Papillary thyroid cancer or papillary thyroid carcinoma , is one of the most common thyroid cancer form to exist. Its incidence rate is as high as 75%-85% and usually occurs in females in age group of 20-55. There is a high risk of occurrence if a patient has a history of childhood irradiation. Even though has a very high occurrence, it has a very good prognosis. Papillary cancer often presents as a thyroid nodule which does not take up radioactive iodine or as an enlarged lymph node showing metastasis .
The course of disease depends on extension stages: occult carcinoma, intrathyoid carcinoma and extrathyroid carcinoma. But, in a study published in 1961 shows that results are more favourable if patient is below 40 years .
Diagnosis of Papillary Thyroid Cancer
Fine needle aspiration is the gold standard for diagnosis with the help of Ultrasound. Among other imaging techniques CT/MRI is used to check hot nodules. Blood markers should be checked and most frequently used is Thyroglobulin – a marker for a well differentiated tumor.
In case of suspicion of lung metastasis, broncho-alveolar lavage is done .
Pathology of Papillary Thyroid Cancer
Empty appearing nuclei or commonly known as ORPHAN ANNIE’S EYES are a histological characteristic of papillary thyroid carcinoma. Histologically , its multifocal and unencapsulated.
Hematogenous spread is less common than lymphatic spread, hence, Usually metastasize to near-by lymph nodes. It usually metastasizes to lung and form small nodules.
Lateral Aberrant Thyroid- This is a result of lymph node metastasis as a result of papillary carcinoma.
Genetic association of Papillary Thyroid Cancer
Most of the associated mutations result in activation of a common carcinogenic pathway called – the MAPK/ERK pathway. Mutation can be a chromosomal translocation involving RET proto-oncogene and NTRK-1 or a point mutation in BRAF oncogene. Most commonly seen is point mutation in nearly 50% of the cases .
Staging of Papillary Thyroid Cancer
For staging we use TMN classification, and divide it into stage I- IV. Survival rate decreases as the staging progresses.
Treatment of Papillary Thyroid Cancer
Age of the patient and size of the nodule mainly determine the choice of treatment .
Stage I and II
- Total thyroidectomy which means total removal of thyroid gland is used when in suspicion of a large spread.
- Lobectomy, or removal of a lobe and all of thyroid is also used to salvage the healthy tissue.
- Total thyroidectomy along with Lymph node removal and any other extra thyroid spread is the most common intervention
- After surgery, I 131 Ablation is used to remove any remnants from surgery.
- And only if I 131 don’t work then External beam radiation is used.
- Usually cancer metastasizes in this stage, so I 131 ablation is used as a therapeutic dose to kill the cancerous cell.
- External beam radiation is used for patients who are unresponsive to I 131 treatment
- Resection of metastases is done only when cells don’t exhibit I 131 uptake.
- As an alternative, TSH suppression therapy along with thyroxine can be used if patient seems unresponsive to I 131 treatments .
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 “Papillary thyroid carcinomas” – Jacqueline Tscholl-Ducommun, Chr. E. Hedinger, http://link.springer.com/article/10.1007/BF00428498#page-1
 “Preoperative Diagnosis of Benign Thyroid Nodules with Indeterminate Cytology” – N Engl J Med 2012; 367:705-715 – August 23, 2012 – DOI: 10.1056/NEJMoa1203208, http://www.nejm.org/doi/full/10.1056/NEJMoa1203208#t=articleBackground
 “Independent Clonal Origins of Distinct Tumor Foci in Multifocal Papillary Thyroid Carcinoma” – Trisha M. Shattuck, B.S., William H. Westra, M.D., Paul W. Ladenson, M.D., and Andrew Arnold, M.D.,N Engl J Med 2005; 352:2406-2412 – June 9, 2005 – DOI: 10.1056/NEJMoa044190, http://www.nejm.org/doi/full/10.1056/NEJMoa044190#t=articleBackground
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