Thyroid cancer treatment
Thyroid cancer is a malignant process in the tissues of the thyroid gland, an endocrine system organ. It manifests with noticeable changes in the neck, so oncologists often diagnose the disease in its early stages. There are many effective treatment methods: surgery (including robotic technique), chemo-, radio-, hormonal-, targeted, ablation, and radioiodine therapy.
Thyroid cancerous nodules can occur anywhere on the thyroid gland. Depending on which part of the gland the tumour originates from, the following forms of the malignancy are distinguished:
- Papillary carcinomas (70 to 80%) start in the thyroid epithelium (differentiated carcinomas).
- Follicular carcinomas (10 to 20%) originate in the gland's follicular cells.
- Medullary or C-cell carcinomas (5 to 10%) arise from the calcitonin-producing C cells scattered in the connective tissue between the thyroid follicles.
- Undifferentiated (anaplastic) carcinomas originate in thyroid gland follicular cells.
Usually, cancer in the thyroid is not aggressive. This formation may not grow for many years and may not metastasise to other organs. But this does not mean that the disease should be observed and not treated. Modern diagnostic methods make it possible to recognise cancer early so the treatment can start shortly. Thanks to timely comprehensive therapy, it is possible to beat the disease and live a long, everyday life. Healthcare providers consider surgery as the primary treatment method. However, several tactics might include an operation combined with other systemic approaches.
Thyroid cancer is a rare malignant disease. About five out of 100,000 people are affected each year. The peak incidence occurs at 45-60, but statistics show that cancer of the thyroid gland is diagnosed in patients of all age categories. So happens that it also appears in children, and the course of the disease is the most difficult in young patients.
Risks and causes of thyroid cancer
The causes of thyroid cancer have not yet been clarified entirely. However, patients under 20 or over 60 years with a rapidly growing thyroid nodule are at increased risk for thyroid malignancy.
- According to studies, people living in the zone of increased radiation got cancer 15 times more often.
- Prolonged exposure to X-rays can trigger cancer cells after decades. Cells mutate and actively divide. Papillary and follicular cancer can develop as a result.
- Genetic predisposition. Scientists have discovered a unique gene inherited and responsible for developing thyroid cancer. When oncologists detect such a gene, they can prescribe an operation to remove the organ as a preventive measure.
- Work with ionising radiation or in hot metals rooms.
- Stressful situations and depression negatively affect the immune system. After all, the immune cells are responsible for recognising and destroying malignant cells.
- Increased levels of thyroid-stimulating hormone (TSH) are associated with iodine deficiency.
The final cause of a thyroid tumour is not always clear. Its development is often associated with radiation exposure and family history. During the explosion of the atomic bombs in Hiroshima and Nagasaki, people who received radiation were ten times more likely to get thyroid carcinoma than other Japanese. Therefore, it can be said for sure that people exposed to radiation get sick more often.
Warning signs of thyroid cancer
The main warning sign of thyroid cancer is a new, rapidly growing nodule in the thyroid gland. In addition, any unusual swelling of the neck should be a reason for immediate medical examination. Thyroid hormones affect all types of metabolism. Therefore, an imbalance of the hormones leads to deterioration of both appearance and general well-being, namely:
- Disrupted sexual function (infertility, change in sex drive, in women - irregular menstrual cycle, miscarriage, congenital disabilities, fetal malformations);
- The emotional background changes ("from depression to aggression");
- Working capacity decreases, memory and attention deteriorate;
- Metabolism suffers (cholesterol level increases, risk of developing diabetes);
- There are palpitations, interruptions in the work of the heart, brittle nails, and intense hair loss.
Another early oncological sign is an increase in the neck lymph nodes. Sometimes this is the only visible symptom of the disease. In the last stages, when the tumour is massive, the following symptoms develop:
- Pain syndrome in the neck with irradiation to the ear.
- Difficult to swallow.
- A lump in the throat.
- The cough is not from a cold or allergies.
- Swelling of veins on the neck.
These symptoms are related to the tumour becoming more extensive and beginning to press on the neighbouring organs - the trachea and oesophagus.
Warning signs alert that you should go to an oncology centre, where qualified specialists will diagnose and prescribe effective treatment. In addition, they will determine whether radiation therapy, thyroid gland removal or radioactive iodine therapy might be options for you.
What are the diagnostic tests for thyroid cancer?
Initial diagnostic steps for thyroid carcinoma is a physical examination that includes extensive palpation of the neck, thyroid gland and lymph nodes; laboratory tests provide information about the function of the thyroid gland by checking for hormones (usually free triiodothyronine - T3, free thyroxine - T4) and the TSH (thyroid-stimulating hormone).
Ultrasound examination of the neck (sonography) shows the position and size of the neoplasm. It is also an essential and routine check for neck lymph nodes.
A fine-needle biopsy can answer whether an existing tumour is benign or malignant. First, the doctor removes tissues from the suspicious region with a thin needle under ultrasound control. Then healthcare provider will examine it under the microscope (cytology).
Thyroid scintigraphy is an imaging procedure that uses radioactive substances to show organs. For example, thyroid tissue can store iodine. If weakly radioactive iodine is injected into the blood, it accumulates almost exclusively in the healthy thyroid tissue and is visible on X-ray imaging. So the specialist identifies areas of the thyroid which are not active (damaged). Another imaging technique is a CT scan of the neck, checking affected organ layer by layer and excluding possible distant metastases.
Laryngeal endoscopy (laryngoscopy) aims to assess the condition of the two vocal folds. Therefore, laryngoscopy is necessary for planning the safe operation for the intact function of the vocal folds and follow-up checks.
Oncologists use the following staging for thyroid cancer:
- Stage I - cancerous cells are only in the thyroid, in one or both lobes.
- Stage II - carcinoma has spread beyond the thyroid gland or is in the thyroid gland but is more significant than 1 cm.
- Stage III - thyroid carcinoma spreads beyond the thyroid gland but has not yet left the neck region or involves lymph nodes.
- Stage IV - the tumour has spread beyond the neck and metastases to distant organs.
Annual preventive check-up of thyroid gland function allows you to avoid such severe complications as hypertension, early atherosclerosis, deterioration of memory and attention, obesity, and heart diseases. But more critical screening will easily find small thyroid nodules (if they are present).
The latest treatment for thyroid cancer
In most cases, thyroid cancer can be treated effectively. The latest guidelines report that papillary and follicular cancer are usually treated surgically. In addition, systemic treatment is given after the surgery to kill the remaining cancer cells.
Surgery is the most crucial procedure to treat thyroid cancer. The main goal is to remove the tumour tissue altogether and thus achieve a definitive cure. Operations on the thyroid glands include:
- Hemithyroidectomy - removes only the cancerous side of the thyroid (the procedure is highly demanded among patients because it allows keeping thyroid hormones production)
- Total thyroidectomy - removes the entire thyroid gland without debris.
- Lymph node dissection - removes cervical lymph nodes that (may) contain malignant cells.
- Robot-assisted DaVinci thyroid surgery is an innovative thyroid cancer treatment with fewer complications and better surgery control than traditional surgery.
As a part of the treatment, doctors will select systemic oncological therapy to prevent relapse. Chemotherapy acts through the bloodstream, thus killing cancer cells outside the thyroid gland. However, there are more precise chemo techniques: transarterial chemoembolisation - injecting drugs into the vessels supplying the tumour in combination with blockage of the arteries and transarterial chemoperfusion (implying antitumour drugs locally).
Oncology treatment makes colossal progress in cancer cell therapies. Such methods include treatments that work specifically on malignant cells without significant effects on normal tissues. For example, thyroid cancer treatment has targeted approaches like immunotherapy (increasing the activity of the immune system against cancer), target therapy (working on tiny particles on the thyroid cancer cell membrane), and hormonal therapy (using hormones that prevent cancer cells from growing).
Typical treatment for thyroid cancer will include surgery followed by radiation therapy. Doctors use special beams to kill cancerous cells and shrink tumours. There are also more advanced radiotherapy types:
- Radioiodine therapy (I-131) uses a liquid containing radioactive iodine. It binds to remaining malignant cells and destroys them without significantly affecting the whole body.
- Proton therapy - is a more accurate and intensive version of external radiotherapy.
While not all patients might be candidates for thyroid surgery, ablation therapy uses radio waves, microwaves, etc., to damage thyroid cancer. Doctors distinguish radiofrequency ablation, microwave ablation), and ethanol ablation for thyroid carcinoma treatment. It is frequently used as a proven alternative to surgical treatment.
What is the prognosis for thyroid cancer?
The prognosis for recovery depends on the combination of methods, the sequence of treatment, and the stage of the disease. Therefore, it is essential to contact a professional at a modern medical centre for the first symptoms. Compared to other, more aggressive forms of cancer, thyroid cancer has a favourable prognosis. On average, 94% of women and 87% of men are alive five years after diagnosis.
Both papillary and follicular cancer with timely and correct treatment in young people have a cure rate of up to 97%. Medullary thyroid cancer is less common, and its prognosis is also favourable. The five-year survival rate for thyroid carcinoma is 70-80%, ten-year - 60-70%, and twenty-year - 40-50%. The survival rate in patients under 40 is higher than after 40.
Is thyroid cancer curable?
The chances of recovery are 50 to 60% and over 90% for carcinomas that are detected early and have not yet metastasised. The very aggressive undifferentiated (anaplastic) carcinoma, on the other hand, progresses and metastases rapidly.
Are thyroid nodules cancerous?
Thyroid nodules are rarely cancerous. In most cases, however, it is not thyroid cancer but a benign tumour (often a thyroid adenoma).
What is the best treatment for thyroid tumours?
Surgery is the most effective way to cure thyroid cancer. Robot-assisted da Vinci thyroid surgery is the best option since it is minimally invasive, not traumatic and does not require long rehabilitation. Radioiodine therapy (I-131) is another innovative non-surgical method. It uses radionuclide to destroy only cancerous cells.
Does thyroid cancer spread?
As the tumour grows, it can break through the connective tissue capsule of the thyroid gland and invade nearby tissue, lymph nodes, or other organs. Individual cancer cells can also reach distant organs via lymph vessels and blood vessels. They can settle and multiply there; secondary tumours (metastases) develop. Metastases from thyroid cancer most commonly occur in the lungs, liver, and bones.
Can thyroid cancer spread to the brain?
Metastases from thyroid cancer most commonly occur in the lungs, liver, and bones. Very rarely (1% of cases) malignant cells from the thyroid gland can reach the brain.
Where can I get Thyroid cancer treatment?
What are the best clinics for Thyroid cancer treatment?
Who are the best doctors for Thyroid cancer?
Prof. Dr. med. Roland Ladurner from Academic Hospital Martha-Maria Munich
Prof. Dr. med Harald-Robert Bruch, MSc, PhD from Oncological and Haematological Praxis Clinic Bonn
Prof. Dr. med. Roland M. Schmid from University Hospital rechts der Isar Munich
Prof. Dr. med. Florian Bassermann from University Hospital rechts der Isar Munich
Prof. Dr. med. Helmut Friess from University Hospital rechts der Isar Munich