.68-30.26 ng / ml.

• thyroglobulin determine papillary and follicular cancer with the presence of metastases;

Important ! The norm in the blood of this protein, secreted by the cells of the thyroid gland, is 1.4-74.0 ng / ml.

• The BRAF gene determines papillary cancer, since it should normally be absent altogether;
• EGFR determines epidermal growth and tumor recurrence, since they are analyzed after removal of the neoplasm;
• antithyroid antibodies in the blood serum indicates an autoimmune thyroid disease, i.e. about an erroneous attack of the organ by the immune system in papillary carcinoma;
• mutations in the RET proto-oncogene confirm medullary carcinoma. The study is carried out for all family members.

Hormone levels are examined to determine the magnitude of thyroid dysfunction.

Namely:

1. after treatment, the level (TSH) should not be higher than 0.1 mIU / l. The increase indicates the return of the disease. The hormone secretes the pituitary gland to stimulate the development of thyroid cells;
2. the level of thyroxine (T4) indicates the active or passive work of the thyroid gland;
3. the level of triiodothyronine (T3) - a biologically active hormone indicates the quality of the gland;
4. a high concentration of parathyroid hormone (PTH) - a substance that the parathyroid glands produce, indicates metastases of medullary cancer.

Radioisotope scanning of the thyroid gland with radioactive iodine determines the tumor foci as defects in the accumulation of the isotope and diagnoses metastases if they accumulate iodine-containing drugs in the absence of the gland itself, which was surgically removed earlier.

The following radiological techniques are used:

1. pneumography of the thyroid gland, it allows you to determine the degree of germination of surrounding tissues;
2. angiography, it reveals the degree of violations of the vascular network, characteristic of malignant tumors;
3. radiography of the trachea;
4. examination of the esophagus with barium, it establishes the pressure and growth of the tumor.

What are metastases and how to find out about their appearance?

If primary thyroid cancer is diagnosed, metastases will form a secondary focus of malignancy in the lymph nodes (regional or local) of the lungs, liver, or spine.

In papillary thyroid cancer, metastases spread through the lymphogenous pathway with the formation of secondary foci on the neck, in the trachea and pharynx, and in the neurovascular bundle. Partially it is possible to detect metastases in the area of ​​lymph nodes: preglottic, peritracheal and cervical.

In follicular thyroid cancer, metastases are spread by the blood stream. They can be found in the tissues of the lungs, in the inert tissues of the ribs and vertebrae of the thoracic region, as well as the lungs. Then you can find out about them by the appearance of a cough with blood, shortness of breath, shortness of breath, constant fatigue. Infiltrates or secondary foci of cancer of different size and quantity are formed in the lungs.

In anaplastic and medullary thyroid cancer, the consequences are much worse, since metastases spread through the hematogenous and lymphogenous pathways. They are found in organs and lymph nodes. The type of cancer is quite rare, but very aggressive. Metastasis can be even at an early stage of the disease. Lungs and bones, liver and brain are affected. Metastases capture the skeletal system of the skull, ribs, spine, pelvis and thighs. Therefore, you can learn about the appearance of metastases by pain syndromes, frequent pathological fractures. X-ray shows voids or dark growths.

In the brain, metastases from thyroid cancer are manifested by migraine-like headaches that cannot be relieved by painkillers.

A recurrence of thyroid cancer with liver metastases provokes jaundice, disrupts digestion. The patient will feel heaviness on the right under the ribs. Severe cases lead to internal bleeding, which is manifested by bloody stools and vomit that looks like coffee grounds.

Metastases in the adrenal glands may not manifest themselves in any way. Only severe damage to these glands will reduce the level of sex hormones, leading to acute adrenal insufficiency. Then the signs of thyroid cancer, the first symptoms of recurrence will be manifested by a sharp decrease in pressure and a violation of blood clotting.

Thyroid cancer: treatment

Differentiated thyroid cancer includes follicular and papillary types of the disease. Tumors develop due to A-cells of the thyroid gland, which form the walls of the follicles. If cells transform into malignant ones, they can capture iodine and synthesize thyroglobulin from it - a specific protein - a precursor of gland hormones. In this regard, diagnostic and therapeutic methods for the treatment of these types of thyroid tumors are based. Treatment of differentiated thyroid cancer is carried out with the help of radioactive iodine and the level of thyroglobulin in the blood plasma is determined. Controlling the spread of cancer ensures effective and complete cure.

Papillary cancer is slow growing and may not have distant metastases, but it often affects the lymph nodes in the neck. At the first stage, it is carried out surgically - thyroidectomy - complete removal of thyroid tissue. In addition, a central cervical lymph node dissection is performed - the lymph nodes of the neck are removed in the central zone: laryngeal, pretracheal and paratracheal. At the second stage, treatment is carried out with the help of radioactive iodine in patients who have lesions of the lymph nodes, tumor germination through the thyroid capsule and aggressive tumor subtypes: high cell and columnar cells.

In case of papillary thyroid cancer, a body scan is completed to establish areas of tumor migration. Next, the patient is prescribed replacement therapy using a synthetic analogue of the thyroid hormone thyroxine - L-thyroxine. It completely copies the structure of thyroxin and covers all the necessary needs of the body.

The patient is examined annually:

1. In the blood, the level of thyroid-stimulating hormone and the free fraction of thyroxine are determined in order to control the adequacy of the dose of L-thyroxine, which was previously prescribed. To identify a possible recurrence of the tumor, determine the level of thyroglobulin and antibodies to it.
2. The neck is examined by ultrasound: the place where the thyroid gland was removed and areas where tumor cells could spread.

In papillary thyroid cancer, the prognosis after surgery and treatment with radioactive iodine is positive.

Follicular cancer grows slowly, metastasizes late and is spread by blood vessels. Due to distant metastases, the prognosis for recovery is less favorable. With a cytological determination of a follicular tumor, patients undergo surgery. If there is only one tumor, a hemithyroidectomy is performed - one lobe is completely removed, and the second (healthy) is left completely intact. The final diagnosis is established after a study of the results of histology.

If a removed cancer node is detected, the operation is repeated and the second lobe of the thyroid gland is removed. This happens in 13-15% of cases. If the node is not cancerous, then additional procedures are not performed. After the treatment regimen, as in papillary cancer.

With follicular thyroid cancer, how long they live after surgery is difficult to answer. With distant metastases, the prognosis for recovery is less positive. But in general, effective treatment allows most patients to recover and live long enough.

In Hurtle cell carcinoma, the tumor is formed from B cells of the thyroid gland (Ashkinazi-Hürthle). It tends to metastasize distantly and regionally and has a low concentration of radioactive iodine, making it difficult to treat. Applied, i.e. suppressive to stop the pathological process and reduce the likelihood of metastases. Carcinoma is diagnosed and treated like follicular cancer.

Chemotherapy, radiation and tracheostomy

When diagnosing common thyroid cancer, they resort to such methods of treatment as radiation therapy and chemotherapy. Then comes the stage when a tracheostomy is acceptable (an operation with opening the trachea and inserting a special tube into the resulting lumen to restore breathing). If the patient has already reached especially dangerous stages, one has to deal with a very disturbing syndrome. It is associated with a feeling of compression of the trachea. Then the operation should be carried out as soon as possible. Otherwise, asthma attacks will begin with the risk of asphyxia. Technically, it can be represented as extremely complex, since the tumor array serves as an obstacle to the trachea.

Surgery for thyroid cancer

The preparatory period includes:

• diagnosis and detection of acute infections or exacerbation of chronic ones;
• consultation with doctors: surgeon, therapist and anesthetist.

Postoperative period

The patient is placed in the ward for a day:

• bed rest;
• drainage from a thin silicone tube to the operation area to remove sputum and ichor.

On the second day, the drainage is removed and the patient is allowed to walk. The patient is discharged 2-3 days after the operation.

Appointed:

• radionuclide therapy with iodine-131 (treatment of thyroid cancer with radioactive iodine) to ensure the destruction of all malignant cells 4-5 weeks after discharge from the hospital;
• treatment with thyroid hormones, which are normally produced by the thyroid gland;
• treatment with Levothyroxine (L-Thyroxine) to reduce pituitary production of thyroid-stimulating hormone to slow down the stimulation of thyroid cells left after surgery and reduce the risk of cancer recurrence;
• treatment with mineral supplements with the presence of vitamin D and calcium to normalize the functioning of organs and quick rehabilitation.

Treatment of thyroid cancer with folk remedies

Simultaneously with the treatment prescribed by the doctor, patients are treated for thyroid cancer with folk remedies: decoctions and infusions in agreement with the oncologist. After surgery and during chemotherapy, infusions with plant poisons should not be taken.

If it is impossible to perform an operation on a patient due to age, cardiovascular diseases or the respiratory system, tumor germination into vital organs, folk methods for thyroid cancer are used to suppress cancer cells.

For treatment, plants with a high content of iodine and other useful components are used, so decoctions and infusions are made from small duckweed, tenacious bedstraw, medium chickweed, and common cocklebur.

After thyroid surgery, apply:

1. nut tincture from green walnuts: chopped walnuts with peel (30 pcs.) Pour vodka (0.5 l) and add honey (1 tbsp.). Insist in a dark place for 15-20 days. Drink on an empty stomach in the morning for 1 tbsp. l. until the tincture is over;
2. infusion of black poplar buds to reduce the production of thyroid-stimulating hormone. Steep boiling water (1 tablespoon) is poured over the kidneys (2 tablespoons) and insisted under a fur coat for 2 hours. Separate the thick and take 1 tbsp. l. before meals;
3. tincture of hemlock (poisonous!) can be purchased at a pharmacy and taken according to the scheme: increase the intake by three drops every day, starting on the first day with 3 drops x 3 times, adjust the dose to 75 drops;
4. tincture from the roots of celandine: the crushed roots are scrolled in a meat grinder and the juice is squeezed out. It is diluted with water (1:1) and infused for 15 days in the dark. Take 1 tsp. x 3 times.

Without surgery, a tincture of the root of the Jungar aconite is used: for 200 ml of vodka - 20 g of raw materials, insist up to 21 days. Start taking 1 drop before meals x 3 times. Every day, add 1 drop for 10 days, then reduce by 1 drop for 10 days. After a two-week break, the course is repeated 2 more times.

Nutrition after removal of a thyroid tumor

Rational nutrition with, and helps rapid recovery after surgery. After coming out of anesthesia for 5 hours do not take liquid. Then you can take small sips of mineral water without gas or fruit juices diluted with water, as far as the sore throat will allow.

On the second and third days, nutrition for thyroid cancer will consist of:

1. from small portions of thin soups from cereals: semolina and oatmeal with the addition of a small amount of butter;
2. puree from lean poultry, fish or beef;
3. 2 soft-boiled eggs;
4. rosehip broth and weak tea with milk.

You can not eat vegetables, dairy products, raw fruits and bread.

On the fourth day, you can eat steam scrambled eggs, mashed liquid milk porridge, baked apple, mashed potatoes, mashed cereal soups with grated vegetables.

After 7-8 days, the diet for thyroid cancer after tumor removal may consist of sour-milk products, grated raw vegetables and fruits (or baked), bread in addition to soups. You can drink cocoa, compotes, rosehip broth.

Important! Food should be soft and lean. Since metabolism decreases due to a decrease in hormones, the patient will gain excess weight when switching to the previous diet. Animal fats should be replaced with vegetable fats, confectionery and bakery products - with fresh fruits. Legumes should be eliminated from the diet or reduced to a minimum, as they interfere with the absorption of the hormone that patients take to compensate for it.

Low-fat sea fish and cabbage make up for the lack of iodine in the body. It is impossible to adhere to starvation or strict diets, as well as to limit protein intake. It is forbidden to smoke, drink alcohol, carbonated drinks, coffee and strong tea.

Prevention of thyroid cancer and recurrence

Prevention of thyroid cancer includes saturating the body with the missing iodine with iodized or sea salt and seafood. It is important to treat thyroid pathology in a timely manner, to be observed by an endocrinologist for patients at risk: with the presence of thyroid pathology, living in areas with iodine deficiency, previously irradiated, having cases of thyroid cancer in the family.

It is necessary to carry out:

• after 3 weeks - prophylactic suppressive TSH therapy with Levothyroxine;
• after 6 weeks - scanning with iodine - 131 to detect residual thyroid cells in other organs and the neck area and prescribe radioactive iodine to destroy them;
• every six months - ultrasound examinations;
• every year - body scan;
• regular monitoring of the level of the hormone thyroglobulin and antibodies to it.

The cause of recurrence may be partial resection or enucleation of the tumor node.

This means that the prevention of recurrence of thyroid cancer consists in adequate in terms of volume and accurate execution of surgical intervention in compliance with the provisions:

• mandatory thorough and wide revision of the thyroid gland with areas of regional metastasis in the paratracheal areas, retrosternal space, areas of neurovascular bundles;
• extrafascial release of the thyroid gland, i.e. ligation of the thyroid arteries: lower and upper and visual control of the recurrent nerves.

In order not to injure the recurrent nerve, clamps should not be applied to the vessels of the gland. A thorough assessment of the operational walker must be made, i.e. the number, localization and consistency of nodes, the state of the capsule, etc.

In order to avoid implantation metastases, it is impossible to injure macroscopically or stitch the altered thyroid tissue. If there is doubt about the absence of malignancy, the final intraoperative diagnosis is used, and an urgent biopsy is performed.

The prevention of thyroid cancer recurrence also includes an adequate volume of surgery in the areas of regional lymphatic drainage. Until now, there are disputes about the advantage of lymphadenectomy as a prevention of cancer recurrence. But, based on experience, many experts believe that it is not advisable to remove non-palpable lymph nodes.

Recurrence may occur due to the upper pole of the thyroid gland, where the tumor node has grown into the cartilage of the larynx. If a recurrent node is isolated, the upper laryngeal nerve may be damaged and paresis of the epiglottis may occur, the act of swallowing will be disturbed, and pneumonia may occur. Prevention of this complication will be the suppression of the muscles of the larynx in small parts as close as possible to the tumor node. Hemostatic clamps should be absent.

Sometimes during the operation, tracheostomy is applied in case of a defect in the wall of the larynx or trachea, bilateral paresis of the recurrent nerves. To prevent the wound from festering, the tracheostomy tube is inserted into a separate puncture (incision) in the skin above the operating one. It will be easier to care for the tracheostomy and there will be no infection of the wound if the incision is the size of the cannula.

Regional relapses can occur due to cicatricial adhesions of metastasis nodes with large vessels. A recurrent tumor may adhere to the wall of the jugular vein. When carrying out repeated operations, it is important to highlight the elements of the neurovascular bundle in tissues that have not yet been changed. But you need to make sure that the common carotid artery can be separated from the tumor. When planning an operation for large recurrences, it is necessary to plan preventive plastic surgery of the vessels, the trachea, if the recurrent node has grown into it.

Often, during the operation of primary thyroid cancer, the surgeon can see that the primary tumor grows to the trachea and leaves tumor tissue in it, which destroys the tracheal wall and causes relapse. Therefore, during the operation, the recurrent tumor and surrounding tissues are now removed, since radiation treatment may not help.

Prognosis of life in thyroid cancer

How thyroid cancer proceeds, how long patients live, depends on the stage, shape of the tumor, how quickly it grows and metastasizes. With early treatment, the prognosis can be good.

How long do people live with a diagnosis of thyroid cancer? It's hard to answer. But when using modern methods of treatment, hormone therapy, radiation therapy, together with physical and chemical methods, it is possible to prolong the life of patients and maintain a good quality of life.

Disability in thyroid cancer

Thyroid cancer is a disease that is difficult to treat using a single treatment method. Therefore, doctors select a complex treatment that includes surgical treatment, radioiodine therapy, radiation therapy and chemotherapy. After treatment, the patient needs constant hormonal therapy. Quite often, patients refuse this treatment because they believe that it will lead to disability. But this is actually not the case, and such are metastases in thyroid cancer.

Group I is given for:

• severe hypoparathyroidism;
• undifferentiated oncology and generalization of the process;
• severe hypothyroidism with the development of severe myopathy, as well as myocardial dystrophy.

Group II is given for:

• bilateral damage to the recurrent nerve.
• hypoparathyroidism II degree and severe hypothyroidism;
• conducting non-radical treatment;
• when diagnosing a dubious prognosis.

III group of disability is given for:

• moderate hypothyroidism;
• mild hypoparathyroidism;
• dysfunction of the shoulder joint.

In thyroid cancer, the average period of temporary disability of patients who have undergone radical treatment is up to 3 months. After the operation, a rehabilitation period is prescribed, the duration of which is calculated depending on the type of malignant tumor, the stage of the disease and the method of surgical intervention. When conducting radiation and chemotherapy - you can expect a longer period of disability.

Partial rehabilitation occurs in 77% within 3 years. Full rehabilitation takes up to 5 years or more. The indication may be a recurrence of cancer, the absence of the effect of therapy in those affected by undifferentiated forms.

Informative video: Tactics of surgical treatment of thyroid cancer

Update: October 2018

Thyroid cancer is a malignant neoplasm that develops from follicular, medullary, or papillary cells.

The increase in the frequency of diagnosis - thyroid cancer over the past 15 years was 6%. According to experts, this is due to the widespread introduction of ultrasound diagnostic methods that can detect the presence of malignant tumors that previously remained undiagnosed at an early stage.

Early signs of thyroid cancer can be detected with the help of self-diagnosis - the so-called "Self-examination of the thyroid gland". Self-examination of the neck often helps to identify swelling and enlargement of individual structures, which indicates a goiter, benign tumors, or thyroid cancer.

For 2014, the following thyroid disease statistics are expected in the United States:

• Approximately 63,000 newly diagnosed cancer cases, 48,000 women and 15,000 men
• 1800 – 1850 cancer deaths 1050 women and 800 men

Thyroid cancer, the symptoms of which make it possible to quickly determine the presence of a pathological process, is usually diagnosed in adults at an earlier age than malignant tumors of other organs. 65% of the total number of confirmed cases are found in patients under 55 years of age. Approximately 2% of thyroid cancers occur in children and adolescents.

In recent decades, the incidence of thyroid cancer has increased significantly, making it the fastest growing malignant cancer in the United States. However, the lethality of the disease remains consistently low compared to other tumors.

Risk factors

Conditions that increase the risk of thyroid cancer include:

• Gender and age (in women, the disease develops three times more often. Also, in women, cancer is detected at an earlier age (40-50 years) than in men (60-70));
• Insufficient intake of foods containing iodine (in regions with insufficient iodine content in food, the development of follicular thyroid cancer is more common. Increases the risk of papillary carcinoma, especially in people exposed to radiation exposure);
• Radiation (exposure to radioactive radiation is a proven risk factor. Radiation therapy to the head and neck in childhood significantly increases the likelihood of disease in the future. Radiation exposure also includes diagnostic procedures - x-rays or computed tomography. The use of these methods in childhood should carried out only according to clear indications and in small doses, if other methods are ineffective).

Studies have shown that after the accident at the nuclear power plant in Chernobyl, there was a sharp increase in the incidence of thyroid cancer by 10 times. At the same time, people with sufficient intake of iodine in the body had a lower risk of the disease. Exposure to radiation on an adult body carries a much lower risk than in childhood.

• Hereditary diseases (sometimes there is a family predisposition to the development of cancer. However, in the general structure of morbidity, they are isolated and do not have a sufficient basis for confirmation).

All these factors lead to the final cause of the degeneration of glandular cells into cancer cells - mutations in the patient's DNA. In the case of burdened heredity, a person acquires a mutated gene even at conception. In other cases, the mutation occurs under the influence of various factors described above.

Types of tumors

Most thyroid cancers are differentiated, that is, they consist of almost unchanged follicular cells of the organ.

papillary carcinoma accounts for approximately 80% of all thyroid cancers. This species is characterized by slow growth and damage to only 1 lobe of the organ. Despite the rather slow growth, the tumor often spreads to the cervical lymph nodes. Papillary cancer is characterized by low mortality and a favorable treatment prognosis.

Follicular carcinoma- the second most common form of thyroid cancer (10%). The frequency of its occurrence is significantly higher in countries with insufficient levels of iodine in the diet. These tumors usually do not spread to the lymph nodes, but may spread to other organs, including the lungs and bones. The prognosis of follicular carcinoma is not as favorable as that of papillary carcinoma, although in most cases, treatment allows you to completely get rid of the disease.

Medullary carcinoma in the structure of thyroid cancer is approximately 6%. It develops from glandular cells that produce the hormone calcitonin, which controls calcium levels in the blood. The presence of a tumor may be indicated by an increased content of calcitonin and a special protein - carcinoembryotic antigen. This type of cancer metastasizes to the lymph nodes, lungs, liver and other organs. This often happens before the tumor is detected. Due to the impossibility of diagnosing and treating this type of cancer with radioactive iodine, the prognosis remains unfavorable at the moment.

Anaplastic carcinoma - a rare form of cancer, accounting for about 2-4% of cases. This is an undifferentiated form of cancer, since the type of tumor cells cannot be accurately determined. This cancer is thought to develop from existing papillary or medullary carcinomas. Symptoms of anaplastic thyroid cancer are characterized by faster development, accelerated tumor growth and early metastasis to the cervical lymph nodes and distant organs, which causes significant difficulties in treatment.

Symptoms

Signs of thyroid cancer are:

• Sensation of an enlarged mass in the neck (usually on one side, often with rapid growth)
• Swelling of the neck in the region of the gland
• Pain in the region of the gland, sometimes extending up to the ears
• Hoarseness and other persistent voice changes
• Difficulty swallowing
• Respiratory failure - shortness of breath, choking, coughing
• Persistent cough not associated with colds (stage 4 thyroid cancer metastasizes to the lungs in 61% of cases)

Pain that occurs when swallowing overstimulates the glands in the throat, producing viscous mucus. Because of this, there is a feeling of "cotton lump in the throat."

The degeneration of glandular cells leads to a decrease in the volume of healthy organ tissue and a decrease in the amount of hormones produced, as a result of which it develops. The symptoms of this condition are:

• Lethargy, lethargy, drowsiness
• Tingling in the limbs
• ), rough voice

With the development of follicular thyroid cancer, on the contrary, the organ is stimulated, which leads to hyperthyroidism. Due to the hyperproduction of hormones by pathological tumor cells, the following symptoms appear:

• convulsions
• feeling hot,
• Insomnia, chronic fatigue
• Weight loss, loss of appetite

stages

Differentiated forms in patients under 45 years of age

Young people are less likely to die from this form of cancer. The division into stages in the described age group is as follows:

• Stage 1 - the tumor has any size, but at the same time it does not undergo decay and does not metastasize to distant organs. Spread to nearby lymph nodes is possible;
• Stage 2 - a tumor of any size, which at the same time has metastases in distant parts of the body.

Differentiated forms in patients after 45 years

• Stage 1 is characterized by limited growth of the tumor (up to 2 cm), which does not have metastases in the lymph nodes and other organs;
• Stage 2 - a tumor with a diameter of 2 to 4 cm, not extending beyond the organ. Metastases to lymph nodes and other organs are absent;
• Signs of stage 3 are an increase in the size of the tumor > 4 cm or go beyond the boundaries of the organ without spreading to the lymph nodes and other parts of the body, or the presence of a tumor of any size that has metastases in the nearest cervical lymph nodes, but without decay and metastasis to other organs;
• Stage 4A - a tumor of any size that has foci outside the organ. Perhaps the presence of metastases in the surrounding lymph nodes (cervical, thoracic), but without distant secondary foci;
• Stage 4B - tumor of any size, characterized by extension deep into the neck towards the spine, or into nearby large blood vessels. Metastasis to lymph nodes is possible, but there are no distant metastases;
• Stage 4C means the presence of metastases in other organs. In this case, the tumor can be of any size and not even go beyond the gland or metastasize to the lymph nodes.

Anaplastic forms

All detected anaplastic forms are obviously considered cancer of the 4th degree, which characterizes an unfavorable prognosis of the disease.

• Stage 4A - the tumor is located within the thyroid gland. There are no distant metastases, but foci in the nearest lymph nodes can be determined;
• Stage 4B is characterized by the germination of the tumor outside the organ without the formation of distant metastases;
• Stage 4C reflects the presence of distant tumor metastases. In this case, the main focus may be within the gland and not have metastases in the lymph nodes.

Treatment

The choice of method of therapy depends on the form of cancer and the stage of tumor development. Thyroid cancer is treated by one or a combination of several of the following:

• Surgery;
• Treatment with radioactive iodine;
• Radiation therapy;
• hormone therapy;
• Chemotherapy;
• Selective therapy (targeted, targeted).

Usually, thyroid cancer is curable, especially if the tumor has not yet begun to metastasize. In a situation where it is not possible to completely cure cancer, treatment is aimed at removing or destroying the majority of cancer cells and stopping their further growth and metastasis. In advanced cases, palliative treatment is performed to eliminate the dangerous symptoms of cancer (pain, respiratory failure, swallowing).

Surgery

Surgery is currently the main treatment for thyroid cancer. The exception is some anaplastic forms.

A lobectomy is an operation that involves the removal of 1 lobe of the thyroid gland. This method is used to treat small-sized cancer that has not penetrated beyond the tissues of the gland. In some cases, such an operation is performed for diagnostic purposes, if the biopsy did not provide a reliable result.

The advantage of the operation is that there is no need to take hormonal drugs in the future, since as a result of the treatment, a healthy part of the gland remains.

A thyroidectomy is an operation in which the complete removal of the thyroid gland is performed. This is the most common surgical treatment. There are total and subtotal thyroidectomy. The latter involves incomplete removal of gland tissues due to the characteristics of tumor growth or the anatomical structure of the organ.

After removal of the thyroid gland, the patient is prescribed daily hormonal preparations (thyroid hormone levothyroxine).

Removal of lymph nodes is usually performed simultaneously with the main operation. Of particular importance is the removal of cervical lymph nodes in the treatment of medullary cancer, as well as anaplastic forms.

Complications and side effects of surgical treatment include:

• Temporary or permanent hoarseness of the voice, as well as its loss;
• Damage to the parathyroid glands;
• Bleeding or formation of a large hematoma in the neck;
• Wound infection.

Treatment with radioactive iodine

When radioactive iodine (Iodine-131) enters the body, it accumulates almost in full in the cells of the thyroid gland. This is the basis of this treatment. After ingestion in the form of a capsule, the drug is absorbed from the intestine into the blood and absorbed by the cells of the gland. Under the influence of radiation, glandular cells (cancer and healthy) are destroyed, while there is no negative effect on all other organs.

This method can be used to destroy thyroid tissue left after surgical treatment. Treatment with radioactive iodine is also effective against metastases in the lymph nodes and other organs.

The described method provides a significant increase in the survival rate of patients with papillary and follicular thyroid cancer, passed into stage 4 (with metastasis). At the same time, the advantages of the method remain doubtful in the early stages, when tumor removal can be effectively performed by surgery.

In order to obtain greater effectiveness from radioactive iodine treatment, it is necessary to achieve a high concentration of thyroid-stimulating hormone in the patient's blood. It promotes the aggregation of iodine by glandular cells. If you have previously had surgery to remove your thyroid gland, you can increase your thyroid-stimulating hormone levels by limiting your daily thyroid hormone intake for a few weeks. An alternative method is the introduction of the medical preparation Thyrogen, which is a solution of thyroid-stimulating hormone. It is administered once a day for 2 days. On the third day, radioactive iodine is administered.

Complications of the method depend on the dose of radiation received:

• swelling in the neck;
• Nausea and vomiting;
• Swelling and hardening of the salivary glands;
• Change in taste sensations;
• Dry eyes (see).

hormone therapy

Regular intake of thyroid hormone tablets serves two purposes:

• Maintaining the normal functioning of the body;
• Stopping the growth of cancer cells left after surgical treatment.

Since after a thyroidectomy the body is not able to produce thyroid hormones, the patient needs to undergo hormone replacement therapy. This helps prevent the recurrence of cancer. Usually, doctors recommend taking hormones in doses exceeding the daily allowance.

Complications and side effects: arrhythmias, osteoporosis (see,).

Radiation therapy

Radiation therapy involves the use of high-intensity radiation to affect cancer cells. Before irradiation, a fine and precise adjustment is made to irradiate only the pathological focus without damaging healthy tissues. Usually this method is not used for the treatment of cancerous tumors that accumulate iodine, since radioactive iodine therapy is a more effective method of treatment. Thus, radiation therapy is used to treat anaplastic forms of thyroid cancer.

When the tumor grows beyond the thyroid gland, radiation therapy can reduce the risk of re-development of the tumor after surgical treatment and slow down the growth of metastases in other organs.

The course of treatment takes place over several weeks, 5 days a week. Before starting treatment, the medical worker will make accurate measurements of the anatomical structures of each individual patient, determine the required exposure angle and set the required radiation dose. The radiation session lasts a few minutes and is absolutely painless.

Side effects of radiation therapy:

• Damage to surrounding tissues;
• Change in skin color;
• dry mouth;

Selective Therapy

At this time, the development of new drugs continues, the action of which is aimed at eliminating only mutated cancer cells. Unlike standard chemotherapy, during which all fast-growing cells are destroyed, these drugs are more selective and affect only cancer cells.

Drugs for selective therapy in medullary thyroid cancer

The treatment of this type of cancer is of greater interest, since standard hormonal therapy, as well as radioactive iodine treatment, remain ineffective in this case.

Vandetanib is a selective therapy that stops tumor growth within 6 months of starting treatment. At the same time, there are insufficient data on the degree of survival of patients taking this drug compared with other groups.

Cabozantinib is another selective therapy for medullary thyroid cancer. The term for limiting the growth of a cancerous tumor when taking the drug is 7 months.

Selective therapy for papillary and follicular thyroid cancer

The need for drugs for the treatment of these types of cancer is less pronounced, since in these cases surgical methods and radioactive iodine therapy are used successfully. Selective therapies include:

• Sorafenib (sorafenib);
• Sunitinib (sunitinib);
• Pazopanib (pazopanib);
• Vandetanib (vandetanib).

Forecast

The effectiveness of treatment and the quality of later life depend on the type and stage of the disease. For 2010, survival statistics were presented by the following figures.

The five-year survival rate for anaplastic (undifferentiated) thyroid carcinomas, most of which have reached stage 4 by the time of detection, is about 7%.

Thyroid cancer is considered a relatively rare neoplasm. The average age of patients is 40-50 years, women are more often ill, however, among older patients, the proportion of men is increasing. Symptoms of thyroid cancer may be absent for a long time, but the presence of previous benign changes in the gland in most patients predetermines close attention to them from specialists.

About 90% of all tumors found in the thyroid gland are malignant neoplasms of epithelial origin (cancers). The papillary variant, often diagnosed in young patients and children, is considered the most frequent and at the same time the most favorable form of cancer.

To date With timely detection, the tumor can be cured completely. The high detection rate of the disease is associated with the possibility of using ultrasound diagnostics for a wide range of individuals and biopsy from pathologically altered areas of the gland.

Why does cancer occur?

The thyroid gland is the largest, unpaired endocrine gland, which is located on the side and in front of the larynx and trachea and consists of two lobes and an isthmus. The main function of this organ is the production of hormones. thyroxine, triiodothyronine(T 3 , T 4), and thyrocalcitonin. These biologically active substances regulate the basic metabolism, participate in the formation of bone tissue, the metabolism of calcium and phosphorus.

For the synthesis of thyroid hormones, iodine is needed, which enters the body from the outside with food and water. The bulk of the gland is built from microscopic follicles containing a colloid - a hormone precursor. The function of the thyroid gland is regulated by the thyroid-stimulating hormone of the pituitary gland, which contributes, if necessary, to an increase in the synthesis of thyroid hormones.

With a lack of iodine in the environment or food consumed, various lesions of the parenchyma of the gland, a decrease in the level of its hormones occurs and, as a result, a change in metabolism, thermoregulation, the function of the cardiovascular system, mineral metabolism, etc., and the manifestations of disorders are systemic.

Often, patients who have been diagnosed with cancer ask themselves the question: why did it occur in them? What were the reasons for this?

It is known that most tumors do not appear on their own, and previous changes are necessary for their development. This also happens in the thyroid gland. Among the most common lesions of the parenchyma are goiter and adenoma.

Goiter is a diffuse or focal pathological process, accompanied by excessive proliferation of parenchyma cells with an increase in its volume. In this case, it is possible to increase both the entire gland (then they talk about diffuse goiter), and its part - nodular goiter. Overstretched by the colloid and enlarged in volume, the follicles can transform into cysts, then the goiter is called cystic.

Adenoma It is nothing more than a benign tumor. It is possible to detect both an isolated adenoma and an adenoma against the background of an existing goiter.

Causes of thyroid cancer include:

• Exposure to ionizing radiation;
• Lack of iodine in the food and water consumed;
• genetic factor;
• The presence of other endocrine pathology, autoimmune diseases, etc.

Possibility of adverse carcinogenic effects ionizing radiation scientists suggested as early as the first half of the 20th century, when children who were irradiated for tumors of the head or neck began to register thyroid cancer more often. In addition, a surge in the incidence of surviving residents of Hiroshima and Nagasaki, as well as among the population of territories contaminated after the Chernobyl accident, once again confirmed the fact that radiation affects the risk of thyroid tumors.

It should be noted that the effect of radioactive iodine was more pronounced in areas with a natural deficiency of this trace element, since the thyroid gland, experiencing its chronic deficiency, began to intensively capture the radioactive isotope.

Lack of iodine in the environment can be the factor that will lead to the development of goiter and, subsequently, cancer. Water and plants in some areas do not carry enough of it, and the population of these areas is deficient.

It is known that the formation of hormones containing iodine (T 3 and T 4) occurs in the thyroid gland, which is captured from the blood by the cells of the follicles. With a lack of a microelement coming from outside, there is an increase in the production of the so-called thyroid-stimulating hormone by the pituitary gland, which is necessary to stimulate the function of the gland. With an increase in the activity of the glandular tissue, an increase in its volume is observed, an increase in the capture of iodine from the bloodstream, and the function is relatively compensated. However, with such constant stimulation, it is possible to transform the foci of hyperplasia of the gland into a goiter. In these cases, they speak of the endemic nature of the disease, indicating a natural iodine deficiency in patients. Cases of cancer against the background of endemic goiter are relatively rare, but careful monitoring of such patients is still necessary.

genetic mutations can also cause thyroid cancer. There are known mutations in the genes of the tenth chromosome, in which cancer of the indicated localization occurs. The disease is inherited and is called familial cancer syndrome.

Complex hormonal interactions, especially characteristic of pregnancy and lactation, predetermine the fact that both goiter and thyroid cancer are more often recorded in women.

Autoimmune diseases accompanied by the formation of special proteins (antibodies) to their own tissues, which have a damaging effect. If autoimmune thyroiditis occurs in the thyroid gland, then certain prerequisites for cancer in the future are possible due to a chronic inflammatory process. The question of the risk of developing cancer in autoimmune thyroiditis continues to be discussed, and according to statistics, these diseases often accompany each other. This combination may be due to the common mechanisms of development of thyroid cancer and autoimmune thyroiditis. Autoimmune processes are also more common among the female population than among men.

Types of thyroid cancer

Depending on the histological type of the structure of a malignant tumor of the thyroid gland There are several types of cancer:

• Papillary carcinoma (by mistake, some patients call it "capillary");
• Follicular;
• Medullary;
• Anaplastic.

The most common variety is papillary cancer thyroid gland, which can be found in children and young people aged 30-40 years. In a third of cases, metastases are detected, and often such tumors develop against the background of a previous nodular goiter. In children, this type is more aggressive than in adults. This variant of the tumor is considered highly differentiated and is characterized by a rather favorable prognosis.

thyroid cancer

Follicular cancer thyroid gland, although it is considered highly differentiated, but its course is more aggressive than that of the papillary. Follicular cancer is detected in patients aged 50-60 years, more often in the form of a single node, very reminiscent of an adenoma (benign tumor), so its diagnosis can be difficult. This type of tumor is prone to metastasis to the lymph nodes of the neck, and sometimes to the bones, lungs and other organs through blood vessels. Metastatic nodes of follicular cancer retain the ability to absorb iodine from the blood, so this feature can be used in diagnosis and further treatment.

Medullary cancer of the thyroid gland, in comparison with the previous two varieties, has a more malignant course. Such a tumor is capable of synthesizing other hormones and biologically active substances (ACTH, prostaglandins, etc.), so the clinical manifestations can be quite peculiar and are associated with the secretory activity of cancer (diarrhea, hot flashes, tachycardia, etc.). Medullary cancer metastasizes to the lymph nodes of the neck and is able to grow into closely located tissues and organs.

Anaplastic cancer considered the most unfavorable, undifferentiated type of thyroid tumors, more often diagnosed in the elderly. With this form of cancer, the organ quickly and significantly increases in size, squeezing and damaging the surrounding organs, which is fraught with impaired swallowing, breathing, up to suffocation. Metastases appear quite early not only in the lymph nodes of the neck, but also in other organs. As a rule, the disease is preceded by the presence of a goiter for a long time. Since anaplastic cancer is considered undifferentiated, the prognosis for it is very unfavorable, the tumor is insensitive to treatment, and most patients die within the first year after diagnosis.

In addition to histological classification, There are different stages of thyroid cancer:

• I stage disease implies the presence of a tumor that does not go beyond the organ and does not metastasize.
• At stage II the appearance of single metastases from the side of the lesion is possible, however, the cancer does not go beyond the boundaries of the gland capsule.
• III stage characterizes neoplasia, which can spread beyond the capsule, as well as give regional metastases.
• With IV degree cancer not only germinates the tissues and organs of the neck, but also gives distant metastases.

Figure: Tumor classification according to TNM system

Metastasis malignant tumors of the thyroid gland occurs first in the regional lymph nodes - cervical. Less often and later, it is possible to detect hematogenous metastases in the lung, bones (especially vertebrae), and brain.

Signs of cancer

Very often, thyroid tumors are asymptomatic, especially in the early stages of development, so the first sign may be the detection of a node without any additional symptoms. In some cases, the tumor is diagnosed already at the stage of the presence of metastases in the cervical lymph nodes.

Since in most cases the tumor is preceded by a nodular goiter, all patients with existing changes in the gland should regularly undergo appropriate examinations so as not to miss the moment of cancer.

Signs of thyroid cancer include:

• The presence of compaction, tuberosity, palpable nodular formation in the gland;
• Soreness in the neck, sometimes in the ear;
• Violation of swallowing, breathing, voice formation.

The presence of a seal is one of the first signs of thyroid cancer. If a fast-growing isolated nodule is found in a healthy patient, then cancer is usually suspected in such cases. It is especially necessary to show oncological alertness in relation to children and young people under 20 years of age, in whom such formations are most often a malignant tumor.

In patients with a previous goiter, attention should be paid to the rapid increase in individual parts of the organ, the appearance of new nodes and other symptoms indicating malignant transformation.

Soreness in the neck usually associated with an increase in the size of the tumor node and the thyroid gland as a whole, in addition, the cause may be the germination of cancer in neighboring tissues, vessels and nerves.

With the growth of neoplasia, damage to the organs and tissues of the neck, as well as the vascular bundle, there is a violation of blood circulation in the form of dilated full-blooded saphenous veins. In the stage of spread of cancer through the lymphatic vessels, metastases in the regional lymph nodes of the neck are quite easily detected.

Individual forms of thyroid cancer may have clinical features. So, papillary cancer grows rather slowly, for years and even decades, and metastasizes only in 20% of patients to regional lymph nodes. Follicular cancer is more aggressive and tends to give hematogenous metastases to the lungs. The medullary variety, due to the ability to synthesize hormones and biologically active substances, manifests itself in a third of patients with diarrhea, and may also be accompanied by carbohydrate metabolism disorders, hypertension, a feeling of heat and redness of the face.

Given the difficulties that may arise in the diagnosis of asymptomatic forms of cancer, especially in patients with diffuse or nodular forms of goiter, You need to be especially vigilant if you have the following symptoms:

• A rapidly growing tumor node, an increase in its density, restriction of the mobility of the gland;
• The presence of thyroid cancer in family members or close relatives;
• The patient's age is under 20 or over 70;
• The presence of hoarseness with enlarged cervical lymph nodes;
• The impact of ionizing radiation on the head and neck area in the past.

Often in children, cancer is detected by the presence of enlarged lymph nodes, so all cases of cervical lymphadenitis or lymphadenopathy should be studied in detail for the presence of a malignant tumor of the thyroid gland.

Video: symptoms and signs of thyroid disease

Cancer Diagnosis Issues

Because the thyroid cancer is often not accompanied by a pronounced clinical picture, the tumor can be detected during preventive examinations. If any of the above symptoms appear, you should consult a doctor who will examine, palpate the gland and lymph nodes of the neck, find out in detail the complaints and the time of their appearance, and also clarify the presence of cancer patients among close relatives.

Patients suffering from goiter for a long time should be under the constant supervision of specialists and undergo regular examinations.

If a tumor-like formation in the thyroid gland is detected, additional studies are prescribed:

• Puncture fine needle biopsy;
• Determination of the level of thyroid hormones;
• Analysis for cancer embryonic antigen;
• Radioisotope scanning;
• laryngoscopy;
• CT, MRI, chest x-ray, abdominal ultrasound if metastases are suspected.

Ultrasound procedure is the most affordable and simplest method for diagnosing various changes in the thyroid gland. With the help of ultrasound, you can detect the presence of nodes, determine their size, localization, number, contours and condition of the surrounding tissue. This study makes it possible to detect formations only a few millimeters in size.

Since it can be difficult to distinguish the benign nature of the neoplasm from the malignant one with ultrasound, such signs as tuberosity of the contour, blurring of the boundaries, the presence of calcifications (calcium salt deposits), increased blood flow should be alarming in terms of the possible malignant nature of the node.

The next step in the diagnosis is fine needle biopsy, which is rightfully considered the "gold" standard for suspected cancer. In this study, using a thin needle and under ultrasound control, tissue is taken from a pathologically altered area of ​​the thyroid gland. The obtained material is sent for further morphological study. As a rule, a puncture biopsy allows you to establish an accurate diagnosis and determine the type of malignant neoplasm.

Needle biopsy

In unclear cases, it is possible to carry out the so-called open biopsy, when during the operation the surgeon takes a tissue fragment of the altered area for urgent histological examination. If the diagnosis of cancer is confirmed, the doctor will expand the scope of the operation to remove the gland, lymph nodes and tissue of the neck in accordance with the principles of surgical treatment for oncopathology. It should be noted that with an urgent (during the operation) study, only papillary cancer can be reliably diagnosed, while other varieties require a more thorough analysis of the removed organ in a planned manner.

Hormone testing The thyroid gland will show a possible violation of its function, however, often the hormonal background remains undisturbed in cancer or changes in benign processes. In medullary cancer, it is advisable to determine the concentration of calcitonin in the blood serum.

Analysis for cancer embryonic antigen shows an increase in its level in the presence of a malignant tumor. This study may be especially valuable in patients suffering from goiter for a long time, for the differential diagnosis of the presence of cancer against the background of goiter.

When voice changes, hoarseness is shown laryngoscopy, allowing you to examine the larynx and determine the lack of mobility of the vocal fold on one side. This symptom is very characteristic of thyroid cancer with damage to the recurrent nerve.

radioisotope scanning is based on the introduction of isotopes of radioactive iodine, which is able to be absorbed both by the tissue of the gland itself and by tumor cells, including in metastases. In cases where the tumor is not able to capture iodine, technetium can be used (for medullary cancer, for example).

The use of additional diagnostic methods, such as CT, MRI, radiography, ultrasound of the abdominal organs, is justified if distant metastasis is suspected in aggressive forms of cancer.

Treatment of malignant tumors of the thyroid gland

The treatment of thyroid cancer today is quite effective, and the choice of specific methods depends on the type of tumor, its size and the presence of damage to the organs and tissues of the neck. The age of the patients is also important.

The most effective way to treat cancer is to surgical operation. In most cases, the entire gland is removed - total thyroidectomy, and with it - the lymph nodes and tissue of the neck.

Surgery

In the case of a small size of the node, it is allowed to carry out an organ-preserving operation, leaving a part of the organ - subtotal resection. Such organ-preserving operations are of particular relevance in children, since it is important to preserve at least some part of the gland capable of producing hormones in the process of the child's further growth.

In all cases of removal of part or all of the thyroid gland, both during the operation and necessarily after it, the diagnosis is confirmed by histological examination.

Since after the operation it is possible to preserve fragments of thyroid tissue, patients are prescribed hormonal preparations to reduce the stimulating effect on the thyroid tissue from the pituitary gland and prevent a possible recurrence of cancer.

The tissue of the thyroid gland, as well as follicular and papillary cancer and their metastases, is capable of absorbing iodine, including radioactive. This feature is the basis radioiodine therapy, in which the destruction of the remnants of not only the gland itself, but also metastatic nodes in the lungs and bones occurs. When exposed to radioactive iodine, growth slows down and metastases regress. The possibility of influencing metastatic foci can significantly improve the prognosis and life expectancy of patients after treatment.

In the case of anaplastic cancer and other malignant tumors of non-epithelial origin (lymphomas, sarcomas), exposure or chemotherapy.

chemotherapy

If a patient has an advanced form of cancer that is not subject to surgical treatment, then doctors limit themselves in such cases to radiation, chemotherapy and the use of radioactive iodine in the case of tumors that are sensitive to it.

Given the passion of many patients with folk remedies, it should be especially noted that thyroid cancer is not the case when their use is justified. It will not be superfluous unless the use of various sedative fees and good nutrition, including a large number of vegetables, fruits, seafood and greens. With such a diagnosis, even at the stage of metastasis, it is possible to achieve good results with proper treatment from specialists, so if you really want to use traditional medicine, you can do it in parallel with traditional methods, but be sure to consult with your doctor.

Life after cancer

As noted above, most thyroid tumors have a fairly favorable prognosis even at the stage of metastasis. This is due not only to the relatively slow growth of cancer, but also to the possibilities of modern methods of treatment.

For papillary and follicular cancers, the five-year survival rate is as high as 85%, with numbers higher among women. Younger patients achieve better treatment outcomes than older patients. In general, with such forms of cancer, one can live for decades, provided that it is detected and treated in a timely manner.

In anaplastic and other undifferentiated forms, the course of the disease is aggressive, metastases appear quite early, and patients after the diagnosis is established live no more than a year.

Since surgical treatment of thyroid cancer most often involves the removal of the entire organ, and patients are forced to take hormonal drugs for the rest of their lives, as a rule, they are assigned a disability group, however, the quality of life and working capacity in most patients are not impaired, which allows them to lead a normal life in further.

The consequences of thyroid cancer are associated with the development of hypothyroidism due to a lack of hormones, but this condition can be successfully corrected by taking tablets. In severe cases, loss or impairment of voice function is possible.

It is quite difficult to prevent the development of cancer, so you need to be attentive to any changes in the body and the thyroid gland in particular, and a timely visit to the doctor will help achieve good treatment results and save life.

Video: thyroid cancer in the program “Live Healthy”

The author selectively answers adequate questions from readers within his competence and only within the limits of the OncoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not currently provided.

The most terrible diagnosis that can be heard is "cancer". Oncology can significantly reduce the quality and duration of human life. However, do not despair if the tumor is found in the thyroid gland. In most cases, such a neoplasm responds well to treatment, the main thing is to recognize its symptoms in time and undergo a diagnosis.

What is pathology

Thyroid cancer is a malignant tumor that develops from glandular cells. Among all neoplasms, thyroid carcinoma is not very common. The disease is diagnosed only in 1-1.5% of cases of oncology.

Women are much more prone to pathology than men, and the disease affects mainly in adulthood and old age - at 45–60 years. Tumors are recorded more often in residents of regions with an unfavorable radiation background and where the external environment is depleted in iodine.

The risk group for the disease includes women who have problems with the thyroid gland (especially benign tumors) and those who have relatives with oncology in the family.

Pathology often has a non-aggressive character, the tumor may not grow for years and not metastasize to other organs. In the initial period, cancer is successfully treated, does not relapse, and patients after therapy have the opportunity to lead a normal life.

Video - oncologist about thyroid tumors

Varieties of the disease

There are several histological (depending on the cellular structure) forms of cancer:

• papillary - occurs most often (about 70%);
• follicular - a rarer formation (20%);
• medullary - occurs in only 5% of cases;
• anaplastic (undifferentiated) - the rarest and most prognostically unfavorable type of tumor;
• lymphoma - also diagnosed very rarely;
• gyurtle - cell carcinoma;
• mixed - diagnosed not too often - up to 10% of all cases of the disease.

The international TNM system implies a classification of neoplasms depending on the size and extent of the tumor in the gland (T), metastatic involvement of the nearest lymph nodes, that is, the presence of regional metastases (N) and tumor metastasis to distant internal organs (M). Each of these criteria has its own interpretation for assessing cancer staging and treatment prognosis.

Table - classification of thyroid cancer TNM

The tumor can be primary or secondary, depending on the place of origin - in the gland itself or through germination from other organs.

There are several stages in the progression of the tumor:

• 1 - the formation is located within the glandular capsule, there are no metastases;
• 2a - a single tumor that disrupts the shape of the gland or several formations without metastases that do not germinate the capsule and do not deform it;
• 2b - there is a unilateral lesion of the lymph nodes (regional metastases);
• 3 - the tumor has sprouted into the capsule, compresses nearby tissues and organs, while there are bilateral regional metastases;
• 4 - the tumor has grown into other tissues and organs, there are distant metastases.

Varieties of tumors

The thyroid gland is made up of a variety of cells that produce many hormones. Different types of glandular tissue serve as the basis for different forms of malignant neoplasms:

• The most common type of cancer is papillary carcinoma. Such a tumor is the most “calm”, grows slowly and rarely metastasizes. This species responds well to therapy and has the best prognosis among other forms of pathology. Tumor cells are very similar to healthy thyroid cells, that is, this cancer is a highly differentiated neoplasm. Papillary tumor most often occurs in women younger than 30 and older than 50 years.
• The follicular tumor has a more aggressive course. Only in 30% of cases it is minimally invasive, that is, it does not affect neighboring organs and vessels. In other cases, such a tumor grows into the tissues and affects not only regional lymph nodes, but also distant organs. However, this species lends itself well to the effects of radioactive iodine, as it consists of follicular cells that are part of the structure of a healthy gland. This type of cancer affects older women more than 50 years of age and is associated with dietary iodine deficiency.
• Medullary carcinoma is a rare tumor composed of parafollicular cells. This form of the disease is much more dangerous than those described above, as it often grows through the glandular membrane into the muscle tissue and trachea. In the occurrence of such a tumor, heredity plays an important role, but there is also a sporadic form, when the patient's parents did not suffer from oncology. Medullary carcinoma in most cases is accompanied by multiple endocrine neoplasia - various disorders of the endocrine glands. Treatment of such a tumor has an unsatisfactory prognosis. Neoplasm cells do not absorb iodine, so radionuclide therapy is ineffective in this case, an operation is necessary with the complete removal of the gland and nearby lymph nodes.
• The most rare and severe form of pathology is anaplastic cancer, in which atypical cells actively divide and develop in the gland. The tumor affects people over the age of 65, it is characterized by aggressive growth and active metastasis. The neoplasm is difficult to treat and has the most disappointing prognosis of all forms of thyroid cancer - it leads to death in about a year from the onset of the disease. This type of cancer usually occurs against the background of nodular goiter, which has a long course.
• Lymphoma of the gland is a non-epithelial neoplasm that develops from lymphoid tissue. The tumor can occur on its own or against the background of thyroiditis. Education quickly increases in size, grows into nearby tissues and squeezes them. Lymphoma responds well to ionizing radiation therapy.
• Hürthle cell carcinoma is formed from B-cells of the gland and is similar to a follicular tumor, from which it differs only in a greater tendency to metastasize, both regional and distant, and a lower ability to absorb radioactive iodine during treatment.

Causes and factors of cancer development

Studies show that cancer very often occurs against the background of long-existing pathologies of the thyroid gland - goiter, adenoma, nodes. This is confirmed by the fact that oncology is registered 10 times more often in residents of areas endemic for goiter. Papillary cystoadenoma has a special tendency to malignancy (malignancy).

Risk factors contributing to the development of a tumor:

• Radiation. After the Chernobyl accident, thyroid cancer is registered 15 times more often.
• Ionizing radiation (radiotherapy) to the head or neck. Long-term exposure to radiation can manifest itself years later as cell mutations that begin to rapidly divide and grow. As a result of these processes, follicular or papillary carcinoma may occur.
• Industrial hazards. Workers in hot shops or enterprises where heavy metals are involved, as well as medical staff whose work is related to X-ray equipment, have a higher risk of getting cancer than people in other professions.
• Mature age. In the process of aging, changes begin in glandular cells that can lead to oncology.
• hereditary predisposition. The risk group includes people whose close relatives have dysfunctions and neoplasms of the endocrine glands.
• Bad habits. The abuse of alcoholic beverages weakens the body's immune forces, and tobacco smoke contains a huge amount of carcinogens.
• stressful situations. Chronic stress leads to a significant weakening of the protective forces.

In addition to external factors, a significant role in the development of oncology is played by the state of the body and the presence of diseases such as:

• chronic inflammatory processes in the thyroid gland;
• long-term diseases of the reproductive system, especially if they cause hormonal disorders;
• neoplasms of the mammary glands;
• tumors and polyps of the colon;
• conditions accompanied by changes in hormonal levels - the period of menopause, childbearing, breastfeeding.

Provoke the occurrence of oncology usually several factors at once.

Manifestations of the disease

At the initial stage, it is very difficult to determine the development of thyroid cancer. The first sign may be a seal in the region of the gland like a small nodule or an increase in the cervical lymph nodes, often unilateral.

With papillary carcinoma, the nodule grows extremely slowly, it is painless and elastic to the touch, as if rolling under the skin. A decrease in the volume of healthy glandular tissue leads to a decrease in the amount of hormones produced, which causes the development of hypothyroidism, which manifests itself:

• lethargy;
• weakness;
• drowsiness;
• hair loss;
• tingling in the limbs.

The follicular form manifests itself as an increase in the cervical lymph nodes and a denser formation. The tumor causes increased production of thyroid hormones, which leads to hyperthyroidism. Hypersynthesis of hormones by tumor cells is manifested by the following symptoms:

• "tides" - a feeling of heat in the head and chest;
• sweating;
• cramps of the limbs;
• sleep disturbance;
• constant fatigue;
• weight loss
• diarrhea.

Medullary cancer is characterized by rapid growth and the addition of symptoms of damage to surrounding organs and tissues.

Common manifestations of a tumor can be:

• irritability;
• loss of appetite;
• increased fatigue;
• weight loss.

Symptoms worsen as the tumor grows.

Manifestations of thyroid cancer depending on the stage - table

Diagnostic methods

The endocrinologist deals with the diagnosis of the disease. First of all, the doctor examines the patient, feels the gland and finds out complaints, the presence of chronic diseases, surgeries, a tendency to allergic reactions, the state of health of relatives (whether there are thyroid diseases).

Ultrasound is used to study the state of the gland. The procedure is necessary to determine the size of the organ, the presence of nodes and tumors. Using ultrasound, it is impossible to determine whether a neoplasm is malignant, therefore, in case of suspected cancer, additional diagnostic methods are used.

MRI (magnetic resonance imaging) makes it possible to distinguish a benign tumor from cancer. CT (computed tomography) allows you to determine the stage of the disease.

The most informative diagnostic method is TAPB - fine needle aspiration puncture biopsy. A needle is inserted into the tumor, with the help of which the doctor takes material for histological examination. If necessary, an open biopsy is performed, during which a small incision is made and a small part of the tumor is excised for microscopic analysis.

Laboratory diagnostic methods:

• An enzyme-linked immunosorbent assay is necessary to determine tumor markers that indicate a specific form of a tumor:
  • elevated calcitonin and changes in the RET proto-oncogene indicate the development of medullary cancer;
  • a high level of thyroglobulin indicates follicular or papillary carcinoma;
  • a large number of antithyroid antibodies indicates a papillary tumor.
• In order to find out how impaired the functional abilities of the gland, the level of steroids is determined in the blood.
• In the general blood test, anemia and accelerated ESR are detected.

Treatment of pathology

Therapeutic tactics depend on the form of the disease, the stage and the presence of metastases. In the treatment, several methods are usually used in combination, among which:

• surgical intervention;
• targeted therapy (anticancer drugs);
• exposure;
• RNT - radionuclide therapy;
• chemotherapy;
• the use of hormonal agents.

Most often, a malignant neoplasm responds well to treatment, especially if there are no metastases yet. In the case of inoperable cancer, therapy is aimed at maximizing the destruction of cancer cells and stopping their further growth. Patients with the most advanced forms of the disease undergo palliative care, that is, aimed at relieving symptoms and improving the quality of life.

Therapy with medicines

Currently, the choice of oncologists falls on drugs for targeted therapy of thyroid cancer. These drugs, unlike classical chemotherapy, selectively destroy tumor cells:

• In medullary cancer, the drugs Vandetanib (Caprelsa), Cabozantinib (Kometrik), which inhibit tumor growth, are prescribed. The drugs are used for a long time - at least six months.
• Follicular and papillary tumors are treated mainly with surgical methods and with the use of radioactive iodine, but sometimes the appointment of anticancer drugs is justified: the patient is prescribed Sorafenib (Nexavar), Pazopanib (Votrient), Sunitinib (Sutent).

Surgical treatment of cancer

The main treatment for thyroid cancer is surgery. Doctors recommend removing a neoplasm of any size surgically. If the tumor is very small, then one lobe of the gland with the isthmus is cut out - a hemithyroidectomy is performed. The second half of the gland, left after the operation, continues to produce hormones.

Most experts believe that the best option is the complete removal of the organ (total or subtotal thyroidectomy). If nearby lymph nodes are affected, they are also removed.

Before the operation, the patient takes tests: clinical and biochemical blood tests, urinalysis, blood group and coagulogram (clotting). The operation is performed under general anesthesia, lasts about 60 minutes, if necessary, remove the lymph nodes - 2-3 hours. An endocrinologist surgeon cuts off the gland from surrounding tissues, restores normal blood circulation in nearby organs, and stitches the wound in layers. On the first postoperative day, the wound is drained, that is, a silicone tube is inserted into the incision site to drain fluid (ichorus). The next day, the drainage is removed and the wound is bandaged. If there are no complications, the patient can be discharged as early as 3-4 days after the intervention.

Usually such operations are well tolerated. The patient may be disturbed by pain at the incision site, swelling of the tissues. These symptoms disappear after about 1-1.5 months. Then the patient can lead a normal full life. If age permits, after the operation, you can become pregnant and successfully bear a healthy child (not earlier than a year after the intervention and prescribed therapy).

Postoperative treatment:

• A month after the operation, the patient is prescribed radionuclide therapy with Iodine-131 to eliminate possible secondary foci.
• Hormone therapy is necessary in case of complete removal of the thyroid gland. Thyroid steroids operated patients have to take for life.
• Suppressive postoperative therapy with Levothyroxine is needed to inhibit the synthesis of thyroid-stimulating hormone by the pituitary gland, which has a stimulating effect on the gland. If the production of the hormone is not suppressed, a relapse may occur.
• After the operation, the patient must be prescribed vitamin and mineral supplements, which are needed for the speedy restoration of organ functions.
• Six months after the removal of the tumor, the patient is examined again: the endocrinologist conducts an examination and prescribes an ultrasound scan. After a year and three years, the patient should again see a doctor and be tested for tumor markers and hormones.

Video - diagnosis and treatment of thyroid cancer

RNT - radioactive iodine therapy

Once in the body, Iodine-131 is completely absorbed by the cells of the gland, which are destroyed. In addition to healthy and tumor cells of the gland, radiation effectively fights metastases, both regional and in distant organs. The method is chosen for the treatment of papillary and follicular carcinomas.

Radiation therapy

Irradiation is not used to combat papillary or follicular formations, as they are amenable to radionuclide therapy. The method is used to treat anaplastic cancer. With diffuse tumor growth, irradiation avoids relapses after surgery and reduces the growth of metastases. The course of radiation therapy is several weeks. The dose of radiation is selected individually.

Photo gallery - methods of treatment of thyroid cancer

Iodine-131 is used to destroy thyroid cells affected by papillary or follicular cancer
Caprelsa is a targeted anticancer drug for the selective destruction of cancer cells.
The hormonal drug Levotherokine is used for suppressive therapy, that is, to suppress the pituitary hormone that stimulates the thyroid gland.
Radiation therapy is used to treat anaplastic and medullary forms of thyroid cancer.
The main treatment for thyroid carcinoma is surgical removal of the organ.

Diet

After removal of the cancerous tumor, you do not need to follow a special diet. The diet should be fortified and varied. Vitamins are mostly antioxidants and come to the rescue in the fight against cancer.

Vegetables and greens are useful for the prevention of tumor recurrence: cabbage of all kinds, radishes, parsley, parsnips, radishes, carrots, celery, green peas, berries, green tea. Meals should include:

• protein food:
  • fish, cheese, cottage cheese, dietary meat;
• sources of simple and complex carbohydrates:
  • fruits, juices, honey, grain and bran bread, various cereals, vegetables;
• fats in the form of vegetable oils.

It is desirable to remove animal fats, fatty meat, rich confectionery products from the diet, and limit sugar. The use of foods rich in iodine (eggs, soy products, seafood) should be discussed with your doctor. At the time of radionuclide therapy, such products are completely excluded from the diet.

Folk remedies

Non-traditional treatment can be used after surgery as an addition to the prescribed drugs or in the case when medicine is no longer able to help (the tumor is inoperable, the patient is very old or has serious concomitant diseases).

It is necessary to be treated with herbs for a very long time - from six months to 5 years, while not stopping taking herbal remedies immediately after the condition improves. Only a fully completed course of therapy will provide the desired effect.

Nut tincture:

1. Grind 30 unripe walnuts with green peel.
2. Add half a liter of vodka or diluted alcohol and 250 g of honey to the nuts.
3. Leave the mixture in a glass container for 15-20 days in a dark place.

Drink the finished product 1 large spoon in the morning before breakfast.

Infusion of poplar buds to inhibit the production of thyroid-stimulating hormone:

1. Pour 2 large spoons of kidneys with 250 ml of boiling water, insist under the lid for 2 hours.
2. Strain the remedy and drink 20 ml 3 times a day before meals.

Celandine tincture:

1. Twist the roots harvested in May in a meat grinder, squeeze out the juice.
2. Dilute the resulting product with vodka 1:1. The medicine is prepared for 2 weeks in a dark place.

Drink tincture of 5 ml three times a day.

Ready-made hemlock tincture can be bought at a pharmacy. You need to drink the medicine according to the scheme: start with 3 drops three times a day, then every day increase the dose by 2 times (6, 9, 12 drops, etc.) Gradually, the amount of tincture taken daily is increased to 75 drops. At this dose, the medicine should be taken for 3 months, after which the amount is reduced to the original.

In celandine and hemlock there are poisons that have a detrimental effect on tumor cells. It must be remembered that these substances should not be taken simultaneously with radiation or radionuclide therapy.

Powerful bioactive substances and poisons are contained in the plant Aconite Dzungarian. Root tincture is recommended for inoperable cancer to improve the patient's condition. The finished medicine can be purchased at the pharmacy network or prepared at home (20 g of plant root per 200 ml of vodka, leave for 2 weeks). It is better to discuss the dosage regimen with your doctor.

Photo gallery - folk remedies for the treatment of thyroid cancer

Poplar bud medicine is taken to suppress the production of thyroid hormones.
Jungar aconite - a poisonous plant that has a detrimental effect on cancer cells
The hemlock contains substances that destroy the cell of a malignant tumor
Celandine juice contains poisons that help fight cancer
Walnut tincture has long been considered an effective tool in the fight against cancer.

Prognosis and complications

The prognosis of treatment depends on the type of tumor and the stage at which therapy was started. The percentage of the probability of a complete cure with early diagnosis of the disease is quite high - 85-90%. Lymphoma and anaplastic cancer have the most disappointing prognosis - death occurs within 6–12 months from the onset of the disease. There is also a high risk of an unfavorable outcome in medullary cancer, which has a tendency to early metastasis to distant organs. Follicular and papillary carcinomas are most easily cured.

Oncology has a more favorable course in middle-aged patients; in older women, the prognosis is unsatisfactory.

The most serious consequences of the disease:

• recurrence of pathology;
• spread of metastases to various organs: brain, bones, lungs, liver;
• hormonal disorders leading to amenorrhea;
• the possibility of death.

Disease prevention

Prevention of thyroid cancer includes the following activities:

• replenishment of iodine deficiency (due to iodized salt, foods with a high content of the element);
• conducting preventive examinations by an endocrinologist for women at risk;
• reduction of industrial hazards;
• general strengthening of immunity.

What to do to avoid thyroid cancer - video

Early diagnosis of a thyroid tumor is the key to successful treatment of the pathology. Preventive examinations by an endocrinologist are an opportunity to lead a long and fulfilling life, so do not neglect regular visits to the doctor.

The thyroid gland belongs to the endocrine system and is unique among its glands not only in size (it is the largest), but also in the multiplicity of functions that it carries out. You can call it the most important: it is responsible for the metabolic rate, determines the temperature, blood pressure, controls and regulates the work of all organs and systems.

The thyroid gland has a peculiarity among other glands in that it secretes the thyroid hormones it produces into the blood as needed, the rest is stored in the gland until necessary. It is abundantly supplied with blood in order to capture iodine from incoming food. The shape resembles a butterfly on the front of the neck, located just below the thyroid cartilage and just above the jugular notch. It is covered with skin, so it can be easily palpated, which is convenient when diagnosing its pathologies.

The former soloist of the Tatu group, Yulia Volkova, admitted on the air of the Mirror for a Hero program that in 2012. During the examination, she was diagnosed with thyroid cancer. After testing, the diagnosis was confirmed. Yulia Volkova was operated on in Moscow, everything went well. But during the operation, the recurrent nerve was accidentally affected, which was discovered after anesthesia in the ward. Due to such an oversight, Yulia Volkova was forced to undergo 3 more additional operations to restore her vocal cords. As Yulia Volkova herself says, this was the most critical and serious moment in her life. That's right, the diagnosis of thyroid cancer is like a sentence for an artist.

TC has also been diagnosed in some other celebrities, but all of them have been treated and are still alive. Among them are the famous presenter Oprah Winfrey, the Bush couple, Rod Stewart, Missy Elliott, the Greek-Canadian actress Nia Vardalos from the movie “My Big Big Greek Wedding” and others.

Information about thyroid cancer

Carcinoma (thyroid cancer) - in 95% of cases it is of epithelial origin, since epithelial cells are perhaps the most active in terms of reproduction. Carcinoma of the thyroid gland (thyroid gland) arises from the cells of the walls of the follicles and parafollicular cells of type C. TC occupies only 1% of all oncologies, and its mortality is only 0.5%. A lot of sick people were noted after the catastrophe at the Chernobyl nuclear power plant.

Thyroid cancer in women has a peak incidence of 45 to 60 years in women, which is 3.5 times higher than in men. But after 65 years they begin to overtake women. How long do people live (prognosis) with thyroid cancer? In children, this tumor is also possible, and in them it manifests itself aggressively. Thyroid cancer is more common among Europeans. Thyroid cancer is considered a non-aggressive tumor that does not grow for years. Thyroid cancer: what is the classification? It is quite complex and ambiguous. When thyroid nodules appear, 5% of them will be malignant - statistical data.

Causes of thyroid cancer

Thyroid cancer: no definite cause has been established. It is noted that in the case of radiation, the incidence increases; for example, after the accident at the Chernobyl nuclear power plant, the incidence increased 15 times. In addition, iodine deficiency affects the frequency. Provoking factors can also include:

1. Radiation therapy to the head and neck can cause cancer - even after decades. The fact is that under the rays of the cells begin to mutate and actively divide. Tumors are most often in the form of papillary and follicular cancer.
2. Age over 40 years. At the same time, cells often fail in the genes, and then even a benign pathology can become malignant.
3. Heredity - a special gene ensures the appearance of a tumor in 100%. The operation is then carried out prophylactically.
4. Harmful production - work with radiation, workshops with hot and heavy metals. 5. Stress - undermine the immune system, the cells of which protect against cancer.
5. Bad habits - alcohol and smoking also undermine the immune system. The appearance of thyroid cancer is promoted by chronic pathologies of the genital area (violations of ovarian hormones and hormonal pathologies of the uterus), mastopathy, rectal formations, benign neoplasms and nodes in the gland, endocrine multiple neoplasia, multinodular endemic goiter. Types and forms of thyroid cancer.

Classification of thyroid cancer: All thyroid cancers have a common name - carcinoma. A heterogeneous group of malignant neoplasms less than 1 cm in size is called thyroid microcarcinoma. It may have a cystic structure and is often located within a fibrous glandular sheath. Among epithelial thyroid cancers, the following types of thyroid cancer are distinguished:

• papillary (occupies 76% - the most frequent and favorable);
• follicular (occupies 14%);
• medullary (unfavorable and accounts for 5-6%);
• anaplastic thyroid cancer (this type accounts for about 4%).
• the remaining percentages are epidermoid cancer, sarcomas and lymphomas.

Malignant tumors of the thyroid gland are divided into highly and poorly differentiated; primary and secondary, operable and inoperable, by cell type. Thyroid cancer: how does it develop and types?

Medullary cancer often grows into muscle tissue and the trachea. Equally often affects both sexes, after 40 years. Usually occurs hereditarily, but can also occur sporadically. When it is always affected by other glands - multiple neoplasia. The complexity of the treatment of this cancer is that it does not respond to radioiodine. Requires radical removal. Thyroid cancer: with thyroid cancer, how long do they live by age? After 50 years, the prognosis is unfavorable and the effectiveness of treatment is low.

Follicular- aggressiveness is greater than with PR. The etiology is often not radiation. Oncology - diseases of the thyroid gland of a malignant nature - are largely determined by the form. Often grows into vessels, mortality is quite high. Name: The tumor resembles vesicles of follicles. 30% of its cases are minimally invasive - without consequences. 70% - metastasize to all distant organs. Despite aggressiveness, RIT is successfully treated.

papillary cancer(adenocarcinoma) of the thyroid gland - 70-80%. It occurs three times more often in women, from 30 to 50 years. May be detected early by palpation. The defeat of the lymph nodes after surgery - 30%. It develops very slowly. The tumor has many small protrusions - papillae (papillae). A highly differentiated form and well treated - 99% of patients after treatment live for more than 25 years.

Anaplastic cancer thyroid gland - is the least common and it is the most dangerous. The cure rate is the lowest. Poorly differentiated form, can occur in the gland even 20 years after irradiation. The tumor grows and spreads to other organs quickly - a few days or weeks. In a quarter of cases, it metastasizes to the trachea, in every second - to the cervical organs and lungs. When diagnosed, anaplastic thyroid cancer is no longer subject to surgery. The most intensive treatment will not give an effect, the prognosis is poor.

Stages of cancer

Thyroid cancer: manifestation and stages - any oncology has 4 stages in its development. The size, localization, growth in breadth and depth of cancer are important for the prognosis and choice of treatment.

The stages of thyroid cancer are also in the amount of 4:

• I stage No symptoms, no metastases. The swelling is localized clearly in the thyroid gland. Size up to 2 cm and in 1 half. The patient himself can feel a small seal. Symptoms and stages of thyroid cancer in women and men do not differ.
• II stage– the tumor has already grown to 4 cm and deformed the gland. At the same time, many small nodules are also fixed. But there is no germination into the capsule yet. Signs and symptoms - a knot in the neck, not a sharp local discomfort. Possible metastases from the side of the lesion to the lymph nodes.
• III stage- germination of the node in the capsule. Compression of the trachea, surrounding areas and ingrowth into them. The tumor is larger than 4 cm. Symptoms of thyroid cancer at the same time - it becomes difficult to breathe and swallow. Shortness of breath and suffocation appear after physical exertion. The voice may become hoarse or hoarse. Neighboring lymph nodes are enlarged. Metastases on both sides.
• IV stage– The thyroid gland is more than 5 cm and immobile. The tumor has penetrated deeply into the surrounding tissues and distant organs. The symptoms depend on the affected organ. Thyroid cancer: in women, the symptoms are similar to those in men.

If it is breathing, then there is a bloody cough. With a headache - migraine-like causeless algia, they are not removed with analgesics. Symptoms: there is a decrease in weight and appetite; hyperthermia and an increase in weakness and impotence.

Signs of metastasis

It should be noted right away that the symptoms in women are similar to those in men. The lymph nodes of the neck - become denser, become larger in size and become inflamed. They grow into the skin, but with PR, this does not affect the prognosis.

Thyroid cancer: what are the symptoms of brain involvement? They are manifested by persistent cephalgia, decreased vision, coordination, convulsions occur.

In thyroid cancer, the first signs of the appearance of metastases in the bone are unreasonable fractures and pain; on x-rays, metastases look like voids or growths. Metastases in the liver - the first symptoms: jaundice, dyspeptic manifestations and heaviness in the liver area. Aversion to meat and fatty foods.

Symptoms of thyroid cancer are divided into initial and subsequent. A knot appears on the front of the neck, one-sided. Elastic, limited mobility and does not hurt. Such formation gradually grows and becomes denser. A normal and healthy thyroid gland never has seals up to 20 years old - keep this in mind. Thus, signs of early thyroid cancer are the appearance of swelling in the front of the neck and an increase in the cervical lymph node from the side of the swelling. Later, the first signs of thyroid cancer are replenished with manifestations:

• growth of nodes and lymph nodes;
• cough appears;
• voice becomes hoarse;
• dysphagia;
• pain in the nodes;
• suffocation.

Thyroid cancer: how does it manifest itself in women? Symptoms do not differ from men's - among other manifestations: general weakness, sweating, anorexia; weight loss.

Diagnostic measures

How to identify thyroid cancer? Ultrasound, X-ray and MRI are performed. Ultrasound of the thyroid gland - reveals the nodes, size and location. Hypoechoic nodes are dangerous, with blurred edges, structural irregularities and pronounced vascular development.

Diagnosis of thyroid cancer must be confirmed by the presence of atypical cells - this is accurately determined by fine needle aspiration puncture biopsy (FNA). Carcinoma: Thyroid hormone readings will depend on TSH levels.

Blood for ELISA - will determine the presence of tumor markers. Some hormones in thyroid cancer will be increased: calcitonin - its growth occurs with a medullary tumor of the thyroid gland. If the operation has already been performed - speaks of M.

Thyroid cancer: tests - diagnosis is carried out at the gene level and thyroglobulin is determined. It increases with papillary and follicular forms of thyroid cancer. In general, the analysis of hormones for thyroid cancer is mandatory.

The BRAF gene is not normally present. If available, it determines the prognosis for PTC. EGFR - reflects the rate of tumor growth. Antibodies against the thyroid gland - an increase in their level in the blood indicates PR. Thyroid cancer: diagnosis and surgery are always closely linked. Mutations of the RET proto-oncogene - its presence diagnoses medullary cancer.

Surgery for thyroid cancer

Carcinoma: Thyroid cancer is treated even if it is suspected. With a small tumor size, 50% of the gland and the isthmus are removed - hemiectomy. The remaining share begins to work for two. Carcinoma - thyroid cancer; in the thyroid gland, many doctors prefer to remove it completely. This will give confidence in the absence of the risk of relapse. Affected lymph nodes and tissues are also subject to excision - thyroidectomy (complete removal of the thyroid gland) and lymph node dissection.

How is the operation performed:

1. The date of the operation is set, by which there should be no exacerbations of chronic diseases or acute ones. All laboratory examinations are carried out: a blood test for hormones and a coagulogram, biochemistry and OAM.
2. Conducting consultations of all narrow specialists.
3. Thyroid cancer is removed under anesthesia. The duration of the removal is about an hour. If lymph nodes are removed, then 2-3 hours.
4. Postoperative medical procedures and measures are already carried out in the ward: drainage is placed in the wound to prevent swelling, it is not allowed to get up, bandaging and wound treatment. The drain is removed the next day. Extract for 2-3 days.

After thyroid surgery

Practically life with a thyroidectomy does not change. The quality of life does not deteriorate. Fertility and performance in women is fully preserved. For the first 10 days, local pain and swelling of the neck persist. It goes away on its own after a month. Before discharge, the stitches are processed by a nurse, then the patient does it at home himself.

RIT is mandatory 4-5 weeks after the operation. After 3 weeks, hormones for the entire life period begin. They are necessary to reduce TSH, which stimulates the thyroid gland with the development of relapse. In addition, it is mandatory to take microelements with vitamin D and Ca.

Postoperative follow-up

Patients after the operation are registered in the oncological dispensary. 1.5 months after the operation, the whole body is scanned with iodine-131. Why? This is necessary to identify foci of metastases. Subsequently, this is repeated once a year. The operated patient must be re-examined after six months. All the time there is a reception of hormonal drugs.

Subsequently, the examination is repeated every six months - ultrasound and tests. The level of thyroglobulin hormones and antibodies to thyroglobulin is regularly monitored. With metastases, they increase.

Postoperative complications

They occupy 1-2%. Complications are divided into specific and non-specific. The latter include bleeding, suppuration of sutures, edema - they occupy less than 1% of cases. All of these can be treated with antibiotic therapy.

Nonspecific complications are detected on the first day - if this is not the case, you don’t have to worry. Specific complications are traumatization of the parathyroid glands and laryngeal nerves. The latter are adjacent to the thyroid gland, sometimes they still touch and there is aphonia, cough, hoarse voice. Most often, the developing phenomenon is temporary.

If the parathyroid glands are damaged, hypoparathyroidism develops - a decrease in Ca in the blood. This is manifested by convulsions and myalgia, tingling in the fingers.

Non-surgical treatment of thyroid cancer

Thyroid cancer is treated, treatment is non-surgical. It is prescribed for inoperable cancer, intolerance to anesthesia, the presence of other contraindications. Such treatment only maintains the general condition.

What are the forecasts

Thyroid cancer: consequences and prognosis - with a mass of less than 3 cm, there is the possibility of a complete cure. Less optimism causes cancer in the elderly.

Thyroid gland: at an early stage, cancer is completely curable with its papillary form. The survival rate of people for 5 years is 95-100% of cases.

Thyroid gland: consequences - stage IV follicular cancer - the patient has a 5-year survival rate in 55% of cases. And at earlier stages - a complete cure.

Survival with neoplasm: with thyroid cancer (stage 4 medullary form) - survival at 5 years - less than 30%. Stages 1 and 2 - cure 98% of patients. Such a patient will live for more than 15 years. With aplastic cancer, life expectancy is less and up to a year.

Disability in thyroid cancer

Thyroid gland: Thyroid cancer can be cured even at stage 3 completely. This requires a number of methods. This includes the operation itself, RIT, radiation therapy. According to the patient's condition, he can be temporarily given a disability group.

• 3 group given if present: moderate hypothyroidism, mild hypoparathyroidism, limitation of shoulder joint mobility (this cannot be ruled out).
• 2 group disability: 2-sided damage to the recurrent nerve, severe hypothyroidism, grade 2 hypoparathyroidism, the treatment was non-radical, unknown prognosis.
• I group is given for grade 3 hypothyroidism, undiagnosed and severe cancer, decreased thyroid gland with myocardial dystrophy and myopathy.

With a radical removal, the sick leave is issued for 3 months. A period of rehabilitation is required.

The number of days in this case is determined by the stage, type of tumor, method of intervention. When prescribing treatment with rays and chemistry, rehabilitation is lengthened. A surgical patient with thyroid cancer can partially recover up to 3 years, and fully - up to 5 years or more. Frequent relapses and treatment failure are important for prolongation.

The treatment of thyroid cancer in Israel and the diagnosis of pathology has very good results. Each approach is extremely individual, taking into account many factors. Oncological surgery in Israel generally has very high achievements. This is due to the powerful diagnostic base of such clinics and the high professionalism of doctors. Treatment of thyroid cancer in Israel is successfully carried out at the Sheba State Hospital in the Department of Radiation Oncology, at the Center. Ruth Rappoport, downtown Rambam.