Medullary Thyroid Cancer

Medullary cancer, arising from cells called C cells or parafollicular cells in the thyroid gland, constitutes 5-10% of all thyroid cancers. This tumor has familial (hereditary) characteristics in 30% of patients. This type of cancer is more likely to spread to the lymph nodes in the neck than other types of thyroid cancer.

The level of a hormone called calcitonin increases in the blood of patients with this disease. This can sometimes make it easier to diagnose the disease.

This tumor, which is seen equally in men and women, presents in two forms:

Patients in the first group, which constitutes the majority, are in their 50s. and consists of individuals in their 60s who have no family history of medullary thyroid cancer. Their tumors are not hereditary (familial).
The disease of the patients in the second group is hereditary. In other words, they are people whose family members have been diagnosed with medullary cancer or who are likely to develop medullary cancer in some of their family members in the future. They usually get this disease at a younger age.

Medullary thyroid cancer can be encountered in patients with syndromes called MEN2a (Multiple Endoctrin Neoplasia) and MEN2b (hereditary anomalies involving more than one organ and system). In patients with this syndrome, thyroid medullary cancer occurs at a younger age than patients whose disease is not hereditary, as well as tumors and dysfunctions in other organs and body parts.

What are the causes of medullary thyroid cancer and in whom is it more common?

This disease occurs in 70% of patients without any known cause.
Genes are responsible for 30% of the disease. That is, these patients genetically inherit this disease.

Unlike papillary thyroid cancer, radiation has not been proven to have an effect on the formation of this disease.

Medullary What kind of symptoms does thyroid cancer cause?

In a significant portion of patients, this tumor appears as a swelling or mass in the front or side of the neck. In this disease, there are generally no symptoms that the patient can notice other than a mass or nodule in the neck or thyroid gland. In very few patients Symptoms such as problems with swallowing and breathing or hoarseness due to the pressure of the mass may also be present.

How is medullary thyroid cancer diagnosed?

In the examinations performed after detecting a mass in the neck or a nodule in the thyroid gland, it may be understood that this mass occurs due to medullary cancer in the thyroid or lymph node enlargement caused by the spread (metastasis) of the cancer.

More rarely, the person When a genetic, that is, hereditary type of medullary cancer is detected in one of the close relatives, the person is also subjected to examinations and it may be revealed that he/she also has medullary cancer or pre-medullary cellular changes.

Diagnostic examinations to be performed in both cases;

– Taking a needle biopsy from the masses and evaluating it by pathology specialists,
– Checking the levels of the hormone called calcitonin in the blood.

Your physician will provide you with the necessary information on this subject.

How is medullary thyroid cancer treated?

The main treatment for medullary thyroid cancer is surgery. Complete removal of the thyroid gland, removal of the lymph nodes in the midline of the neck, behind the breastbone, called the board of faith, and sometimes cleaning of the lymph nodes on the side of the neck (neck dissection) are surgical interventions.

In patients who have undergone surgery, surgery is performed. In the post-operative period, radiotherapy (radiation therapy) is also added to the treatment in a significant portion of patients.

Radioactive iodine application (atomic therapy) is almost never beneficial or has no place in the treatment of this disease.

Patient and disease. Choosing the most appropriate treatment for your condition requires serious experience and medical knowledge. Your physician will determine the most appropriate way to follow in planning your treatment.

Is another operation or treatment required after medullary thyroid cancer surgery?

In case medullary cancer is detected in the removed thyroid gland tissue, the patient's age, gender, other diseases Many factors such as whether the tumor is present or not, the size of the tumor, the cell characteristics in the microscope, the spread of the tumor to the lymph nodes, the surrounding or distant organs, may require a second surgery (if not removed, thyroid surgery). It may bring up additional treatments such as removing the other half of the tumor or cleaning the neck lymph nodes) or radiotherapy.

Evaluating all these factors and choosing the most appropriate treatment for the patient and the disease requires serious experience and medical knowledge. Your physician will determine the most appropriate path to follow in planning your treatment.

What is neck dissection in the treatment of medullary thyroid cancer and when is it necessary?

A part of the surgical treatment of malignant tumors in the head and neck region is the disease involved. It is a neck dissection operation, which is the systematic removal of obvious or possible lymph nodes without damaging vital structures in the neck. This operation is almost always performed simultaneously with the removal of tumor tissue.

Medullary thyroid cancer is also a tumor that can, and often does, metastasize (spread) to the neck lymph nodes. For this reason, dissection of the anterior neck region (see areas VI – VII in the figure), where this tumor most frequently metastasizes, is often performed as a precaution. If there are metastases in the lymph nodes in these areas (on examination, ultrasound or MRI), dissection becomes a particularly necessary procedure during the removal of the thyroid gland.

Medullary thyroid cancer sometimes spreads to the lateral parts of the neck (see figure). Regions II – III – IV – V) can metastasize. In this case, a neck dissection involving these areas may be necessary.

Your physician will inform you about the necessity of neck dissection.

Why is it important to protect the nerves in thyroid surgeries?

The superior laryngeal nerve, which controls the tension of the vocal cords, and the inferior (recurrent) laryngeal nerve, which provides movement of the vocal cords, are very important structures in terms of voice and speech. In case of damage to the superior laryngeal nerve, the patient has difficulty making high-pitched sounds, while in case of damage to the recurrent laryngeal nerve, serious hoarseness usually occurs.