Although it is not the most common cancer of the human body, the incidence of thyroid cancer has been increasing all over the world in recent years. In the USA, 20-25 thousand people are diagnosed with this disease every year. Like all thyroid gland diseases, thyroid cancer is more common in women. Approximately 75% of these cancers are seen in women, but when seen in men, their course is worse than in women.
Although cancer statistics in our country are not kept as well as in western countries, comparing our country's population to the USA, it is roughly at least 5 cases per year. -We can predict that 6 thousand people will develop this cancer. This figure may be even higher because iodine deficiency is serious enough to constitute a public health problem in some regions in our country and the iodization of salts is not common enough.
An important feature of these cancers is that they occur in the 40-45 age group. When diagnosed under certain conditions, they have a very good course with appropriate treatment and often give the patient the opportunity to live a normal lifespan.
WHAT ARE THE TYPES OF THYROID CANCER?
While thyroid cancers develop from the thyroid gland cell from which they originate, they are examined in 2 groups according to their degree of differentiation from the original cell:
Well-differentiated cancers: Those that mimic the cell structure and cell order from which they originate quite well. It is a type of cancer that offers more treatment options and a better prognosis.
'Papillary cancer' (75-80% of thyroid cancers and the type with the best prognosis)
'Follicular cancer' and 'Hürthle cell cancer' (5-15% of thyroid cancers and a type with a very benign course)
Poorly differentiated cancers: It is a type of cancer that less closely mimics the cell structure and cell order from which it originated, is less responsive to treatment methods, and has a less satisfactory prognosis.
' Medullary cancer' (5-10% of thyroid cancers)
'Anaplastic cancer' (about 5% of thyroid cancers and the worst type)
These two groups of cancers constitute the most common cancers of the thyroid, and the first group covers up to 90% of total thyroid cancers. The fact that tumors with a relatively benign prognosis are more common than those with a poor prognosis is an important factor in thyroid cancer patients. It means more diverse treatment options and longer life expectancy for the majority of patients.
WHAT ARE THE CAUSES OF THYROID CANCER?
Thyroid cancer Different types may occur for different reasons. While some types occur due to insufficient iodine intake with food, some types occur as a result of deteriorations in genes and are inherited from subsequent generations (genetic transmission). In addition, radiotherapy (beam therapy, radiation therapy) applied to the neck area for some diseases, especially in childhood, or radiation from nuclear power plants or explosions that mixes with the air we breathe and the food we eat, also causes some types of thyroid cancer.
WHAT ARE THE SYMPTOMS OF THYROID CANCER?
Thyroid cancer often occurs as a 'nodule' (lump, mass) in the thyroid gland. If this thyroid nodule is large enough, it can be noticed by the patient or his relatives. Sometimes the nodule is detected during a doctor's examination for a health check or during a neck ultrasound examination performed for another reason. Sometimes thyroid cancer spreads to the lymph nodes in the neck and appears as lymph node enlargement in the neck that is noticed by the patient without any noticeable enlargement in the thyroid gland. In some patients, the presence of cancer is detected when the thyroid removed after thyroid surgery performed for another reason is examined by pathology specialists.
If thyroid cancer grows too much, it can put pressure on the esophagus and windpipe and cause difficulty in swallowing and breathing. can. In addition, the nerves that enable the movement of the vocal cords in the larynx can be surrounded by cancer as they travel behind the thyroid gland, which may cause hoarseness.
HOW IS THYROID CANCER DIAGNOSED?
The thyroid surgeon's closest teammates in the diagnosis and treatment of thyroid cancers are 'endocrine specialist' (hormonal diseases specialist), 'pathology specialist', 'radiology specialist' and 'nuclear medicine specialist'. In addition to these doctors, 'radiotherapy specialist' (ray therapy specialist) and 'oncology specialist' (general cancer specialist) can also support the team when additional treatment methods are needed in advanced cancers.
The thyroid gland in the person. The most effective method used today to detect whether there is a nodule is thyroid ultrasonography. Ultrasound imaging method not only enables detailed detection of nodules in the thyroid gland, but also helps in taking samples with a needle from nodules that cannot be detected manually by directing the needle to the correct target. The thyroid scintigraphy method, which was used in the past, is now used not for detecting nodules, but rather for determining activity.
Thyroid scintigraphy method, which is located within the thyroid gland and exceeds 1 cm in size or exhibits suspicious findings on ultrasound imaging Smaller nodules should be examined to see if they contain cancer. Cancer is diagnosed with great accuracy by entering the nodule with a thin needle and taking samples from the cells and by experienced pathologist doctors examining these cells under a microscope. After detecting a nodule in the thyroid gland, if there is any doubt, thyroid fine needle aspiration biopsy (FNAB) performed on the nodule determines whether the thyroid nodules are malignant or not. FNAB is the gold standard in diagnosis, and in experienced hands, the sensitivity is 98% and the positive predictive value is 99%. TIAAB; In good hands, it is a low-risk, fast-yielding and easy-to-apply method. Performing FNAB under ultrasound guidance increases the diagnostic value. If the biopsy result is benign and the patient has no other complaints, thyroid nodules can be followed. If the biopsy result is suspicious or malignant, surgical treatment is initiated. If the material taken is insufficient, the biopsy should be repeated, and if the material is still insufficient, surgical intervention should be considered by evaluating the patient's clinical and current risk status.
In recent years, the advancement of diagnostic methods in thyroid diseases and the development of technical facilities. For this reason, thyroid ultrasonography and thyroid fine needle aspiration biopsy can be performed in many cases. For this reason, the possibility of diagnosis of even incipient thyroid cancers is very high today.
WHAT CAN BE DONE TO PREVENT THYROID CANCER?
Salts Iodination is a practice that has been used in many countries recently. However, while this method reduces the frequency of some types of thyroid cancer, it increases the incidence of other types of thyroid cancer. It may increase the frequency of cancers. Considering that some types of thyroid cancer may show familial transmission, it has become a practice in our country to undergo genetic screening tests for blood relatives of patients with such tumors. Thus, family members who carry genes that cause cancer to develop in the future can be identified and the thyroid gland can be surgically removed before cancer develops.
HOW IS THYROID CANCER TREATED?
The basic treatment for almost all types of thyroid cancer is surgery. The principle of surgery is to carefully preserve the nerves going to the larynx and vocal cords while removing the thyroid gland, and the lentil-sized parathyroid glands, which are located just behind the thyroid gland and secrete the hormone called 'parathormone', which keeps the level of calcium mineral in the blood constant. In the case of some very small tumors limited to one side of the thyroid gland, removal of that half of the gland and subsequent oral hormone supplementation constitute sufficient treatment. In other cases, the thyroid gland should be completely removed without damaging the structures mentioned above, and additional treatments depending on the type, size and spread of the tumor: Thyroid hormone supplementation, 'radioactive iodine' (atomic) therapy, external 'radiotherapy' (ray therapy, radiation therapy), Treatments such as 'chemotherapy' (treatment with cancer drugs) can be added.
In case the nerves going to the larynx are cut or seriously damaged, the patient may experience permanent hoarseness, coughing while eating and drinking, and even severe respiratory distress. It creates very annoying problems. To correct this situation, larynx and vocal cord surgeries may sometimes be required, which can only be performed by Ear, Nose and Throat physicians. Damage to all four parathyroid glands causes decreases in calcium levels in the blood; It may cause numbness and spasms in the hands, around the lips and in the feet. In this case, the patient is forced to use calcium and vitamin D pills for life.
These surgeries are performed by people who are experienced in this type of surgery, have knowledge of the region's 'anatomy' and 'endocrine' (hormonal diseases) knowledge of the neck anatomy. ) application by surgeons as mentioned above. It can minimize the 'complications' (undesirable bad results of a surgery or treatment method).
Most thyroid cancers consist of cells that absorb iodine from the blood, and radioactive radiation is used in the treatment of these diseases. It has led to the use of iodine as a treatment method.
If this treatment method is to be used in the patient, healthy thyroid tissue that will absorb radioactive iodine must be minimized, that is, preferably all or almost all of the thyroid gland must be removed.
Thus, the radioactive iodine given to the body is absorbed only by the thyroid cells that have spread to surrounding tissues or distant organs and causes their destruction.
THYROID CANCER INNOVATIONS IN SURGICAL TREATMENT
Nowadays, thyroid surgeries are performed with necklace-style incisions that were made in the past and covered almost the entire front of the neck. Instead of making incisions in the form of a necklace that covers almost the entire front of the neck, sometimes up to 2.5 cm above the half of the thyroid to be removed for diagnosis in the midline or on the sides. It can be done through long incisions. These small incisions both reduce postoperative pain and enable the incision scar on the neck to heal in a more barely noticeable way.
In addition, the length of the incision required to remove the thyroid gland with the help of optical instruments called endoscopes. can be shortened further. In this method, called endoscopic thyroidectomy, the patient's post-operative pain and problems related to large scars that may appear in the future are reduced. Naturally, surgery can be performed through these small incisions only if the nodule and the thyroid are below a certain size.
WHAT IS THE POST-TREATMENT PROCESS FOR THYROID CANCER?
Thyroid cancer may recur years after treatment is completed. For this reason, patients need to be under control and have some imaging and tests done periodically. One of the unique characteristics of thyroid cancers is that they produce substances 'proteins' that are not produced by other tissues and cells. This is very helpful in understanding whether there are any remaining tumor cells after treatment and in early recognition of recurrences. For example, the thyroid is completely removed and visible.
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