Thyroid cancer: definition, diagnosis and treatment

What is thyroid cancer and what types are there?

Thyroid cancer is a group of tumor diseases that obey general histological characteristics, characterized by the fact that these cells have become dysregulated, that is to say, they do not have the normal regulation that the rest of the healthy cells have and they function, let us say, independently. There are basically four types. Two of them are very benign, the first of them, papillary cancer, is the mildest tumor, let us say with the best prognosis, that exists in all oncology, and they are cells that differentiate very little from normal cells, they advance very slowly and therefore have a good prognosis, the disease itself. A third type is called medullary thyroid cancer, it has origin in different cells, cells that secrete another hormone, not the thyroid hormone but calcitonin and it occurs in a percentage of 30 – 40% of cases with family origin. This syndrome is also characterized by other types of tumors. Finally, there is anaplastic cancer, a very aggressive cancer, which is produced by a massive differentiation of these follicular cells, the basic cells of the thyroid, which occurs mainly in the elderly and which really has a poor prognosis but fortunately occurs in very few cases.

How is it diagnosed?

Thyroid cancer is usually diagnosed by chance. The patient is usually asymptomatic and it is because of a check-up for any other circumstance, an ultrasound for a cervical injury or trauma or a company check-up, that a nodule can be diagnosed in the central area or parallel to the central area, which is where the thyroid is located. And on other occasions it is true that the patient himself or someone else can see a formation protruding or one can palpate a nodular area. Other times, much more rarely, it can be diagnosed due to complications of an aggressive cancer, which can cause hoarseness, voice alterations… but these are very rare. The definitive diagnosis will be made with a clinical examination, a history, and fundamentally by means of an ultrasound and a cytology, which is called F.N.P. or fine needle puncture. There are other tests to identify the extent of the tumor, but essentially these are the fundamental ones, which are used preoperatively.

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How is thyroid cancer treated?

In principle it is a surgical treatment. It is the basis of the treatment and what will allow the patient to be cured. However, in addition to surgery, there will be another type of treatment that must be performed in some cases it can be omitted, in cases with very little advanced stages or very small tumors, but in general it will always be given, which will be radioiodine or radioactive iodine to complete the elimination of all the cellular remains that may have remained and that the surgeon has not been able to remove. Thirdly, the patient, once discharged, will have to be treated with thyroid hormone replacement therapy in order to keep the TSH hormone levels as low as possible. Finally, the overall follow-up of the treatment will be mainly by your endocrinologist, but also by the endocrine surgeon so that there is an evaluation of some tumor marker such as thyroglobulin or ultrasound control or by magnetic resonance imaging to see how the operated area evolves.

Can the surgery be performed by any general surgeon?

In principle, complex surgeries involving technical difficulties and doubtful prognoses, as in any part of the human body surgery, must be performed by experts. In principle it should be performed by a surgeon with high anatomical and surgical training in cervical surgery and the aim of this is to avoid complications and surgical sequelae arising from injuries of parathyroid glands, nerves or major vessels that are in the cervical region and, on the other hand and fundamental, for a correct and complete removal of the lymph nodes. Lymph nodes that will determine the prognosis and evolution of this disease and that must be performed correctly and completely if possible in a first intervention.