thyroid cancer Introduction
iI. Types of thyroid cancer
In Hong Kong, up to 90% of thyroid cancers are classified as well-differentiated papillary and follicular types, which have a better prognosis.
The most common group affected is young women.
It is relatively rare, and the disease mainly affects the elderly.
Rare, people with the disease usually have a hereditary family history
Rare, the people who develop the disease are the elderly
The following are common symptoms in patients with thyroid cancer:
Painless lumps in the neck
The voice continues to be hoarse
Neck pain or sore throat
Difficulty swallowing or breathing, feeling oppressive
Persistent cough
Weight loss
Risk factors for thyroid cancer
iII. Diagnostic methods for thyroid diseases
Diagnostic methods for thyroid cancer include:
The doctor will touch the patient's neck with their fingers to check for any abnormalities in the thyroid gland and lymph nodes.
A fine needle is inserted into the lump in the neck to extract cells, which are then examined under a microscope for cancerous growths. Doctors may use ultrasound scans to pinpoint the needle insertion location. If a fine-needle aspiration is insufficient to obtain enough tissue, a core needle may be used for biopsy. Generally, open biopsies are rarely used for thyroid cancer.
Screening for thyroid cancer:
Doctors will use ultrasound to create images of the neck and inside the thyroid gland to see if the tissue is a solid mass or fluid.
Medical staff will inject a small amount of radioactive iodine into the patient's blood vessels to measure the radiation dose to the thyroid gland. Because well-differentiated cancer cells absorb radioactive material, scanning can help detect the location of cancer cells.
A series of X-ray images are taken, and the images are input into a computer to create a three-dimensional image, thus revealing detailed information such as the size and location of the tumor. The patient needs to receive contrast agents for the examination.
Using a tracking agent containing radioactive glucose (FDG), a three-dimensional anatomical image is obtained by displaying the location of absorption, revealing the location of cancer cells.
Staging of thyroid cancer
According to the guidelines of the American Joint Committee on Cancer and the American Cancer Society, well-differentiated thyroid cancer can be divided into stages I to IV:
Issue 1
Issue 2
Issue 3
Issue 4
iV. Treatment methods for well-differentiated thyroid cancer
Surgery
Surgery is the primary treatment for thyroid cancer. Depending on the patient's condition, the doctor will decide whether to remove only part of the thyroid gland or the entire thyroid gland. During surgery, the doctor will check the lymph nodes near the thyroid gland for any involvement of cancer cells; if the cancer cells have begun to spread beyond the thyroid gland, the doctor will remove surrounding tissue as well.
After the removal of all or nearly all of the thyroid gland, patients need to take thyroid hormones for life to replace the hormones originally produced by the thyroid gland. This also helps suppress the secretion of thyroid-stimulating hormone (TSH). If TSH levels are high, it may stimulate the remaining cancer cells, increasing the chance of thyroid cancer recurrence.
Endoscopic thyroidectomy
Endoscopic thyroidectomy involves removing the thyroid gland using an endoscope and specialized instruments. The incision site can be moved from the neck to below the collarbone, areola, or armpit. Minimally invasive thyroid surgery is now used in many countries; however, it is not suitable for patients with malignant thyroid tumors because malignant tumors require larger incisions, and a clear view ensures complete tumor removal. Currently, this method is only chosen for patients with benign thyroid tumors or very small thyroid cancers.
After undergoing thyroidectomy, patients may experience the following:
- Damage to vocal cord nerves, esophagus or trachea
- Hoarse and weak voice
- Tired
- Removal of the parathyroid gland can lead to a significant drop in calcium levels, which can easily cause numbness or convulsions in the limbs. Patients can take calcium supplements and vitamin D supplements.
- A scar will remain above the collarbone after surgery, but it will gradually fade over time.
Overall, the risks of thyroid surgery are very low when performed by experienced doctors and teams.
Radioisotope Iodine (Iodine-131)
After surgery, if cancer cells are not completely eliminated or metastasize or spread, the patient may need to receive radioactive iodine therapy. This is an internal radiation therapy in which radioactive iodine is administered to the patient in capsule or liquid form. Thyroid cancer cells are destroyed after absorbing radioactive iodine, while normal cells are rarely affected.
About four weeks before receiving radioactive iodine therapy, patients need to stop taking thyroid hormones, as thyroid hormones can hinder the absorption of radioactive iodine and render it ineffective. Patients may switch to injectable synthetic thyroid-stimulating hormone (rhTSH) to avoid problems caused by discontinuing thyroid hormones. Furthermore, about two weeks before treatment, patients should begin to avoid foods high in iodine, such as seafood, iodized salt, and cough medicine, and should also avoid eggs, cheese, and milk to prevent affecting the treatment's effectiveness.
Four to five days after treatment, the radioactive isotope iodine in the body will be excreted through urine, blood, saliva and sweat. Therefore, during this period, the patient must be isolated in the hospital to avoid contact with other people. Once the radiation level drops to a safe level, the patient can be discharged, which takes about several days.
Radioactive isotope iodine will not have long-term effects on patients, and female patients can get pregnant normally in the future. However, pregnancy and breastfeeding are not recommended in the first year after treatment.
The following side effects may occur when receiving radioactive isotope iodine therapy:
- Disgusting
- Dry mouth
- Dry eyes
- Change in taste or smell
- Pain in the neck or chest
Most side effects are temporary. If you feel unwell, you can talk to your medical staff to see if there are any ways to relieve the symptoms.
Thyroid hormone supplementation
For patients with early-stage thyroid cancer, thyroid hormones only play a supplemental role after treatment, and excessively high doses are not recommended. However, for mid-to-late-stage thyroid cancer, the use of higher doses of thyroid hormones to suppress tumor recurrence is quite common. In addition, some patients may need to take calcium and vitamin D supplements after parathyroidectomy.
External beam radiation therapy
External beam radiation therapy, commonly known as "electrotherapy" or "radiotherapy," uses high-energy X-rays to irradiate cancer cells to locally control tumors. Doctors may consider external beam radiation therapy if a thyroid cancer patient still has residual cancer cells after surgery, if the tumor cannot be completely removed surgically, or if there is extensive lymph node metastasis. External beam radiation therapy may also be used if the cancer recurs or spreads.
Currently, most external beam radiation therapy (EMT) treatments for thyroid cancer utilize intensity-modulated radiation therapy (IMRT). This technique uses computer-programmed radiation intensity to irradiate the tumor from multiple angles, achieving better treatment results and significantly reducing side effects. Each IMRT treatment for thyroid cancer lasts approximately twenty minutes, with a total course of about thirty sessions (six weeks). Patients do not require hospitalization; they only need to attend regular treatment appointments. Before starting ERT, the hospital will custom-make a transparent plastic mask for the patient's head and neck. This mask connects to the treatment bed to ensure the patient's head is in the correct position during the radiation therapy.
External beam radiation therapy may cause the following side effects:
- Nausea and tiredness
- Sore throat and difficulty swallowing
- Dry mouth, change in taste
- Skin reaction at the site of irradiation
Most side effects are temporary. If you feel unwell, you can talk to your medical staff to see if there are any ways to relieve the symptoms.
Targeted therapy
- Sorafenib
- Lenvatinib
- Dabrafenib
- Trametinib
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