What are the known well-differentiated thyroid cancers?
There are 2, papillary cancer and follicular cancer. The papillary type is the most frequent and has the best prognosis. It occurs in all ages, although it is more frequent in women (3 to 1). In more than half of the cases it is multiple (several tumor nodules in the gland). The follicular type is less frequent, about 5-10% of cases. Its histological diagnosis is more complicated, so a simple cytology is not enough, and it is diagnosed accurately after removal of the tumor.
What is the prognosis of differentiated thyroid cancer?
In general, the prognosis of these tumors is very good, especially that of papillary cancer. In addition, in the case of metastasis, the latter presents a local or regional invasion, through the lymphatic vessels. On the contrary, although the prognosis of follicular cancer is also favorable, it has an invasive preference through the blood vessels, which is always less advisable.
Is surgery effective in eliminating differentiated thyroid cancer?
In most cases it is, given the low aggressiveness of the tumor cells and the lack of distant extension of the disease in most cases. However, treatment and follow-up must be multidisciplinary, with a surgeon, an endocrinologist and, if necessary, an expert in nuclear medicine.
Is recurrence of these tumors frequent?
Yes, it can reach 30% in a period of 10 years, although there are variables that can modify these figures, such as the size of the tumor, age, sex or the specific histological characteristics of the tumor. Despite this, treatment of recurrence, generally local, is very effective, allowing high-resolution ultrasound and measurement of thyroglobulin level, adequate follow-up, in most cases.
Is it a hereditary disease?
In principle there is no clear genetic correlation, although there is a so-called familial non-medullary thyroid cancer responsible for 5% of cases, which is classified as such when at least two relatives of the patient (in the first degree) have had the disease, in the absence of radioactive exposures or other genetic syndromes. They are papillary type tumors.
For all these reasons, it is important that people with this family history be followed up prophylactically.
What is papillary microcarcinoma?
A papillary tumor of less than 1 cm in size is defined as such. It is not usually associated with any type of symptom, given its small size, but the routine use of high-resolution ultrasound diagnoses it more frequently. Its prognosis is therefore excellent.
Who should operate on this type of tumor?
Any surgeon with expertise in endocrine pathology of the neck and with a high annual casuistry, ideally above 30 cases per year, on a sustained basis. This will avoid numerous complications, mainly those related to the lesion of the laryngeal recurrent nerve. It is true that there are modern techniques that facilitate its vision that, although they are useful in complex cases, have not shown superiority over the most important factor for them not to occur, which is the surgeon’s experience.