Papillary thyroid carcinoma. Thyroid adenocarcinoma or glandular cancer. Symptoms of papillary thyroid carcinoma

Medical statistics show that diseases thyroid gland at the present time - one of the most common. They are diagnosed in every third person, especially in old age. The most dangerous disease is considered to be cancer (carcinoma) of the thyroid gland. This diagnosis scares everyone who hears such words. But in reality, everything is not as scary as it seems. Modern medicine so developed that it allows the disease to be determined by early stage and successfully get rid of it. Let us consider in detail one of which is called “papillary thyroid carcinoma”.

Features of the disease

Papillary cancer is more common than other types. A malignant formation appears from healthy organ tissue and is visualized as a cyst or irregular tumor large sizes. In 80% of all cases, the patient is completely cured of this type of carcinoma.

If we talk about other types of cancer, then in comparison with them, papillary cancer tends to develop for a very long time. Another feature is that metastases of papillary thyroid carcinoma often spread to the lymph nodes.

As a rule, only 1 node is found in a patient, in rare cases there are several. Most often, people aged 30-55 years suffer from this disease, mostly women (but sometimes men are also diagnosed with this disease).

Causes

So far, no one can accurately determine why thyroid cancer develops. Doctors suggest that most likely the reason lies in cell mutation. Why such mutations occur is also unclear.

A tumor develops after the cells have mutated. They begin to grow, gradually affecting healthy organ tissue.

Scientists suggest that papillary thyroid carcinoma develops due to:

• insufficient amount of iodine in the body;
• environment;
• ionizing radiation;
• hormonal imbalances;
• congenital pathology;
• bad habits (smoking, alcohol abuse);
• frequent viral and bacterial infection respiratory tract.

Signs

This form of cancer develops slowly, so initial stages it is determined by chance and not from any symptoms. The person has no discomfort, nothing hurts, he lives full life. When the tumor begins to grow, this leads to painful sensations in the neck area. A person can feel a foreign lump himself.

In later stages, papillary thyroid carcinoma causes the following symptoms:

• increase cervical lymph nodes(in most cases on one side, where there is a malignant tumor);
• neck pain;
• feeling foreign body when swallowing;
• sometimes the voice becomes hoarse;
• breathing difficulties appear;
• When the neck is compressed (especially when a person is lying on his side), significant discomfort is felt.

Stages

Is papillary thyroid cancer classified in any way? Stages, the signs of which are the basis for diagnosis:

1. Age up to 45 years:

• Stage I: any size of formation. Sometimes cancer cells spread to nearby tissues, The lymph nodes. Metastases do not spread to other organs. A person does not feel any signs of illness, but sometimes there is slight hoarseness and slight pain in the neck.
• Stage II: stronger growth cancer cells. Metastases affect both lymph nodes and organs that are located close to the thyroid gland (lungs, bones). The signs are quite pronounced, they cannot be ignored.

2. Age after 45 years:

• Stage I: the tumor is no more than 2 cm, no other organs are affected by papillary thyroid cancer. Symptoms of the stage: the person does not feel any special changes, or the signs are mild.
• Stage II: the tumor does not extend beyond the boundaries of the thyroid gland, but the size reaches 4 cm.
• Stage III: size greater than 4 cm, cancer cells affect nearby organs.

The big picture

The appearance of a nodule or lump is the first sign of thyroid cancer. Papillary thyroid carcinoma is characterized by single formations, in rare cases multiple. If the node is deep and its size is insignificant, then a person cannot feel it on his own. Even an endocrinologist cannot determine up to 1 cm. Only after an ultrasound are such small formations found or after cancer cells have begun to spread to the lymph nodes, and they, in turn, have enlarged.

At small size nodes, the disease is called “occult papillary carcinoma”. This kind of formation is not very dangerous, even at the stage of metastasis. The tumor moves freely in thyroid gland, may move during swallowing. But when they spread to surrounding tissues, the malignant formation becomes motionless.

Metastases very rarely spread to other organs (except lymph nodes). This happens only in advanced stages of the disease. Metastases have the property long time don't make yourself known. In most cases, papillary cancer affects the lymph nodes, less often it spreads to another lobe of the thyroid gland.

Features of cells

Main characteristics malignant formation:

• size - from several millimeters to several centimeters;
• in rare cases, mitoses are observed;
• in the center of the formation there may be calcium deposits or scarring;
• the tumor is not encapsulated;
• cells have no hormonal activity.

Survey

Initially, the doctor palpates the neck in the area of ​​the thyroid gland. The cervical lymph nodes are also palpable. If the doctor discovers something, the patient is sent for an ultrasound, which can be used to determine the presence of formations, their size and structure.

The cytological picture of papillary thyroid carcinoma is the main objective of the examination. For this, a fine-needle needle is used. aspiration biopsy, which is carried out strictly under ultrasound control.

To understand whether there are metastases in other organs, the patient is not sent an x-ray.

Important!

Cytologic papillary thyroid carcinoma is a misnomer that makes no sense. There are concepts " cytological examination"(determining the structure of cells in order to identify pathology) and "papillary carcinoma".

Treatment

How to help a patient diagnosed with papillary thyroid carcinoma? Treatment consists of surgery. For this disease, thyroidectomy is used. There are two possible operation options:

• partial thyroidectomy;
• total thyroidectomy.

To completely destroy cancer cells, they resort to radioactive iodine therapy, which is carried out after surgery.

Partial thyroidectomy

This type of surgery is indicated for patients with a small malignant tumor located in one of the lobes of the organ. It is important that the cancer cells do not spread anywhere else. As a rule, in such cases the node does not exceed 1 cm in diameter. The duration of the procedure is no more than 2 hours.

The patient is not at risk of developing hypothyroidism, because the hormone is synthesized by the unaffected lobe of the thyroid gland. Sometimes hormonal replacement therapy is required.

Total thyroidectomy

The procedure involves complete removal of the thyroid gland. Both lobes of the organ are excised, as well as the isthmus that connects them. Sometimes it becomes necessary to remove cervical lymph nodes. This happens in cases where they are greatly enlarged and metastases are found in them. The duration of the procedure is approximately 4 hours.

After this type of operation, the patient will have to take hormone-containing medications for life. After all, there is no thyroid tissue left in the body.

Radioactive iodine therapy

This therapy is used when surgery has already been done. It is aimed at destroying the remains of cancer cells. Metastases that have spread beyond the organ to the lymph nodes are very dangerous. Using radioactive iodine, it is possible to kill such cells. They often remain in the thyroid gland itself after a partial thyroidectomy.

Even if cancer cells have spread to the lungs, radioactive iodine therapy can successfully get rid of them.

Postoperative period

Thyroidectomy is complicated surgery, but recovery after it is quite fast. Most patients who have to undergo such surgery do not feel much discomfort after the procedure. A person can return to their normal lifestyle immediately after being discharged from the hospital.

Some people feel that after the procedure they will not be able to eat properly or drink water. But that's not true. The incision does not affect swallowing of either solid or liquid food.

Possible complications

In rare cases, the operation ends in complications:

1. Damage to the recurrent nerve, which controls the voice.
2. Hoarseness of voice or slight change in voice. Sometimes the voice changes forever.
3. Damage parathyroid glands. They are located behind the thyroid gland, so they can be affected during surgery. But this happens very rarely among inexperienced surgeons. Damage threatens to disrupt the metabolism of phosphorus and calcium. As a result, all this leads to hypoparathyroidism.

Forecast

What can papillary thyroid carcinoma mean for a person? The prognosis is favorable in most cases. Even if cancer cells have spread to the lymph nodes, the patient can live for a long time. Statistics show that after surgery a person lives:

• more than 20 years in 70% of cases;
• more than 10 years in 85% of cases;
• more than 5 years in 95% of cases.

As you can see, papillary thyroid carcinoma is not so scary. The survival rate is quite high even in cases where the tumor has spread beyond the thyroid gland.

Further examination

After full course treatment, a person should regularly visit an endocrinologist. This is necessary in order to monitor your general health. Sometimes cancer comes back, so you will have to undergo a full examination every year:

• blood test (determines the effectiveness replacement therapy, as well as the presence of malignant tumors, remaining metastases);
• Ultrasound of the thyroid gland and lymph nodes;
• body scan with iodine.

Papillary thyroid cancer - dangerous disease, but in most cases you can completely get rid of it. The main method of treatment is surgery, after which it is necessary to resort to radioactive iodine therapy.

Papillary thyroid carcinoma is considered the most common form of cancer of this organ. About 80% of oncology cases in this area are papillary cancer. This pathology is often accompanied by metastases in the lymph nodes, which causes high frequency relapses.

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Causes of the disease

According to statistics, the peak incidence of papillary carcinoma occurs between 30 and 50 years of age. This pathology three times more common in women than men. At 50% clinical cases At the time of diagnosis, the patient has metastatic lesions of the lymphoid tissue.

Kinds

In oncological practice, the following types of malignant neoplasms of the thyroid gland are encountered:

1. Anaplastic thyroid cancer.
2. Follicular tumor.
3. Modular gland cancer.
4. thyroid gland.

Papillary thyroid carcinoma: causes of development

The occurrence of papillary carcinoma in most cases is associated with the following risk factors:

• Exposure to ionizing radiation:

The carcinogenic effect of radiation rays is confirmed by statistical data on cancer incidence after the Chernobyl accident and the nuclear bombing of the cities of Hiroshima and Nagasaki. As a result of these disasters, 7% of people in the surrounding areas were diagnosed with thyroid cancer.

• Radiation therapy:

Patients treated with gamma radiation have an increased chance of developing papillary carcinoma. This is explained by the development of systemic mutations in the human body under the influence of ionizing radiation.

• Iodine deficiency:

In some cases it promotes education malignant tumors thyroid gland.

• Tobacco smoking and abuse of strong alcoholic beverages.
• Genetic predisposition.

Symptoms of papillary thyroid carcinoma

The cancerous process in the thyroid gland proceeds slowly and in the early stages does not cause subjective sensations in patients.

Over time, a pathological compaction of glandular tissue forms in this area. The patient can independently determine the node, which may also correspond metastatic lesion cervical lymph nodes. At this stage, most cancer patients experience:

1. Slowly rising pain syndrome. In the later stages of tumor growth, pain can be relieved with the help of narcotic analeptics.
2. Respiratory and swallowing dysfunction. Such pathological conditions are often associated with the risk of suffocation.
3. The presence of unusual hoarseness of the voice. A sudden change in voice timbre in older age should alert the patient to the possibility of oncology.

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Diagnostics

The main way to determine the diagnosis of cancer of the thyroid gland is aspiration. During the procedure, the doctor pierces pathological tissue with a thin-walled needle and collects a small area malignant neoplasm. In some cases, it is necessary to extract a biopsy from several areas of compaction. Subsequently, the biological material is subjected to cytological and histological examination in laboratory conditions. Ultimately, aspiration biopsy indicates the type, stage, and extent of cancer.

To clarify the size and structure of the tumor, the oncologist may resort to ultrasound examination. The ultrasound method is based on measuring the penetrating ability of sound waves, which forms a graphic image of the affected organ on the monitor screen.

Computed tomography is necessary to assess the extent and extent of cancer. An X-ray scan of the neck area determines the exact size of the papillary carcinoma and the presence of metastases in nearby lymph nodes.

To the complex diagnostic measures also includes analysis circulatory system on the amount of thyrotropin. Based on the concentration of this hormone, the oncologist draws up an anti-cancer treatment plan.

Treatment of papillary thyroid carcinoma

Most effective technique Treatment of malignant lesions of the thyroid gland is considered to be surgical intervention. During surgical operation tumor tissue, the thyroid gland and adjacent lymph nodes are subject to excision. The patient is usually operated on general anesthesia.

Papillary carcinoma, for which surgery was performed traditional way, often requires therapy with radioactive iodine. The use of this drug is recommended within 1-2 months after radical removal neoplasms. Iodine in radioactive form is capable of remaining in the primary focus of oncology after surgery.

Treatment with radioactive iodine does not pose a danger to the patient’s body as a whole. Safety this drug consists in the absorption of iodine ions only by the cells of the thyroid gland. So everything radioactive elements localized in the thyroid gland.

In addition, the patient should follow the correct and periodic intake of hormonal medications.

Forecast

The most favorable prognosis for the disease is for patients under 40 years of age. Also, a positive outcome of therapy is observed when tumor growth is limited and does not extend beyond the thyroid capsule. In such cases, postoperative survival is at 95%.

in late stages of growth with significant spread oncological process and the presence of metastases has an unfavorable treatment outcome. Significantly worsens the course of this disease development of secondary lesions in the lungs and bone tissue.

Thyroid cancer is a rare occurrence. Among all forms of this pathology, malignant thyroid tumors account for only 1.5%, but they deserve attention because their number is growing every year. Over the past two decades, the number of people diagnosed with thyroid cancer (TC) has doubled. Scientists cite environmental degradation and man-made disasters as the reason for this. The disease is mainly found in people over 40 years of age, but in Lately There are more and more patients young. According to statistics, women suffer from thyroid cancer 3 times more often than men. The bulk of malignant tumors in the thyroid gland is adenocarcinoma. We will talk about it in this article.

The thyroid gland in humans is located in the neck. It consists of two lobes and an isthmus and is shaped like a butterfly. Its size in adults ranges from 2 to 4 cm, and its volume is 18-25 ml (in men it is larger). The thyroid gland is an organ endocrine system, it absorbs iodine, which enters our body with food, and with its help secretes such important hormones, such as thyroxine, triiodothyronine and calcitonin. They perform the function of regulating all metabolic processes, including the birth and destruction of cells. Thyroid hormones control heat exchange, energy synthesis, growth bone apparatus, oxidative reactions and oxygen absorption by tissues. The stable functioning of this organ affects normal physical, mental and mental development person.

The thyroid gland is mainly composed of three types of cells - A, B and C cells, each of which produces its own hormone. can appear in any of them and reach considerable sizes (up to 20 cm). As it grows, it infiltrates along the isthmus from one lobe to another, then grows into the thyroid capsule and spreads to neighboring organs and tissues. It mainly affects the muscles of the neck, jaw, trachea, and sternum wall.

Metastasis in 60% of cases occurs through the lymph nodes (preglottic, pretracheal, mediastinal) and in 40% through blood vessels.
Due to its location it is easy to detect and probe. Therefore, 70% of tumors are found in the first stages and successfully treated, which gives a great chance of living for 10-20 years. Another advantage is the relatively calm course and slow growth of such tumors.

Causes and risk factors

Often the cause of adenocarcinoma of the thyroid gland is either nodular goiter, as well as hyperplasia caused by a lack of iodine in the body. Chronic thyroiditis(inflammation of the thyroid gland) is found in 18% of cancer patients. accompanies thyroid cancer in 65% of cases.

Also big influence produces ionizing radiation (radiation), to which a person could be exposed for the treatment of other tumors in the head and neck area, and the consequences of radiation can occur even after decades. In cities with increased level radiation, 15 times more cases of cancer are registered.

Other important factors risk:

• inflammatory diseases of the female genital organs and mammary glands. They cause cancer in 44% of cases, which is why it is so important for women to monitor their health and undergo an annual examination;
• heredity. Development is possible whose parents were closely related to the effects of radiation (for example, during the Chernobyl accident). 33% of people with this diagnosis have relatives with diseases of the endocrine organs;
• iodine deficiency. It can be avoided by eating foods containing iodine or special vitamins;
• genetic predisposition. If there are certain damaged genes in a person's DNA, then there is a high probability that at some time he will develop cancer. The causes of such mutations are not fully understood;
• polluted environment, work in hazardous conditions;
• stress and mental shock;
• smoking and alcohol;
• taking antithyroid drugs.

One of these factors (and even more so a combination of several) can cause carcinoma, but this is not a pattern.

Types of glandular thyroid cancer

According to the degree of differentiation, adenocarcinoma is distinguished:

1. Highly differentiated.
2. Moderately differentiated.
3. Low differentiated.

The difference between these species is the structure of their cells. The lower the degree of differentiation, the more differences are visible in cancer cells compared to healthy tissue. With well-differentiated carcinoma, these differences are insignificant. Treatment methods and prognosis for the patient depend on the degree of differentiation. For the last two types, it is necessary to use more radical methods, strong chemotherapy and high doses irradiation. The first one will be easier to treat.

Adenocarcinoma is also divided into histological types, depending on what type of tissue it grows from. From A-cells and B-cells is formed:

• Papillary adenocarcinoma of the thyroid gland. This option occurs in 60% of cases. This tumor grows slowly and has a good prognosis, despite the fact that it often metastasizes to the lymph nodes. Papillary thyroid cancer can be unilateral or, less commonly, bilateral.
• Follicular adenocarcinoma. Takes 10-20%. It is also a non-aggressive type of cancer with favorable prognosis (they are slightly lower than for the first type). Metastasizes predominantly hematogenously, to the bones. The main cause is iodine deficiency.
• Follicular and– highly differentiated. They can grow for a long time, even 10 years, and not cause any symptoms. But at any moment their differentiation may decrease. Both types are more often found in.

It grows from C-cells (occupies 5-10% of the total number of thyroid cancers). It is poorly differentiated, which means it is more aggressive than papillary and follicular. A feature of medullary cancer is the ability to secrete various hormones(calcitonin, serotonin, prolactin, melanin and others), which is why its specific manifestations appear, such as diarrhea.

There is also anaplastic or undifferentiated carcinoma. It is rare (4-5%). This cancer cannot be classified as any type of tumor due to severe damage to the cell structure. It grows among healthy tissue, intertwining with it, so that there is no clear boundary between them. For the anaplastic type, the prognosis is disappointing, since it grows very quickly and forms metastases, and is also difficult to treat.

Symptoms of thyroid adenocarcinoma

Very often, there are no symptoms of a thyroid tumor in the first stages, which is why it is detected after it becomes visually noticeable. Highly differentiated forms occur latently, without any significant changes in the functioning of the thyroid gland. Aggressive types of cancer manifest themselves faster, this is primarily due to metastasis to nearby tissues and structures.

In this regard, the following signs of thyroid adenocarcinoma appear:

• enlarged lymph nodes;
• neck pain or discomfort when swallowing, lump in throat;
• voice change;
• shortness of breath, cough;
• enlarged veins in the neck;
• increased body temperature;
• emaciation, fatigue, weakness;
• diarrhea (occurs with medullary cancer).

For timely detection of thyroid adenocarcinoma (especially in people at risk), it is recommended to undergo an annual examination. You also need to examine your neck yourself and if you find any abnormalities, contact a specialist.

Stages of thyroid adenocarcinoma

There are 4 stages of development of glandular thyroid cancer:

• at stage 1, the tumor is small in size (up to 1 cm) and is located in one of the lobes of the thyroid gland;
• at stage 2, a neoplasm (or several) measuring 1-4 cm in diameter, which is located inside the gland. It can affect both lobes. There are no regional metastases;
• Well-differentiated tumors at stage 3 are more than 4 cm in size and are mainly limited to the gland capsule. Or these may be small lesions with minimal growth into nearby tissues. Medullary and anaplastic cancer already forms metastases in the lymph nodes during this period;
• Stage 4 is characterized by a tumor of any size with growth beyond the thyroid gland, damage to regional lymph nodes and distant metastases.

Diagnosis of thyroid adenocarcinoma

The first method by which thyroid adenocarcinoma can be detected is by simply palpating the neck area. In this way, tumors even smaller than 1 cm can be detected. This symptom is observed in 90% of patients, exceptions may be hard-to-reach or very small tumors. Also, using palpation, the doctor examines the lymph nodes, which are often enlarged.

Diagnosis of a thyroid tumor includes a blood test for hormones (thyroid-stimulating hormone, triiodothyronine and calcitonin).

To confirm the diagnosis you must do:

• radioisotope scintigraphy. This method is based on the ability of the thyroid gland to absorb iodine, while cancer cells cannot do this. The patient must take a dose of radioactive iodine, which will be absorbed by the gland, then an x-ray is taken. Based on the results, you can see the contours of the thyroid gland and its structure, as well as the neoplasm itself. This method is not very effective, since minor pathologies It won't be visible on an x-ray. It is often used to monitor patients undergoing surgery;
• Ultrasound. This method is widely used to diagnose thyroid cancer and is 90% accurate. Ultrasound can detect neoplasms with a diameter of 1-2 mm; the procedure itself is non-traumatic, easy and affordable. By using ultrasound examination metastases in the lymph nodes can be determined with great accuracy. CT or MRI are used as needed if ultrasound data were unsatisfactory;
• fine needle aspiration. Using a needle, the doctor takes part of the adenocarcinoma material to later determine its type. This procedure is mandatory and its results influence the confirmation of the treatment plan. Sometimes tumor tissue is examined directly during surgery.

To determine the presence of metastases in the lungs, radiography is used.

Treatment of thyroid tumor

In almost all cases, surgical removal tumors. Exceptions include adenocarcinomas with multiple distant metastases. The scope of the operation varies. For small tumors of the first stage, resection of 1 lobe of the gland is performed. At the second stage, subtotal resection is already needed - removal of most of the organ. For patients with the third stage, thyroidectomy is indicated, that is, removal of the thyroid gland. In case of metastases in lymph nodes, lymph node dissection is performed.

After radical operations Patients develop hypothyroidism (lack of hormones produced by the thyroid gland). To correct it, you must constantly take the drug L-thyroxine. When part of an organ is removed, in most cases one lobe of the thyroid gland copes with its work and hormone therapy is not needed. I make the decision to prescribe it based on blood tests.

Treatment of thyroid adenocarcinoma may include and are used in combination with or for unresectable patients. It is advisable to use these methods only for medullary and undifferentiated forms. For papillary and chemo- and radiation therapy do not give results.

A specific method that is used for people with this disease is. Gland cells, and along with them cancer cells, absorb the drug, causing the latter to be destroyed. Radioiodine therapy does not work if the tumor is radioresistant.

Life expectancy for thyroid adenocarcinoma

The prognosis for thyroid adenocarcinoma is generally good. About 70% of patients live more than 20 years. The patient's chances depend on the type of tumor. With the papillary form, the 5-year survival rate is 92-96%, the 10-year survival rate is up to 94%. With follicular, these figures are slightly lower: 80% and 70%, respectively. People with anaplastic cancer live no more than a year.

Carcinoma (cancer) of the thyroid gland occurs in medical practice not so common: it accounts for about 1% of all cancers. However, it requires serious attention, both from the doctor and from the patient: the earlier it is diagnosed, the better the prognosis for the patient.

Our detailed review and the video in this article will help you understand what this pathology is, what morphological types it has (papillary, medullary, follicular thyroid carcinoma), how to recognize cancer at an early stage, and defeat the disease forever.

Despite extensive clinical researches, which are carried out in relation to oncopathology, the exact causes of thyroid cancer are not yet known.

Among the risk factors that provoke malignant degeneration of cells are:

• iodine deficiency in the environment;
• goiter, benign tumors of the thyroid gland;
• hereditary predisposition (thyroid carcinoma in one of the close blood relatives);
• hormone-dependent tumors in women (ovarian, uterine, breast cancer);
• hormonal fluctuations caused by pregnancy and childbirth, menopause;
• harmful factors at work (ionizing radiation, the effects of heavy metals).

Note! Age is another risk factor for thyroid carcinoma. This disease most often develops in women over 40-45 years of age and in men over 55 years of age.

Carcinoma occurs from the papillary or medullary epithelium of the thyroid gland.

The tumor may be:

• primary, developing directly from tissues endocrine organ;
• secondary, provoked by the germination of cancer cells into the thyroid gland from neighboring organs, as well as their hematogenous or lymphogenous spread.

Important! Benign tumors can also develop into carcinoma over time. Therefore, thyroid adenoma in most scientific sources is considered a precancerous condition and requires dynamic monitoring.

Morphological classification

Depending on the morphological type of cells from which the tumor develops and the degree of their differentiation (maturity), several types of thyroid carcinoma are distinguished.

Papillary carcinoma

Papillary cancer ranks first in prevalence. It accounts for about 70% of all malignant thyroid tumors.

This form of carcinoma received its name due to its special morphological structure. If you look at a section of tissue under a microscope (pictured), you can see characteristic palillary (from the Latin papilla - papillary) protrusions on the surface of cancer cells.

As a rule, such carcinoma has a favorable prognosis: the tumor grows slowly and in 80-90% of cases affects only one lobe of the thyroid gland. Metastasis to nearby lymph nodes somewhat worsens the chances of recovery.

Follicular carcinoma

Follicular adenocarcinoma of the thyroid gland occurs in 5-10% of cases of all malignant lesions of the organ. It develops from follicular (thyroid hormone-producing) cells.

Note! Along with hereditary predisposition, the main factor in the development of follicular thyroid cancer is iodine deficiency in the body.

This form of malignancy is considered more aggressive, but rarely spreads beyond the thyroid gland. Metastasis to lymph nodes, lungs and bone tissue occurs in case of late diagnosis and lack of adequate treatment.

Medullary carcinoma

The medullary type of malignant lesion of the thyroid gland is rare: it accounts for about 5%. This carcinoma develops from the parafollicular cells of the organ (C-cells), which are responsible for the production of the hormone calcitonin.

Medullary cancer tends to spread, so it is distant metastases in the lymph nodes, trachea, lungs and liver can be diagnosed even before the primary focus is determined.

Microcarcinoma

Thyroid microcarcinoma is a specific subgroup of thyroid tumors, the size of which does not exceed 1 cm. This form of cancer can develop from any type of cell - papillary, follicular or medullary. Despite its small size, such carcinoma can be very aggressive and spread to nearby lymph nodes.

Clinical signs: how to recognize the first signs of the disease

Symptoms of thyroid carcinoma are not always obvious, so for a long time the disease may go undetected. A palpable dense nodule in the neck, the size of which ranges from 5 millimeters to several centimeters, prompts attention to the patient’s health problems.

Is a nodule in the thyroid gland always cancer?

Don't be alarmed ahead of time: most thyroid nodules are not cancer. Even if the node reaches a significant size, in 95% of cases it is benign. Prevalence nodular goiter increases with age: this common problem persons over 35-40 years old.

However, it is important for every patient to undergo comprehensive examination to accurately determine the morphological structure of the node.

Typical signs of carcinoma

Most often, patients with thyroid cancer consult a doctor with complaints of:

1. One or more knots in the neck. With carcinoma, the formation is dense to the touch and has lumpy edges.
2. Swelling of the neck can be noticeable when the nodular formations are of a significant size, especially when the patient makes swallowing movements.
3. Enlargement of regional cervical lymph nodes.
4. Hoarseness occurs when a large tumor node compresses the larynx and disrupts the process of normal sound production.
5. Violation free breathing and swallowing appears when the tumor node presses on the trachea and esophagus.
6. Sore throat and neck pain are also sometimes found with thyroid carcinoma. They are not typical symptom diseases, but may indicate extensive damage or spread of cancer to neighboring organs.

Early diagnosis methods

The standard algorithm for examining patients with suspected thyroid cancer is presented below:

• Collection of complaints and anamnesis. Tell your doctor in detail about when the first signs of the disease appeared and whether you took any medications or treatments traditional medicine made with your own hands.
• Examination and palpation of the thyroid gland will allow the doctor to determine the size, density and consistency of the tumor node.
• Laboratory tests:
  1. are common clinical tests blood and urine: with carcinoma, leukocytosis, anemia (decreased hemoglobin level), accelerated ESR are observed;
  2. analysis of thyroid hormones: TSH, T3, T4; assigned for evaluation endocrine function thyroid gland;
  3. determination of the level of thyroglobulin - a specific carrier protein, the concentration of which increases with thyroid cancer. This allows us to consider this substance as a tumor marker.
  4. Test for calcitonin (increased in medullary thyroid cancer).
• Instrumental research methods:
  1. Ultrasound of the thyroid gland and cervical lymph nodes;
  2. Biopsy with morphological study the obtained biomaterial.

Morphological examination is the main method for diagnosing cancer

To reliably determine the morphological structure of the cells of a tumor node and confirm or refute the diagnosis of carcinoma, it is necessary to conduct a fine-needle biopsy with examination of the obtained biological material. The procedure is carried out under ultrasound guidance and consists of puncturing the neck and taking a small piece of thyroid tissue.

Microscopy of the resulting sample will allow us to determine the cellular structure of the formation and determine correct diagnosis including tumor type and extent.

Table 1: Indications for biopsy:

Principles of treatment

Main method radical treatment carcinoma is the surgical removal of the thyroid gland. A promising direction in the treatment of highly differentiated forms of cancer is the use of radioactive iodine (isotope I131).

This treatment method allows for targeted destruction tumor cells, which were not removed during surgery, and also fight distant metastases.

Important! Modern medical instructions do not require immediate removal of small (less than 1 cm) thyroid nodules that have become an accidental finding on ultrasound. If the patient makes no complaints, but hormonal background not impaired, dynamic observation is preferable.

Taking levothyroxine will help meet the body's need for thyroid hormones and prevent regrowth of thyroid tissue. Selection and adjustment of the dosage of the drug is carried out by the doctor individually based on laboratory and clinical data.

Forecast

In most cases, thyroid carcinoma is a curable disease. The prognosis is considered favorable for young patients with papillary, follicular and, to a lesser extent, medullary cancer.

Unfavorable factors for the life and health of the patient include:

• elderly age;
• large size (4 cm and above) of the primary tumor;
• the presence of metastases in the brain and internal organs.

Note! The prognosis of thyroid carcinoma depends not only on the stage tumor process, but also on the degree of differentiation of cancer cells. Well-differentiated (mature) forms of the tumor are considered less aggressive and rarely cause damage to neighboring organs or invasion into blood vessels. Low-grade forms (immature, similar in structure to stem cells) forms are more malignant and lead to the development of complications.

Despite the difficulties in diagnosing and treating malignant tumors of the thyroid gland, papillary, follicular or medullary carcinoma has a relatively favorable course and prognosis for the patient. After the therapy, most patients are considered recovered, and with the exception of the need for daily intake hormonal drugs their lives return to normal.

Papillary thyroid cancer or papillary carcinoma is the most common form of cancer of the glandular cells of the epithelium of this endocrine organ. The thyroid gland consists of 3 types of cells: papillary, follicular and medullary. Thyroid cancers are divided into 4 types, depending on which cells undergo mutation:

• Papillary thyroid cancer occurs in 80% of cases and has the most favorable prognosis for survival.
• Follicular carcinoma – 10%. Early diagnosis provides a good prognosis for complete cure.
• Medullary oncological tumor – 6-8%. The survival prognosis is extremely unfavorable due to the impossibility of early diagnosis using radioactive iodine. Fine needle biopsy (FNA) also gives only a 20% chance of diagnosis.
• Anaplastic carcinoma – 1-2%. This rare, very aggressive form of undifferentiated origin occurs only in elderly patients over 70. This cancer develops from papillary and medullary cells of the gland affected by the cancer.

Risk factors that contribute to cancer include hereditary predisposition, chronic iodine deficiency in food and damage from ionizing radiation due to man-made disaster or during special treatment. Statistically, thyroid cancer is diagnosed 3 times less often in men than in women. As a rule, thyroid cancer is observed in young women - up to 40-50 years of age and in older men - after 60 years of age.

There are several types of papillary thyroid cancer:

• Typical form.
• Microcarcinoma. This type has a fairly favorable prognosis due to the small (less than 1 cm) size of the formation, which practically does not develop or grow.
• Papillary follicular carcinoma. This formation combines the characteristics of both types. Metastases do not spread much and do not reach distant organs. Has a favorable prognosis.
• Solid. Often diagnosed in patients exposed to radiation. Metastases mainly affect blood vessels and lymph nodes.
• Oncocytic carcinoma. Education of this type is quite rare in people. However, the form is considered quite aggressive, the degree of metastasis to distant organs and systems is high.
• Diffuse sclerotic tumor. Very rare view education, is more often diagnosed in children aged 7 to 14 years. This type is characterized by many foci, spreading throughout the thyroid gland. Metastasis to the lymph nodes and lungs is almost always observed. This disease is the most dangerous and unfavorable.
• Clear cell. This form cancer noted only in 0.3% of cases. It has been studied quite little, metastases mainly spread to the kidneys.
• High cell. Is aggressive look, grows very quickly in size and affects the thyroid gland. It has high level spread of metastases to nearby and distant organs.
• The mixed form is a combination of papillary, follicular and solid structures. It is observed in half of the cases of all diseases.

In addition, there are encapsulated (tumor inside its own capsule) and non-encapsulated types of papillary cancer.

Clinical degrees of development

The identification of degrees or stages of cancer development does not depend on its differentiation. When compiling the classification, the patient’s age and histological structure malignant formation. Papillary thyroid cancer stages I and II are divided according to age into 2 conditional subgroups: 1) up to 45 years; 2) patients over 45 years of age. This grading makes it possible to more clearly determine the survival prognosis for the patient.

The main signs by which the stage of development of papillary carcinoma is determined, according to international classification TNM:

(VI zone of lymph flow) no

First signs and characteristic symptoms

This type of tumor, in the overwhelming majority, develops extremely slowly. As a rule, it affects only one lobe of the gland, but it can also affect adjacent lymph nodes.

• Papillary carcinoma begins asymptomatically, without hormone imbalance, without increased antibody production, and without any serious signs.
• When the first or second stage is diagnosed early, patients complain of general lethargy, dry skin, difficulty breathing, a cotton ball in the throat, swelling of the neck in the area of ​​the gland, soreness and unreasonable cough, difficulty swallowing, and hoarseness.
• If papillary carcinoma has spread to the lymph nodes, then palpation reveals their enlargement, and patients complain of pain in the throat, chest and uncomfortable feeling in the armpits.
• In the advanced IVC stage, symptoms are varied and depend on which organs are affected by metastases. There are signs of cancer intoxication. Patients quickly lose weight, their skin becomes sallow-gray, and they are constantly plagued by pain, which can only be relieved with narcotic drugs.
• At any stage of cancer, given the characteristic slow progression papillary form, and in the case of large tumor sizes, the level of secretion of thyroxine and triiodothyronine decreases and hypothyroidism additionally develops.

Diagnosis and treatment

Among all types of thyroid cancer, papillary carcinoma has the best survival prognosis. The diagnosis is clarified using ultrasound. If the size of a thyroid nodule exceeds 10 mm, a fine-needle aspiration biopsy (FNA) is performed. If necessary, the following may be additionally prescribed:

• X-ray;
• radioisotope scintigraphy or determination of the expression of certain genes.

At the IVC stage, additional research to identify organs affected by metastases.

Treatment of papillary cancer includes the following procedures:

• Surgical intervention - thyroidectomy.
• The extent of the operation depends on the size of the tumor and the presence of metastases. The operation is performed under general anesthesia. Modern methods allow you to achieve an excellent cosmetic effect - the scar is very small and almost invisible. Unfortunately, the operation does not affect the restoration of voice timbre. Immediately after the operation, the patient is prescribed hormone replacement. You need to be prepared for the fact that the first time correct dosage will not be found - symptoms of hypo- or hyperthyroidism may occur.
• Treatment with radioactive iodine.
• This type of treatment is carried out after surgery. Approximately one month before the start of such treatment, taking hormones is canceled and eating is prohibited. sea ​​salt, seafood, dairy products and finished products containing the E127 additive. Radioactive iodine taken in the form of liquid or special capsules. Side effects are rare, and discomfort and symptoms are caused by prior withdrawal of hormones.
• Radiotherapy.
• This treatment is only used in stage IVC. The number of courses and sessions is selected purely individually. Possible side effects: dry mouth, nausea, vomiting, painful swallowing, lethargy. These unpleasant symptoms, after a few weeks, disappear on their own.

Survival prognosis

How long patients diagnosed with papillary thyroid cancer will live after surgery directly depends on the stage of development of the disease, the extent of resection of the affected area and general condition body. It should be noted that at the moment there is no statistical evidence that early diagnosis small papillary tumors has a positive effect on length and quality of life, but a more favorable prognosis is observed for younger patients.

Five-year forecast:

• in patients with stages I and II up to 45 years - 100% survival rate;
• I and II after 45 – almost 100%;
• Stage III – 93%;
• IV A and B – from 60 to 70%;
• IVC stage – up to 51%.

The average survival rate for a five-year period after surgery is 97%.

Estimated indicators of survival forecasts after the operation: from 5 to 10 years – 93-83%; from 10 to 15 years – 83-80%; from 15 to 20 years – 80-75%. European statistics say that women cope with the consequences of surgery much better than men. The overall average survival rate after thyroidectomy in women is 85%, in men – 74%.