How to treat thyroid cancer?

Thyroid tumor is a common and frequently-occurring disease, most of which are benign adenomas and a few are cancers and rare sarcomas. According to 16 national statistics, Colombia, Hawaii and Iceland have the highest annual incidence rate of 3.5%/65438+ 10,000, while Denmark has the lowest annual incidence rate of 0.9/65438+ 10,000, and Japan, Finland and Switzerland are in the middle.

Thyroid tumors are mostly painless single nodules, which should be differentiated from other thyroid diseases in clinic. Sometimes differentiated adenocarcinoma is very similar to adenoma, and imaging and fine needle aspiration are helpful for diagnosis.

Thyroid tumors mostly occur in young women, and surgical resection is the only treatment. Thyroid cancer is composed of many cancers with different biological behaviors and pathological types, and its onset age, growth rate, metastasis route and prognosis are obviously different. The treatment of thyroid cancer includes surgery, radiotherapy and chemotherapy, among which surgery is the main treatment. A small number of residual lesions after differentiated cancer surgery can be controlled by radiotherapy. The treatment of cancer involving bilateral recurrent laryngeal nerve and trachea is still an unsolved problem in the field of contemporary surgery.

Because thyroid cancer has many different pathological types and biological characteristics, its clinical manifestations are also different. It can coexist with multiple thyroid nodules, most of which are asymptomatic. Occasionally, there are nodules or masses in the anterior cervical region, and some masses have existed for many years and have only recently increased or metastasized rapidly. Some patients have no discomfort for a long time after resection, and they only pay attention to it after cervical lymph node metastasis, pathological fracture, hoarseness, respiratory disorder, dysphagia and even Horner syndrome. Local signs are also different, such as asymmetric thyroid nodules or lumps, lumps or glands, which move up and down with swallowing. When the surrounding tissue or trachea is invaded, the mass is fixed.

(1) Papillary carcinoma is a well-differentiated thyroid carcinoma and the most common one, accounting for about 3/4 of the total. Lesions are generally single, with different sizes, and the smallest diameter is below 0.5cm, which is called microcarcinoma. Cryptocarcinoma with a diameter below 1cm is called cryptocarcinoma, and the diameter of large lesions can be greater than 10cm. Small tumors are often solid lesions, and large tumors are often accompanied by cystic changes. When cystic changes, there are grape cluster nodules protruding in the capsule cavity and old blood in the cavity. This kind of cancer generally has no capsule, and only 5% of it is incomplete. Microscopically, some tumor cells are arranged in papillary shape, with different sizes and lengths, and there are more than 3 branches. The center of papillary process is fibrous vascular sac, and the cells are the same size. The nucleus is small and rarely divides. Papillary carcinoma is often accompanied by follicular carcinoma, but the tumor is still named papillary carcinoma, not follicular carcinoma or mixed type. If papillary carcinoma contains undifferentiated carcinoma and should be named undifferentiated carcinoma, it also means that this undifferentiated carcinoma may be the further deterioration of papillary carcinoma. Sometimes the lump is very small, and cervical lymph node metastasis is often found. The malignant degree of this cancer is low, and the annual survival rate of 10 can reach 88%. Clinically, papillary carcinoma often appears solitary nodules in thyroid region, most of which are above 1cm in diameter. Concealed cancer is more common in autopsy, or a mass is found when lymph node metastasis occurs in the neck area.

(2) Follicular carcinoma accounts for 10% ~ 15% of all thyroid cancers. When examined by naked eyes, follicular carcinoma is a tumor with a substantial capsule, which is often densely covered by a rich vascular network. Smaller tumors are very similar to thyroid adenomas. The section is reddish brown, and fibrosis, calcified bleeding and necrosis are often seen. Histologically, it consists of follicles with different degrees of differentiation. In well-differentiated patients, follicular structure is typical and cell atypia is small. At this time, it is difficult to distinguish it from adenoma, and the pathological diagnosis depends on capsule or vascular infiltration. In poorly differentiated patients, follicular structure is less, cell atypia is greater, and mitotic images are more, which can be arranged into rope-like solid nests. Sometimes cancer cells penetrate the capsule and enter multiple veins to form tumor thrombus, which often becomes the starting point of distant metastasis, so follicular carcinoma is more common in blood metastasis, and the literature reports account for 19% ~ 25%. Follicular carcinoma is more common in middle-aged and elderly women aged 40 ~ 60, and its clinical manifestations are similar to papillary carcinoma, but the tumor mass is generally larger, with less local lymph node metastasis and more distant metastasis. A few follicular cancers infiltrate and destroy adjacent tissues, which may cause respiratory tract obstruction and other symptoms.

(3) Medullary thyroid cancer was first described by horn in 195 1, and this special type of cancer was further clarified by Hazard in 1959. And named it medullary carcinoma. It accounts for 3% ~ 10% of the total thyroid cancer. The tumor is generally round or oval with clear boundary, hard or irregular texture, infiltration of thyroid parenchyma around it, gray or reddish section, bleeding necrosis and calcification, and the average diameter of the tumor is about 2 ~ 3 cm. Microscopically, cancer cells are oval, polygonal or spindle-shaped, with a small to moderate mitosis; Cells are arranged in nested bundles or glandular cavities. There are different amounts of amyloid in the matrix. When there are more cancer cells, there is less amyloid, and vice versa. The same is true for metastatic lesions. Medullary thyroid carcinoma is a moderate malignant tumor, which can occur at any age. There is no significant difference in incidence between men and women. Most of them are sporadic, and about 10% are familial. Clinically, besides thyroid mass and cervical lymph node metastasis, like other thyroid cancers, it also has its own unique symptoms. About 30% patients have a history of chronic diarrhea, accompanied by carcinoid syndrome in facial flushing, or Cushing's metabolic syndrome, which is related to tumor cell products.

Familial medullary carcinoma has the following characteristics:

① The onset age is relatively young, with an average age of 33 at the time of diagnosis, and the average age of sporadic medullary carcinoma at the time of diagnosis is over 55.

② All of them were bilateral adenocarcinoma, with multicentric lesions of glandular lobe and asymmetrical tumor distribution and morphology. There may be a huge tumor on one side and only histological signs on the opposite side, but all of them are bilateral lesions without exception. Sporadic cases are mostly unilateral tumors.

③ The tumor mass of familial medullary carcinoma is small, and some findings are hidden by screening. In sporadic cases, the diameter of the tumor is greater than 4cm.

④ Lymphatic metastasis in familial patients is rare, and distant metastasis is even less, which may be due to early detection.

⑤ Familial medullary carcinoma is mostly located in the place with dense parafollicular cells, that is, at the junction of the upper and middle third of the glandular lobe.

⑥ Familial medullary carcinoma is often accompanied by pheochromocytoma or hyperparathyroidism.

(4) Undifferentiated thyroid cancer is a highly malignant tumor, which is rare, accounting for about 5% ~ 10% of all thyroid cancers, and it is common in the elderly. Undifferentiated cancer grows rapidly and often invades surrounding tissues early. Macroscopically, the cancer has no capsule, the section is pale, bleeding and necrosis. Histologically, undifferentiated carcinoma can be divided into prismatic cell type and small cell type. The main manifestation is the mass in the anterior cervical region, which is hard, fixed and unclear. Often accompanied by dysphagia, dyspnea, hoarseness and neck pain and other symptoms. Both necks are often accompanied by lymphadenopathy, and blood metastasis is also common.