Among the numerous forms of malignant neoplasms, thyroid tumors account for only 1-3%, and in men they fluctuate within 0.5%, in women - 1%. At the same time, it is the most common tumor of the endocrine system organs. Over the past 20 years, the incidence of thyroid cancer (TC) has more than doubled. It is assumed that in the future, under the influence of environmental factors, one should expect not only an increase in the number of patients, but also mortality from this disease.
It is a malignant tumor of the endocrine system resulting from malignancy (malignancy) of the epithelial cells of the thyroid gland. A particular danger in diseases of the thyroid gland is the appearance of nodules in it. It has been statistically proven that up to 30% of all nodes are transformed into malignant at a certain stage, that is, they become cancer cells.
Thyroid cancer affects not only the elderly, but also in young people, in adolescence and even childhood. Moreover, in childhood, before puberty, thyroid cancer occurs equally often in both boys and girls, which may indicate the exogenous (external) nature of the disease.
There is a definite dependence of the frequency of thyroid nodules on age. In children who have not been exposed to radiation, nodes in the thyroid gland are rare - in 0.05-1.8% of cases. In adults, they are determined by palpation (by feeling) in 6.4% of women and in 1.5% of men aged 30-50 years. With ultrasound, nodes are detected 10 times more often. According to research data, in persons over 50 years of age, nodules of the thyroid gland are observed so often that they can be considered as manifestations of the age norm. But not every node develops into a malignant tumor. The incidence of cancer among solitary thyroid nodules ranges from 2.7 to 54%.
There are several types of thyroid cancer. The most common are papillary carcinoma and follicular carcinoma, which are grouped and belong to the types of highly differentiated thyroid cancer. Modular carcinoma, anaplastic carcinoma, and thyroid lymphoma are rare types.
The etiology of thyroid cancer has not been finally established. Thyroid tumors are considered dyshormone. They arise against the background of inhibition of the thyroid gland function due to iodine deficiency, antithyroid drugs, and ionizing radiation. The development of thyroid cancer is also facilitated by such diseases as nodular goiter, thyroid adenoma, thyrotoxic goiter, recurrent forms of goiter, connective tissue benign tumors (fibromas, angiomas).
• external irradiation of the neck area; • receiving procedures with radioactive iodine in childhood and adolescence; • the use for therapeutic purposes of high doses of drugs such as thiouracil, propylthiouracil and others that disrupt the synthesis of thyroid hormones; • long-term exposure to chemical carcinogens; • insufficient intake of iodine with food and disruption of the processes of its metabolism; • violation of hormonal balance in the body; • genetic predisposition (if any of the family members had thyroid cancer).
Symptoms of thyroid cancer and its initial period are not very specific. Therefore, patients often have to be treated for a long time for other ailments - depression, nervous and cardiovascular disorders, kidney disease, etc. However, a swelling, mass, or nodule on the front of the neck can be seen or felt; this can be noted by the doctor during a routine examination. Painful manifestations, as a rule, are not typical. Some of the late manifestations are: immobile multinodular formations in the gland, immobility of the thyroid gland when swallowing, hoarseness.
When the lungs are affected, shortness of breath occurs, sometimes a cough; the enveloping of the bronchi with metastases leads to inflammation in the lung tissue, which is manifested by an increase in temperature, an increase in general weakness, and a cough with purulent sputum. With bone metastasis, the skull, long bones of the limbs, scapula and pelvic bones are often affected.
The main difficulties in the timely diagnosis of thyroid cancer are due to the fact that a malignant tumor can exist for a long time under the guise of or against the background of other diseases of the thyroid gland.
The leading role in the diagnosis of thyroid diseases is played by: a correctly collected anamnesis (a set of information about the development of the disease, living conditions, past diseases, etc.) and examination of the patient.
• Clinical examination of the gland visually and by palpation. • Assessment of the functional state of the gland by laboratory and instrumental methods. • Radioimmunological methods using standard test kits. • Methods for assessing the structure and condition of the thyroid gland include: • computed tomography; • ultrasound diagnostics; • radionuclide diagnostics; • scintigraphy (a method for registering the distribution of radioactive substances in an organ or tissue); • fine-needle aspiration biopsy - widely used for accurate diagnosis under ultrasound guidance. This procedure involves removing a portion of the gland tissue from the node by means of a conventional injection. It allows you to make an accurate diagnosis within 30 minutes to several hours.
• surgical; • ray; • combined (surgery with preoperative, and more often - postoperative radiation therapy); • complex (radiation therapy, surgery, hormone therapy).
When choosing a method of treatment, the morphological form and differentiation of the tumor, the stage of the process, etc. are taken into account.
In malignant tumors of the thyroid gland, the beginning of therapeutic action, as a rule, is an operation, which in most cases allows complete removal of the cancerous tumor.
If cancer is diagnosed, surgery is performed immediately. It pursues two goals: complete removal of the tumor and creation of conditions for further effective therapy with radioactive iodine, followed by high-dose hormone therapy with levothyroxine. Treatment with radioactive iodine is not used in every case. The need for it is determined during the first follow-up examination and radioiodine testing 1 month after the operation.
Carrying out courses of radioiodine therapy is carried out to destroy the "remaining" normal cells of the thyroid gland and cancer cells. With this in mind, radioiodine therapy courses are conducted with the aim of:
• preventive (destruction of the remnants of the gland tissue); • treatment of local relapses and metastases in nearby lymph nodes; • for devitalization (destruction) of distant metastases to organs and systems of the human body.
The courses of treatment are performed with interruptions of different duration, during which hormone therapy with levothyroxine is necessarily continued. The latter is vitally necessary for the patient, since his body can no longer produce thyroid hormones on its own and needs to be taken from outside on a daily basis.
The results of complex therapy in the Republic of Belarus over the past 15 years suggest that the prospect of thyroid cancer treatment with early diagnosis is very favorable. More than 80% of all cases of the disease are successfully curable. It is noteworthy that better results and faster cure are observed in pediatric and young patients.
Given that thyroid cancer is prevalent in almost all age groups, and that it can return or spread to other parts of the body even many years after surgery, certain preventive and protective measures must be followed. These include:
• to be more attentive to their own health, the health of loved ones and relatives, especially children and the elderly, showing a certain alertness to the appearance of any negative changes in the body. • do not show complacency and carelessness regarding the appearance of a goiter or any nodes in the thyroid gland, but consult a doctor in a timely manner. • give up bad habits and lead a healthy lifestyle.
• be regularly examined by an oncologist or onco-endocrinologist, especially in the first 5-10 years after surgery with monitoring of the hormonal status in the blood. • maintain close contact with the attending physician and show personal activity and perseverance in the impeccable and full implementation of the doctor's recommendations. Following these recommendations will help to avoid serious complications in the case of thyroid diseases and maintain health for many years.