Although not everyone is aware of and still considers the disease rare, thyroid cancer is currently the fourth most common malignant neoplasm (tumor) in Brazilian women.
Another fact that is striking is that the tendency, according to Carolina Ferraz, an endocrinologist at the Thyroid Node Center at the Samaritano Hospital of São Paulo, is that thyroid cancer overcomes the incidence of breast cancer.
Ludmila Koch, an oncologist at Israeli Albert Einstein Hospital, explains that the thyroid (or thyroid) is one of the largest endocrine glands in the human body, weighing approximately 15 to 25 grams (in adults). It has the shape similar to a butterfly, shield or letter H. It is located on the front of the neck, just below the? Adam's apple? (a laryngeal cartilage) and has two lateral lobes, one on either side of the trachea joined in the midline by an isthmus ?, he says.
Carolina comments that when it comes to thyroid, most people think only of being overweight and / or thinning their hair. But thyroid is responsible for regulating the function of important organs, such as the heart, brain, liver and kidneys, by producing hormones.
Who is more likely to have thyroid cancer?
Thyroid cancer is the most common malignant neoplasm of the endocrine system. Ludmila explains that the frequency in women is twice as high as in men. "It is supposed to have some relationship with hormones, but there is no definitive research yet," he says.
Also read: 10 Foods That Can Prevent Cancer
Also according to the oncologist, about 5 to 10% of thyroid cancer cases have a similar family history. "Medullary thyroid carcinoma may be associated with a genetic syndrome with a strong family hereditary component called Multiple Endocrine Neoplasia (MEN)," he explains.
However, Ludmila points out, the main association of thyroid cancer occurs in patients who receive radiation to their thyroid glands. "The risk of radioinduced thyroid cancer is higher in women, some Jewish populations and patients with a family history of thyroid cancer," he says.
Thus, it can be said that the exact cause of thyroid cancer is not yet known, but some risk factors make some people more vulnerable to the disease:
- Women;
- Age over 40 years;
- Radiation exposure;
- Family history of thyroid cancer;
- Thyroid nodule.
It is noteworthy that having a risk factor does not mean that the person will necessarily have thyroid cancer, as some people develop the disease without having any risk factor. But anyway, prevention is always the best way, so anyone with a thyroid nodule or any of these risk factors should not hesitate to get a medical evaluation.
Thyroid Cancer Symptoms
Ludmila explains that both papillary and follicular carcinoma are usually asymptomatic (in the early stages).
According to the oncologist, when signs appear, the most common is usually the appearance of a palpable or visible nodule in the thyroid or neck region.
In later stages, adds Ludmila, there may be:
- Increased lymph nodes and neck volume;
- Difficulty swallowing;
- Hoarseness (or change in voice pitch);
- Cough (which does not stop);
- Difficulty breathing.
It is noteworthy that other neck cancers and other benign diseases can cause the same symptoms, so only detailed exams can identify if there is even one cancer. And: the earlier the diagnosis, the greater the chances of treatment success.
The Different Types Of Thyroid Cancer
Although thyroid nodules are relatively common, fortunately, most are benign, as Ludmila points out.
The oncologist explains that different types of thyroid cells give rise to different types of cancer and also determine the severity of the disease and the type of treatment.
Below you know the different types of thyroid cancer:
Papillary carcinoma
It represents most cases (about 80%). According to Ludmila, it develops in follicular cells and has slow growth. "They usually reach a single thyroid lobe, but may have multiple foci of the disease within the thyroid," he says.
The oncologist adds that although it can reach the lymph nodes of the neck, treatment for this cancer is often successful and rarely is the disease fatal.
Follicular carcinoma
It accounts for about 11% of cases and, according to Ludmila, is more common in places where the population is not adequately supplied with iodine. "Unlike papillary carcinoma, this cancer rarely affects the lymph nodes, but can reach the lungs and bones," he says.
Despite a slightly worse prognosis than papillary carcinoma, the disease usually responds well to treatment, as Ludmila points out.
Hurthle Cells
It represents 3% of cases and is often classified as a follicular type. "They tend to come later, about 10 years later than the average age of thyroid follicular tumors (around 45)," Ludmila explains.
The oncologist adds that it is not often spread to lymph nodes (lymph nodes), "but may recur locally, in the neck or metastasize to liver and bones," she says.
This type of thyroid cancer is seen as a more aggressive variant than follicular.
Spinal cord
It represents 4% of cases originating from thyroid parafolicular cells. According to Ludmila, in 75% to 90% of patients, this type of cancer occurs sporadically and, in other cases, is an autosomal dominant inherited disease.
Anaplastic
It represents 2% of cases, ie it is a very rare tumor. According to Ludmila, it is probably the most aggressive solid tumor. The prognosis is fatal?
Thyroid Cancer Diagnosis
Ludmila explains that the clinical importance of thyroid nodule evaluation is precisely the need to exclude thyroid cancer. "Nonpalpable nodules (noted on imaging) have the same risk of malignancy as palpable nodules," he says.
The initial assessment, according to the oncologist, includes clinical history including: information on the symptoms presented, possible risk factors, family history and other clinical conditions. The physical examination will give the doctor possible signs of thyroid cancer and other health problems. During the examination, the physician will pay special attention to the size and consistency of the thyroid and lymph nodes in the neck. Will the dosage of thyroid stimulating hormone (TSH) be requested ?, he explains.
"The initial evaluation will determine whether a fine-needle aspiration biopsy will be needed or, if the nodule has a low risk of being malignant, it may be accompanied by physical examination and serial ultrasounds," says Ludmila.
Ultrasound examination is recommended for all patients, according to Ludmila, "important to determine if a nodule is solid, the number and size of nodules, and whether nearby lymph nodes are enlarged."
In aspiration biopsy, Ludmila explains, does the doctor use a very thin needle to aspirate some tumor cells? which are later sent for review.
Sometimes, the oncologist adds, the results of fine-needle aspiration are inconclusive. "So a surgical biopsy is needed to get a larger tissue sample, especially if the doctor suspects that the lump may be malignant," he says.
Imaging tests help locate the lesion and are extremely useful in determining the extent of the disease (referred to as staging of thyroid cancer), individualizing each case. They can be used: Chest X-ray, Computed Tomography, Magnetic Resonance, Thyroid Scintigraphy or Positron Emission Tomography ?, highlights Ludmila.
Thus, in general, are / can be used for diagnosis of thyroid cancer:
- Evaluation of clinical history;
- Physical examination (paying attention to the size and consistency of the thyroid and neck lymph nodes);
- Thyroid stimulating hormone (TSH) dosage;
- Ultrasound examination;
- Aspiration biopsy;
- Surgical biopsy;
- Imaging exams.
Thyroid Cancer Treatment
Primary treatment, according to Ludmila, involves surgery, adjuvant radioactive iodine, and suppression of thyroid stimulating hormone (TSH) levels. It is performed by experts in head and neck, nuclear medicine and endocrinology ?.
Note that the treatment varies depending on the type of cancer and also if it has spread. In general, treatment options include:
Surgery: part or all of the thyroid gland and abnormal lymph nodes are removed. In some cases, nearby lymph nodes may also be removed (even if they are not visibly abnormal). After surgery, the person takes thyroid hormone in place of thyroid hormones that can no longer produce.
Radioactive Iodine: A small amount of radioactive iodine is ingested to destroy thyroid tissue not removed by surgery. It can even treat thyroid cancer that has spread to lymph nodes and other parts of the body.
External Radiation: It is a less common treatment in which radiation is directed to the nodules from a source outside the body.
Chemotherapy: It can be used in patients with anaplastic tumor, but is hardly used to treat other forms. In chemotherapy, drugs are used to eliminate cancer cells.
How to prevent thyroid cancer?
Ludmila explains that, unfortunately, there is no way to prevent thyroid cancer. ? The important thing is the early diagnosis ?, highlights.
Thus, regular medical appointments and proper examinations are the best way. At any different symptoms, the person should seek medical advice. And besides, of course, you should always be mindful of your health by taking general checkups regularly.
As one of the main risk factors is radiation exposure, radiation workers or patients who perform many tests involving radioactive substances should be even more alert.
Top News about Thyroid Cancer
Much important research on thyroid cancer continues to be done around the world. The expectation is to find out more and more about causes of the disease, if it can be prevented and its treatment improved.
Below you will find information about the main news / studies that have been done about thyroid cancer:
1. Tyrosine kinase inhibitors
Ludmila explains that when there is significant and symptomatic progression and differentiated tumors do not respond to iodotherapy, agents that block the formation of new blood vessels can be considered, preventing tumor cells from receiving nutrients and oxygen through the circulation. This is done through drugs known as kinase inhibitors, such as lenvatinib, sorafenib, sunitinib, pazopanib, axitinib, vandetanib or cabozantinib depending on the histological type, he says.
"Not all of these tyrosine kinase inhibitors (TKIs) are approved in Brazil and there are many others being analyzed in clinical studies," adds the oncologist.
2. Genetic Causes
By knowing the genetic causes of hereditary medullary thyroid cancer, is it possible to identify which family members carry the abnormal RET gene? which may lead to their thyroid being removed to prevent the disease.
3. The surgery
Surgery is already an effective treatment for most types of thyroid cancer and is usually performed without causing major side effects.
However, it is a fact that some patients feel uncomfortable with the neck scar after surgery. Therefore, new research has been done to seek improvements in the aesthetic issue of this type of surgery.
4. Use of chemotherapy
Research is continuing with the proposal to test the effectiveness of chemotherapy drugs, as well as chemotherapy associated with radiotherapy in the treatment of anaplastic thyroid cancer.
5. Targeted Therapy
Although thyroid cancers generally do not respond well to chemotherapy, interesting data is emerging on some drugs. So-called target therapy targets specific targets in cancer cells (unlike standard chemotherapy drugs acting on developing cells).
This type of medication may work in some cases and often has less severe side effects.
Thyroid Cancer Questions and Answers
Below, oncologist Ludmila answers some of the main questions about thyroid cancer.
1. Is it possible to remove the thyroid?
Ludmila Koch: It is possible and this surgery is called thyroidectomy. The type of surgery, partial or total thyroidectomy, will depend on several factors discussed between the patient and the doctor.
2. Will the person with thyroid cancer necessarily become hoarse?
Ludmila Koch: Overall, thyroid surgery progresses well, with rare complications. All surgery, however, involves a risk of complications and voice alteration (such as hoarseness) can be a complication due to the proximity of the gland to the nerves responsible for vocal cord movements. It usually recedes within a few weeks, but may continue for several months. Vocal rehabilitation may be indicated through speech therapy, showing the importance of the work of the multidisciplinary team.
3. What are the chances of cure for the person with thyroid cancer?
Ludmila Koch: Thyroid cancers are among the least lethal cancers. They can be diagnosed early and the survival rate 5 years after diagnosis reaches 97%.
4. Does thyroid cancer kill?
Ludmila Koch: Well-differentiated thyroid cancer can metastasize in 3% of cases and, depending on progression, can be fatal. However, extremely rare anaplastic carcinoma is the most aggressive type and has the most difficult treatment.It is responsible for 2/3 of thyroid cancer deaths.
5. Is chemotherapy always used for thyroid cancer?
Ludmila Koch: Chemotherapy is rarely used to treat most types of thyroid cancer. It is combined with radiotherapy for anaplastic thyroid cancer and is sometimes used for other advanced cancers. Schemes based on doxorubicin with cisplatin, or gemcitabine with oxaliplatin, are the most active combinations for well-differentiated tumors and may be used in patients who have failed target therapy.
Now you probably have clarified your main questions about thyroid cancer and you already know: signs such as neck lump, change in tone of voice, difficulty in swallowing, shortness of breath or family history of cancer may be evidence of the onset of the disease. . It is not necessary to despair, but it is very important to seek medical help in these cases and, in addition, always be attentive to health in general, performing consultations and routine examinations.
Thyroid Nodules & Thyroid Cancer: What You Need to Know | UCLA Endocrine Center (April 2024)
- Cancer, Prevention and Treatment
- 1,230
