Thyroid cancer is a group of tumors of different histological types. In most cases, follicular and papillary cancers are detected; they are considered to be prognostically favorable. The disease can be cured with surgery and radioiodine therapy in most patients. A worse prognosis is seen in medullary and anaplastic cancer, even at stage one-three. These tumors often recur after surgery and do not accumulate radioactive iodine.
The treatment of the disease usually begins with surgery. Intervention options are described below.
Lobectomy is the removal of a lobe of the thyroid gland. The organ consists of two parts. There is also an isthmus between them. The doctor removes only the lobe in which a malignant tumor is detected. The isthmus is also subject to resection. This operation for thyroid cancer is used infrequently. The specialists resort to it in the following cases:
In addition, lobectomy is used in some cases as a diagnostic operation. The primary method of confirming the diagnosis is a biopsy. According to its results, it is sometimes impossible to give an unambiguous answer whether it is cancer or not. In such cases, doctors have to remove part of the organ to examine it in the laboratory. If thyroid cancer is diagnosed, then the scope of surgical intervention is likely to be expanded. Doctors will perform a revision surgery to remove the entire thyroid gland.
Lobectomy as a treatment method has an obvious advantage over thyroidectomy (radical removal of the thyroid gland). Since part of the organ is preserved, the patient produces thyroid hormones. This means that he will not have to receive thyroid hormone replacement therapy for the rest of his life.
Thyroidectomy is the main treatment option for the disease. Most patients prefer this operation. The Surgery involves the total removal of the thyroid gland. The procedure is performed through an incision a few centimeters long on the front of the neck.
After a thyroidectomy, the patient must receive lifelong hormonal therapy, since the production of the patient's hormones stops. However, disease control is improved. Doctors will be able to detect a recurrence in time if it suddenly happens. Radionuclide diagnostics with radioactive iodine and a blood count for thyroglobulin are used for monitoring.
Neck lymph node dissection is an optional stage of the operation. In papillary and follicular cancer, the neck lymph nodes are removed only if signs of metastasis are detected. However, in more aggressive medullary or anaplastic cancers, lymph nodes are often removed even if there is no evidence of metastasis.
The scope of lymph node dissection depends on the stage of the disease and the histological type of thyroid cancer. In differentiated tumors after surgery, radioactive iodine therapy is usually performed. It is highly likely to destroy all metastases. Therefore, only the largest lymph nodes, which have increased due to the growth of metastatic tumors, are subject to removal. However, lymph node dissection is often performed at a higher scope in anaplastic or medullary cancer. This is because the cells of these tumors cannot accumulate radioactive iodine.
The surgical removal of the thyroid gland is a relatively low traumatic operation. The patient does not usually have to stay in the hospital for a long time. He can return home the very next day.
Possible complications:
The parathyroid glands are often removed along with the thyroid gland. These are small organs located behind the thyroid gland. As a rule, there are four of them. The parathyroid glands also produce hormones. They regulate the level of calcium in the blood. Therefore, a frequent consequence of the operation is decreased calcium levels, which can cause seizures, numbness and tingling in the legs and arms. These complications can be treated with drugs.
More than 90% of thyroid cancer cases are differentiated tumors. They are sensitive to radioiodine therapy, It is taken up by all thyroid cells, both healthy and malignant, and no matter where they are located. As a result, radiation destroys the remnant of the primary tumor, metastases in regional lymph nodes and distant metastases.
The goals of radioiodine therapy vary. Basically, there are three of them:
To determine the indications for radioiodine therapy, the specialists use:
According to the examination results, the patient is assigned to one of the risk groups: low, intermediate or high.
The risk of cancer recurrence or progression is considered low if the entire tumor is removed, there are no distant metastases on whole-body scintigraphy, and there is no invasion of the cancer into the blood vessels. Up to 5 regional metastases are allowed if their size does not exceed 2 mm (micro metastases).
The risk of cancer recurrence is considered intermediate if metastases in regional lymph nodes up to 3 cm are detected, their number is more than 5, the tumor is more than 4 cm, penetrated into vessels, cancer cells outside the thyroid gland are detected, radioactive iodine accumulating tumor foci are found, BRAF V600E mutation is detected.
The risk of recurrence is considered high in residual tumor, TERT and BRAF mutations, the presence of metastases larger than 3 cm, extension of thyroid cancer outside the organ, high thyroglobulin levels, and detection of distant metastases.
In low risk, radioiodine therapy is not performed. Intermediate or high-risk patients require radioactive iodine therapy after surgery.
In some patients, thyroid cancer is considered radio-refractory, namely, resistant to radioiodine therapy. It is deemed to be so if:
Radioiodine resistance occurs initially or during treatment in about 10% of patients. The risk of radioiodine resistance among patients with distant metastases is higher, exceeding 30%. The development of this condition worsens the prognosis of pathology. Ten-year survival of such patients is about 10%.
In the development of radioiodine resistance, other treatment options are used instead of radioactive iodine:
Surgery is most often used for local or regional recurrences. The tumor usually re-grows from the lymph nodes. Therefore, central or lateral neck dissection is often used for treatment. If it has already been performed earlier, at the stage of primary surgical treatment of cancer, then doctors limit themselves to removing only individual tumor foci that are detected during preoperative diagnostics and surgery.
Radiation therapy is the main treatment option for metastases to the bone and central nervous system. It is successfully used in combination with surgery to remove recurrent neck tumors. Progressive irradiation options are used abroad to safely deliver high doses of radiation to the tumor.
Ablation is the destruction of a recurrent tumor by various types of energies or chemicals. For example, ethanol ablation, radiofrequency, microwave. The most commonly used is radiofrequency one. Doctors insert a probe into the tumor, heat the tissues, and the tissues of the neoplasm are destroyed.
Chemoembolization is a minimally invasive procedure performed through an incision in the leg from inside the blood vessels. The doctor reaches the neck vessels through the femoral artery. He examines the arterial bed with the help of a contrast agent and X-rays. Drug-saturated microspheres, tiny balls containing chemotherapy drugs, are injected into the superior and inferior thyroid arteries. As a result, the tumor dies due to two mechanisms: the blockage of blood flow deprives it of oxygen, and the release of drugs from emboli destroys the remaining cancer cells within a few weeks.
In the advanced stages of cancer, various options for drug therapy of thyroid cancer are resorted to.
Hormone therapy is carried out for two purposes. The first one is to compensate for the deficiency of hormones caused by the removal of the thyroid gland. With the help of drugs, the normal course of metabolic processes in the body is ensured. The second goal is to suppress the growth of tumors. Such therapy is called suppressive. The mechanism of its action is realized through the pituitary hormone TSH (thyroid-stimulating hormone). It stimulates the function of the thyroid gland and the growth of its tissue, including tumorous ones. The lower the TSH level, the slower the tumor grows.
Since TSH is a hormone that regulates thyroid function, the level of its secretion is regulated by a feedback mechanism. The more thyroxine in the blood, the less the pituitary gland produces TSH. If the amount of thyroid hormones decreases, then the pituitary gland tries to stimulate the organ and produces more TSH. Accordingly, to reduce TSH, the concentration of thyroid hormones in the blood must be high. Therefore, doctors use high doses of hormonal drugs to suppress TSH production and reduce the growth rate of the neoplasm.
Chemotherapy is rarely used and has low efficacy. In addition, the disease can be cured without it in most cases. Chemotherapy is more often used for poorly differentiated types of cancer that are not sensitive to radioactive iodine. Chemotherapy can be combined with external beam irradiation.
Target therapy is an advanced and most effective drug therapy option, often used in advanced stages of the disease. Doctors perform diagnostics to determine mutations in the tumor cells. Depending on the detected changes in the genes, drugs that can reduce the size of the neoplasm and inhibit tumor growth for a long time are selected.
In countries with progressive medicine, drugs of the following groups are used:
Immunotherapy is currently in clinical trials.
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The program includes:
Required documents
Price from: on request
Type of program: Outpatient
Expected duration of the program: 3 days
__________________________________________________________________________________
The program includes:
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 4 days
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The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan of the thyroid gland and lymph nodes of the neck, thyroid scintigraphy. This will allow your doctor to assess how effective radioiodine therapy will be and how well you will tolerate it. In addition, the doctor will calculate the dosage of the drug you need.
Radioiodine therapy with I-131 includes oral administration of the drug. You will take 1 to 4 radioactive iodine capsules or drink about a teaspoon of liquid with radioactive iodine. You will take the drug in your ward, without visiting the manipulation room or operating room.
After taking radioactive iodine, you will stay in your ward for 24 to 48 hours. The next morning after the procedure, the dosimetrist will determine the amount of radiation in your body. If the amount is low, you will be allowed to leave your ward and will be discharged from the hospital. If the amount is high, then the dosimetry control will continue for another day, until a low amount of radiation in your body is detected.
The isotope I-131 can accumulate not only in the thyroid gland, but also partially in the salivary glands. This can cause dry mouth. To get rid of this side effect, you will dissolve sour candies, as this stimulates the work of salivary glands.
The drug is quickly excreted by the kidneys, and after 48 hours you will no longer pose a danger to others. After the procedure, you should drink at least 1 glass of water per hour and visit the toilet regularly. This will allow you to quickly remove radioactive iodine from the body. Food can be usual, without excess iodine in the diet.
During these 48 hours, you can read, use a mobile phone, tablet or computer. All these devices will not be a source of radiation in the future.
Control examination includes scintigraphy, which is performed 7-10 days after radioiodine therapy. Based on the results of the examination, the doctor will determine how well the cells of the thyroid gland (or cancer metastases) have accumulated radioactive iodine. In a few weeks after the procedure, you will have a control blood test for thyroid hormones. In the future, you will visit an endocrinologist regularly.
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 5 days
_________________________________________________________________________________________
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
Chemotherapy is carried out as the day hospital procedure, without mandatory admission to the hospital. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.
After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. If your general condition is good, your doctor will allow you to leave the hospital. You will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.
Required documents
Price from: on request
Type of program: Outpatient
Expected duration of the program: 4 days
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