Papillary thyroid cancer, which constitutes 70% - 80% of cancers seen in the thyroid gland, has probably become one of the most frequently diagnosed cancers of the body with the development of diagnostic methods such as ultrasound and needle biopsy. It is one of the types of cancer that can often be treated successfully and has the most satisfactory results, especially in individuals under the age of 45.
This slow-growing tumor can sometimes metastasize (spread) to the lymph nodes in the neck. It is a common situation that we encounter surgery to remove the tumor-containing half or all of the thyroid gland, sometimes to cleanse the lymph nodes in the neck from the body (neck dissection), and then, if necessary, radioactive iodine treatment to completely restore the patient's health.
Micropapillary. What is thyroid cancer (papillary microcarcinoma)?
If it is understood that a thyroid nodule smaller than 1cm in the thyroid gland tissue contains papillary thyroid cancer, micropapillary thyroid cancer is in question. This situation may occur in the following ways:
1- After the nodule shows suspicious findings on ultrasound, samples taken from it with a fine needle biopsy show the presence of thyroid papillary cancer,
2- In the thyroid tissue removed by surgery, there are no large nodules. , Detection of one or more papillary cancer focuses smaller than 1cm.
3- Upon detection of papillary cancer focus in the lymph nodes in the neck, in addition to neck dissection, the thyroid gland is also removed and this gland is examined by pathologists. Detection of one or more papillary cancer foci.
An additional feature of micropapillary thyroid cancer is that if there is no metastasis to the neck lymph nodes and the tumor is limited within the thyroid gland tissue, the tumor-containing half of the thyroid gland is removed (in both halves of the gland). If a tumor is detected, its entire removal can be provided) to provide adequate treatment. Most of the time, surgical treatment is sufficient, and then an additional method such as radioactive iodine treatment is not needed. However, in such cases, the treatment method to be applied may vary depending on the characteristics of the person and the disease, and the physician's preference.
For this reason, It may be better to discuss your questions face to face with your doctor.
What are the causes of papillary thyroid cancer and in whom is it more common?
The relationship between radiation and papillary thyroid cancer is a scientifically proven fact. Especially individuals who are exposed to radiation before the age of 20 are more likely to develop cancer in the thyroid gland in the following years than other individuals. It is a known fact that individuals exposed to atomic bomb radiation in Japan and to radiation after the nuclear power plant accident in Chernobyl develop papillary thyroid cancer more frequently than those who are not exposed.
Although the reasons other than radiation are not clearly known, papillary thyroid cancer develops more frequently. It is thought that 5-15% of thyroid cancers occur due to genetic reasons. For this reason, individuals with a family history of papillary thyroid cancer are more likely to have this tumor compared to those without. It is known that papillary thyroid cancer is 2-3 times more common in women than in men.
What kind of symptoms does papillary thyroid cancer cause?
Patients with papillary thyroid cancer usually present to the physician in three different ways:
How is papillary thyroid cancer diagnosed?
In the front part of the neck, where the thyroid gland is located. a lump, a nodule, or a suspicious-looking nodule noticed in the thyroid gland by ultrasound Fine needle biopsy is standard practice. If the biopsy result is suspicious for thyroid cancer, what needs to be done is to remove the half of the thyroid gland with the nodule, usually surgically. In this way, if there is cancer, a definitive diagnosis is made by examining the thyroid gland by pathologists.
How is papillary thyroid cancer treated?
The main treatment for this disease or its suspicion is surgery. If papillary thyroid cancer is suspected or diagnosed in the thyroid gland after a fine needle biopsy, surgical removal of the tumor-containing lobe (half) or the entire thyroid gland is often the standard treatment method.
The main treatment for this disease is surgery. The extent of surgery to be performed, e.g. The decision of whether half or all of the thyroid gland will be removed and whether the neck lymph nodes will be cleaned or not is made by the physicians directing the treatment, depending on many characteristics of the patient and the disease.
The important thing here is to completely remove one or both halves of the thyroid gland. . In this case, depending on the results of the pathology examination, the probability of needing a repeat surgery decreases, and if necessary, the work to be done becomes easier and healthier. The job becomes easier for the surgeon and the endocrinology and nuclear medicine specialist physicians who may later be involved in the treatment.
According to the preference of the physicians directing the treatment in this disease, radioactive iodine treatment can be added to increase the effectiveness of surgical treatment.
Papillary. Is another operation or treatment required after thyroid cancer surgery?
In case papillary cancer is detected in the removed thyroid gland tissue, the patient's age, gender, whether there are other diseases, the size of the tumor, the cell characteristics in the microscope examination, the extent of the tumor to the lymph nodes, the environment Many factors, such as its spread to distant organs, may lead to a second surgery (if not removed, the removal of the other half of the thyroid gland or cleaning of the neck lymph nodes) or additional treatments such as radioactive iodine therapy (popularly known as atomic therapy), and rarely radiotherapy.
Evaluating all these factors and choosing the most appropriate treatment for the patient and the disease requires serious experience and medical knowledge. requires. Your physician will determine the most appropriate path to follow in planning your treatment.
What is neck dissection in the treatment of papillary 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.
Papillary thyroid cancer is also a tumor that can metastasize (spread) to the neck lymph nodes. For this reason, especially in large tumors, dissection of the anterior neck region where this tumor most frequently metastasizes (see areas VI – VII in the figure) 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.
Papillary 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.
In what cases is radioactive iodine treatment (atomic therapy) necessary in papillary thyroid cancer? ?
The cells in the thyroid gland and the tumor cells originating from them absorb the iodine atoms given to the body to produce thyroid hormone or its precursors. This is an advantage in the treatment of some thyroid diseases (such as hyperthyroidism) and some thyroid cancers. When the radioactive isotope of iodine is introduced into the body, tumor cells absorb these atoms and the radiation released from the atoms causes the death of those cells. Thus, it is aimed to destroy the tumor cells that still remain in the body after surgery (in the neck area or in distant organs and areas such as lungs and bones). In order to achieve this, healthy thyroid tissue, which is much more hungry for iodine than tumor cells, must be completely or almost completely removed from the body by surgery.
Nerves cannot be protected in thyroid surgery. What is important?
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 if the recurrent laryngeal nerve is damaged, there is usually serious hoarseness.
The superior laryngeal nerve, which controls the tension of the vocal cords, and the inferior (recurrent) nerve, which provides the movement of the vocal cords. Laryngeal nerves are very important structures for 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.
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