Thyroid Cancer

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Thyroid is one of the largest endocrine glands in the body. It’s a butterfly shaped structure, with 2 lobes connected in the centre and is located in the base of neck, just below Adams Apple. Its main function is to produce hormones:  T3, T4 and Calcitonin.

These hormones play a key role in regulating weight, blood pressure, body temperature and heart rate. In past decade, incidence rate of differential cancer, both men and women, has increased. Studies have documented a higher rate of occurrence in colder areas as compared to hotter ones. [1]

Thyroid cancer

Signs and Symptoms of Thyroid Cancer

These are the signs and symptoms given below

  • Most commonly observed sign by a patient is a Lump or swelling in neck which makes him visit a doctor.

It’s commonly associated with difficulty to swallow or breathe and pain in neck region.

  • Changes in voice – mainly hoarseness for a long period along with constant cough not related to cold can also be noticed
  • For a GP, enlarged lymph nodes are an indication for further investigation.

Classification of Thyroid Cancer

Thyroid cancer is classified based on the cellular representation and the cells causing cancer.

Papillary Carcinoma

It is the most common subtype of thyroid cancer but with an excellent prognosis. Incidence rate is reported to be around 75%-85% It is associated with increased risk with irradiation.

Follicular Carcinoma

Incidence rate of 10%-20%  and with a good prognosis. Exhibits uniform follicles.

Medullary Carcinoma

Incidence rate is  5%-8%. It is a cancer of parafollicular cell  “C cells” that produce calcitonin.

Undifferentiated / Anaplastic

Mostly occurs in Older Patients and is associated withvery poor prognosis.

Thyroid Lymphoma                                      

It is a rare form of thyroid cancer that begins in the immune system cells. [2]

Risk Factors of Thyroid Cancer

There is no specifically associated risk factor for thyroid cancer and is a topic of many clinical researches. Some of the few documented risk factors:

  • Sex- Females have a higher incidence recorded in the literature
  • Exposure to high levels of irradiation, especially in childhood
  • Genetically inherited syndromes like multiple endocrine neoplasia, familial meduallary thyroid cancer, familial adenomatous polyposis.

Diagnosis of Thyroid Cancer

Your symptoms can be evaluated by many Health professionals who can help determine your risk for thyroid cancer include:

  • Endocrinologists
  • Family medicine physicians
  • General practitioners
  • Internists
  • Nurse practitioners
  • Physician assistants

To diagnose the disease a series of tests and steps will be followed by any physician you plan your appointment with. The first and foremost is physical examination. If your doctor has a suspicion in that case you ll be required to undergo Laryngoscopy, CT/ ultrasound, followed by fine needle biopsy and some blood tests to check hormonal levels.

Tests for Thyroid Cancer

Once a treatment has begun, it becomes very important to check the status of your cancer, if its under regression or progression. So some tests are conducted at regular intervals like Ultrasound, Serum Thyroglobulin level and Radioactive iodine scans.

Early Detection

No screening tests available at the moment, but you can visit your doctor and mention it. Since its genetically linked, it becomes important to tell you GP about your family history and get it documented in your personal file, if anyone in your family had thyroid cancer.

Genetic tests can be done to check for any hereditary causes. [3]

Treatment of Thyroid Cancer

Various treatment options are available depending on age and staging of cancer. Your doctor can suggest you following treatment options.

  • Surgery

Most common and best treatment is Surgery to remove the cells that are cancerous or even the doubtful cells. Removing both lobes is called total thyroidectomy. Lymph nodes may also be removed during surgery.

  • Radiotherapy

Radioactive iodine, is used after a waiting period post- surgery to destroy any remaining thyroid tissue. In this period patient might experience symptoms similar to hypothyroidism like fatigue, weight gain, depression and memory loss

  • Thyroid-stimulating hormone (TSH) suppression therapy.

This therapy causes a reduction of the TSH in your body, which may help prevent the growth of any remaining cancer cells.

Out-patient therapy for Thyroid Cancer

Even after the surgery, a patient is supposed to continue with life-long hormone replacement therapy as thyroid hormones play an important role in regulating body metabolism.Hormones levels should be checked using regular blood tests.

In recent researches, Lenvatinib, was associated with significant improvements in progression-free survival and the response rate among patients with iodine-131–refractory thyroid cancer. [4]

 

References


[1] “Cold Climate Is a Risk Factor for Thyroid Cancer” by Lehrer S, Rosenzweig KE – 2014 Oct 26, http://www.ncbi.nlm.nih.gov/pubmed/25558467


[2] Chapter 20, Mitchell, Richard Sheppard, Kumar, Vinay; Abbas, Abdul k, Fausto Nelson – Robbins Basic Pathology, 8th edition,

http://www.mayoclinic.org/diseases-conditions/thyroid-cancer/basics/causes/con-20043551


[3] http://www.webmd.com/cancer/tc/thyroid-cancer-treatment-overview?page=2


[4] Lenvatinib versus Placebo in Radioiodine-Refractory Thyroid Cancer,Martin Schlumberger, M.D., Makoto Tahara, M.D., Ph.D., Lori J. Wirth, M.D., Bruce Robinson, M.D., Marcia S. Brose, M.D,N Engl J Med 2015; 372:621-630, February 12, 2015, http://www.nejm.org/doi/full/10.1056/NEJMoa1406470?query=featured_home

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