Introduction to Thyroid Cancer
First, an overview of
Thyroid is the body's largest endocrine glands, and only a touch of the glands in the body surface, is located anterior is the middle of the bottom before the larynx and trachea from the left and right middle lobe and the isthmus connecting to its composition The occurrence of malignant glands shall be thyroid cancer.
Thyroid cancer is a common head and neck cancer, accounting for body tumors 1% ~ 2%, can occur at any age between 30-40-year-old for the incidence peak of women's more common, a long incubation period, slow growth, early metastasis. Age investigate the incidence of men each year less than 3 / 10 million, while women do 2 ~ 3 times higher, the age distribution of various types of thyroid cancer is also different, papillary adenocarcinoma of the most widely distributed, can occur at 10 years of age children to centenarians, follicular thyroid carcinoma more common in 20 to 100 years old, medullary carcinoma prevalent in the 40 ~ 80 years old, undifferentiated cancer, prevalent in the 40 ~ 90 years old.
2, pathological
Thyroid cancer (carcinomaofthyroid) sub-papillary carcinoma (about 60%, more common in young women, low-grade), follicular thyroid carcinoma (about 20%, more common in middle-aged, moderately malignant), undifferentiated carcinoma ( about 15%, more common in the elderly, high-grade), and medullary carcinoma (rare, medium malignant) of four, most of the development of slow transfer of late, the prognosis is good.
(A) papillary thyroid carcinoma is the most common type of cancer, accounting for about 60%. Sizes. The general well-differentiated malignant low. Carcinoma of the soft friable crisp, color dull red; but elderly patients with papillary carcinoma Zhuang are generally more hard and pale. The center of cystic papillary carcinoma often change, capsule filled with bloody fluid. Sometimes cancer tissue calcification may occur, sand-like cut surface. The cystic degeneration and calcification and cancer of the malignant degree and prognosis. Carcinoid tumor under a microscope to see the papillae formed by the columnar epithelium, sometimes mixed with follicle-like structure, and even found the follicular variant of papillary situation.
Papillary adenocarcinoma leaves a complete capsule, to the post can also be pierced capsule and invaded the surrounding tissue, broadcast mainly by means of lymph node, cervical lymph node metastasis generally the most common, about 80% of children and 2 % of adult patients with palpable lymph nodes, followed by the transfer of blood to the lungs or bone.
(B) follicular carcinoma than papillary carcinoma rare, accounting for about 20% of thyroid cancer, ranking the second place, the average age of patients than papillary carcinoma have a large. Cancer soft, flexible, or rubber-like, rounded, oval or sub-leaf-shaped nodules. Red-brown cut surface, showing fibrosis, calcification, hemorrhage and necrosis. Well-differentiated follicular carcinoma and normal thyroid gland in the microscope, the organizational structure similar to, but there are capsule, blood vessels and lymphatic invasion by the phenomenon; poorly differentiated follicular carcinoma were seen irregular structure, cell density into a group-like or cord-like, very few follicles to form. Although the approach can be spread through the lymph node metastasis, but mainly transferred to the lungs through the blood, bone and liver. Some of follicular carcinoma after surgical resection can be separated by a very long time to see the recurrence, but the prognosis of papillary carcinoma is less than good.
(C) medullary thyroid cancer, thyroid cancer accounts for 2 ~ 5%. By Hazard in 1959 the disease was first described, with secretion of calcitonin and the thyroid gland associated with pheochromocytoma and thyroid gland hyperplasia (Ⅱ type multiple endocrine neoplasia, MEN Ⅱ) characteristics. Medullary thyroid carcinoma from the gills of embryos after the body (ultimobranchial body), from the bright parafollicular cells (C cells) changed from. Parafollicular cells are endocrine cells derived from neural crest, these endocrine cells have a common function, which is capable of taking 5 - such as serotonin and dopamine precursors, and approved to be one of the decarboxylase decarboxylation, it is also known as amine pre - precursor uptake and decarboxylation cells (amine precursor uptake and decarboxylation), referred to as APUD cells. Tumors are mostly solitary nodules, occasionally multiple, quality hard and fixed, there is amyloid deposition, very little uptake of radioactive iodine. Cancer cells mainly by the polygon shape and spindle cells arranged in diversity.
(D) anaplastic thyroid cancer, thyroid cancer accounted for 15%, mainly occurred in patients older than middle-aged men and more common. Mass was hard but not rules, fixed, fast growing, and soon filled with involving the thyroid gland, usually in the short term could be infiltrating the trachea, muscles, nerves and blood vessels, causing swallowing and breathing difficulties. Local tumor may have tenderness. See cancer tissue under a microscope, mainly by poorly differentiated epithelial cells, cells were pleomorphic, common mitosis. Cervical lymph node enlargement can occur, but also lung metastasis. Disease prognosis is poor, ineffective treatment of radioactive iodine, external irradiation only control local symptoms.
3, symptoms
Because thyroid cancer there are many different types of pathological and biological characteristics, their clinical performance is so different. It can exist with multiple thyroid nodules, most asymptomatic, even found that there is an anterior cervical area nodule or mass, and some tumor has existed for many years, it has rapidly increased in the near future, or shift. Some of the main discomfort in patients with long non-demolition, to the late cervical lymph node metastasis, pathologic fracture, hoarseness, respiratory disorder, dysphagia, Horner syndrome, even before attention. Local signs are not the same, there was asymmetry in thyroid nodule or mass, lump or gland, the up and down with swallowing activity. Be surrounding tissue or tracheal invasion, the mass that is fixed.
(A) papillary carcinoma is a well-differentiated thyroid cancer is the most common form of the total, 3 / 4; lesion is usually solitary, volume size, the smallest diameter of 0.5cm below , termed micro-cancer; diameter of less than 1cm called hidden cancer, a large lesion diameter greater than 10cm. Small tumors are often substantial lesions, while large tumors are often accompanied by cystic change. Cystic degeneration cystic wall can be seen grape cluster-like nodules conspicuous cavity, the cavity there are old bloody memory. This type of cancer in general no capsule, only 5% had an incomplete capsule. Some of tumor cells under a microscope arranged in papillary, papillary size, of varying lengths, common for more than three branches, the nipple center fibrovascular capsule, cell size uniformity; nucleosomes and split rare. Papillary carcinoma often accompanied by follicular thyroid carcinoma component, the tumor is still called papillary carcinoma, not known as the follicular thyroid carcinoma or mixed type. If the papillary carcinoma contains an element of undifferentiated carcinoma, while the name should be undifferentiated carcinoma, but also means that a kind of undifferentiated carcinoma, papillary carcinoma may be a further deterioration. Sometimes a small lump, neck lymph node metastasis commonly found. The relatively low degree of malignancy, 10-year survival rate of up to 88%. Papillary thyroid cancer in the clinical areas are often isolated nodule diameter more in more than lcm. Insidious nature of cancer more common in the autopsy, or cervical lymph node metastasis has occurred when the tumor was found.
(B) follicular thyroid carcinoma accounts for 10% of the total number of thyroid cancer, 15%, visual inspection to see follicular thyroid carcinoma is a substance with a coating of the tumor capsule on the often densely covered with a rich vascular network, the more small is very similar to cancer and thyroid adenoma. Red-brown cut surface, often can be seen fibrosis, calcification of hemorrhage and necrosis. Histologically, by different degrees of follicular differentiation posed. Were well-differentiated follicular structure, more typical, cell atypia relatively small. Then with the adenoma is not easy distinction, dependent on capsule or vascular invasion to determine the pathological diagnosis. Poorly differentiated follicular structures were relatively small, cell shaped large mitotic figures are also more common, can be showed cord-like solid nest-like arrangement. Sometimes cancer cells into the various veins piercing the formation of capsular invasion, distant metastasis often become the starting point, so prevalent in the blood of follicular carcinoma metastasis, reported in the literature account for 19% ~ 25%. Follicular thyroid carcinoma more common in 40 to 60-year-old middle-aged women, the clinical performance and papillary carcinoma is similar, but Aikuai generally higher and less lymph node metastasis, while the more distant metastasis. A small number of follicular thyroid carcinoma infiltration and destruction of adjacent tissues, airway obstruction and other symptoms can occur.
(C) medullary thyroid carcinoma in 1951, first described by the horn, such as further elaborated in 1959, Hazard of this particular type of cancer. And was named medullary carcinoma. The total number of thyroid cancer accounts for 3% ~ 10%, the tumor generally cylindrical-type or oval type, the boundary clear, quality hard or irregular shape, with peripheral infiltration of thyroid substance, white or reddish aspect may be associated with hemorrhage and necrosis and calcification, tumor diameter, an average of about 2 ~ 3cm. Cancer cells under a microscope showed oval type, polygonal or spindle, mitotic small to medium; cells arranged in nests, or glandular cavity ribbon-shaped beam. Stroma containing varying amounts of amyloid, cancer cells for a long time, less amyloid, whereas on the multi-amyloid; metastasis also do so. Medullary thyroid carcinoma is a moderately malignant cancer, can occur at any age, no significant difference in incidence rates for men and women, mostly sporadic, about 10% of familial. In addition to clinical and other thyroid cancer, goiter, like a block and cervical lymph node metastasis, there is also its unique symptoms. About 30% of patients had history of chronic diarrhea and facial flushing associated with carcinoid syndrome may, or cushing metabolic syndrome, and the product of the tumor cells.
Familial medullary carcinoma of the following features:
① younger onset, diagnosis, the average age was 33 years, diagnosis of sporadic medullary carcinoma of the average age of over 55 years of age.
② gland carcinoma are bilateral and multi-center leaf lesions, tumor distribution and shape asymmetry, may be a huge tumor and the contralateral side only histologic signs, but, without exception, were bilateral lesions. Were mostly sporadic unilateral tumor.
③ familial medullary carcinoma Aikuai smaller, due to screening, there are hidden find. Were more sporadic than Aikuai diameter 4cm.
④ familial those rare lymph node metastasis, distant metastasis is more rare, may find earlier with the rules.
⑤ familial medullary carcinoma were located parafollicular cell concentration of branches, namely lobe at the junction of upper one third.
⑥ familial medullary carcinoma often accompanied with pheochromocytoma or hyperparathyroidism.
(D) of the Department of anaplastic thyroid cancer, a high degree of malignancy, less common, accounting for all thyroid cancer, 5% ~ 10% occur in the elderly. Rapid growth of undifferentiated carcinoma, often an early violation of surrounding tissue. Eye view of progression-free capsule, flesh cut surface, pale and bleeding, necrosis, histology of undifferentiated carcinoma can be divided into edge-type cell and small cell type two kinds. Mainly for the anterior zone mass, quality hard, fixed, ill-defined. Often accompanied by difficulty swallowing, breathing Yang, hoarseness and neck pain in the area and other symptoms. Two often accompanied by swollen neck lymph nodes, blood metastasis than common.
Thyroid cancer patients can self-examination in the following ways:
1, note that the shape of goiter. The shape of goiter generally divided into two categories, was butterfly-shaped, more common in endemic goiter, thyroiditis and some patients with hyperthyroidism; The other is a part of the emergence of a thyroid swollen round blocks, more common in thyroid cyst, thyroid adenoma, including thyroid cancer.
2, pay attention to the size of the tumor. If the tumor showed diffuse swelling or multiple nodular enlargement, mostly endemic goiter; generally benign tumors or cysts in a single nodule more than 2 centimeters in diameter; more than 2 centimeters in diameter should be suspected thyroid cancer.
3, pay attention to mass smoothness and Flex. Carefully with the thumb and index finger touching the surface of tumor. Smooth surface, the same persons, mostly endemic goiter; surface, were not very smooth, from the possibility of thyroiditis large; showed a single nodular enlargement, but the smooth surface, even those who may adenoma; a single nodular enlargement , performance is not smooth, showing a sense of physical persons, should be suspected cancer.
4, pay attention to mass growth rate. Endemic goiter was slowly increased, duration of up to several years or even decades; number of benign tumors and cysts course of the disease can be months to several years; thyroid cancer tumor growth has been faster in more than a dozen days or a month or within the obviously increased.
5, pay attention to whether the mass around the touch lymph nodes. If the thyroid can touch around the hard texture of the lymph nodes, should be highly suspected to be associated with regional lymph node metastasis of thyroid.
4, common treatment
Usually have surgical treatment, chemotherapy, hormonal therapy, radiation therapy, Chinese medicine treatment.
5, diffusion and transfer of
Of thyroid cancer cells can be transferred to other organizations and organs go, the most common is transferred to the neck lymph nodes, can be transferred to the lungs, brain, bones, etc.; if the first surgery of thyroid cancer, cervical lymph nodes found transfer of the neck lymph nodes should be removed as far as possible. If you find lung, brain, bone, etc. transfer, if a single metastasis, surgical resection method can remove metastatic carcinoma. However, a single metastasis is rare, usually broad shift. For the extensive transfer, treatment with radioactive iodine 131 effective in some patients with thyroid hormone therapy has different degrees of therapeutic effects, long-term application of sufficient quantity, patients can survive longer.
6, the prognosis is
In malignant tumors, the prognosis of thyroid cancer in general is good, a lot of thyroid cancer have been transferred, the patient is still alive there is more than ten years. There are many factors related to prognosis, such as age, gender, histological type, disease extent, transfer case and surgical methods, of which the pathological type of the most important. Well-differentiated thyroid cancer patients, 95% can be more long-term survival, especially in the biological characteristics of papillary adenocarcinoma tendency to good prognosis of the best, but a few can also be a high degree of malignancy into an undifferentiated carcinoma; undifferentiated carcinoma the worst prognosis, patients often die within six months. Larger tumor size, infiltration greater the opportunity, the prognosis is also worse. According to statistical information, with or without lymph node metastasis does not affect the patient's survival, primary tumor has not been controlled or local recurrence can result in increased mortality, cancer spread or direct invasion of a greater extent than lymph node metastasis is more important Jampa .
