Thyroid tumors
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Thyroid tumors can be:
- benign: adenoma;
- malignant;
- primary;
- epithelial: papillary ca, follicular ca, medullary ca, anaplastic ca;
- non-epithelial: malignant lymphoma, sarcomas;
- secondary: metastasis of breast, lung and kidney carcinoma .
- primary;
Risk factors for the development of thyroid malignancy include:
- ionizing radiation (previous irradiation of the neck);
- genetic influences;
- high level TSH;
- untreated autoimmune thyroiditis
- MEN2A syndrome
- pheochromocytoma.
Epidemiology
- have an increasing incidence, the most common endocrine tumors
- they occur most often between the ages of 40 and 50, but are not uncommon in children either
- more in women (2:1)
Differentiated thyroid carcinoma
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Differentiated carcinoma is the most common malignity of glandula thyroidea. We distinguish:
- Papillary carcinomas – grow slowly x tendency to local recurrences, metastasize mainly to the cervical lymphatic nodes.
- Follicular carcinomas – metastasize hematogenously (bones, lungs).
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Clinical characteristic
- A solitary growing knot of solid consistency (sometimes already in the present goiter – faster growth + change in appearance at USG;
- in an advanced stage – nodal metastases of the neck (less frequent distant metastases);
- thyroid function is not altered (x functionally active metastases may be a source of hyperthyresis).
Diagnosis
Therapy
- Total thyroidectomy (optionally in combination with selectively modified block neck resection;
- radioiodine therapy;
- external beam radiotherapy;
- substitution-suppression therapy (synthetic analogs of thyroid hormones – levothyroxine, replaces missing hormones and inhibits TSH in the pituitary gland).
Thyroglobulin is used as an early marker of recurrence/metastasis.
Prognosis
- Very good with early detection of the disease;
- worse in elderly patients and in distant multiple metastases.
References
Related articles
Sources
- DÍTĚ, P. Internal Medicine. 2. edition. Praha : Galén, 2007. vol. 586. ISBN 978-80-7262-496-6.
- KLENER, Pavel. Internal Medicine. 3. edition. Praha : Galén, 2006. vol. 1158. ISBN 80-7262-430-X.
| Thyroid gland diseases | |
|---|---|
| non - cancerous diseases | Hypothyroidism • Congenital hypothyroidism • Chronic (autoimmune) thyroiditis • Myxedema coma • Hyperthyroidism • Graves-Basedow disease • Thyrotoxicosis • Thyrotoxic crisis • Neonatal hyperthyroidism • Goiter (pediatrics) • Thyroiditis • Thyroid gland diseases |
| cancer illnesses | Thyroid adenoma • Toxic adenoma • Differentiated thyroid carcinoma • Anaplastic thyroid carcinoma • Medullary thyroid carcinoma |
| thyroid examination | Examination of thyroid function • Thyroid diseases examination |
| Portal: Endocrinology and metabolism | |
Portal: Internal Medicine | Endocrinology | Oncology | Otorhinolaryngology | Surgery >
Differentiated carcinoma is the most common malignancy of the thyroid gland. We distinguish:
- Papillary carcinomas – they grow slowly x tend to local recurrences, they metastasize mainly to the cervical lymph nodes.
- Follicular carcinomas – metastasize hematogenously (bones, lungs).
Clinical picture
- Solitary growing knot of solid consistency (sometimes already present in the goiter – faster growth + change of appearance at USG);
- in advanced stage nodal metastases on the neck (less often distant metastases);
- thyroid function is not altered (x functionally active metastases may be a source of hyperthyroidism).
Diagnostics
Therapy
- Total thyroidectomy (possibly in combination with selective modified block neck resection);
- radioiodine therapy (iodine131I isotope);
- external radiotherapy;
- 'substitution-suppression therapy (synthetic analogues of thyroid hormones – levothyroxine, replaces missing hormones and inhibits TSH synthesis in the pituitary gland).
Thyroglobulin is used as an early marker of recurrence / metastasis.
Prognosis
- Very good with early detection of the disease;
- worse in elderly patients and in distant multiple metastases.
Anaplastic thyroid carcinoma
Anaplastic thyroid carcinoma i. e. anaplastic thyroid cancer is a rare (1–5 % of thyroid carcinoma). It usually affect individuals older than 60–70 years. Characteristic features for this type of tumor is: rapid growth of cancerous nodules, invasion to surroundings and mechanical syndrome (due to pressure). It creates distant metastasis (lymph nodes, lungs, liver, CNS).
Therapy
- Radical chirurgical intervention (total thyroidectomy),
- paliative care – cytostatic drugs + external radiation;
- often the therapy is only supportive.
Prognosis
- Unfavorable, the medain survival is 5 months.
Links
Related articles
Literature
- DÍTĚ, P., et al. Vnitřní lékařství. 2. vydání. Praha : Galén, 2007. ISBN 978-80-7262-496-6.
- BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 2014]. <http://jirben.wz.cz>
References
- KEUTGEN, Xavier M, Samira M SADOWSKI a Electron KEBEBEW. Management of anaplastic thyroid cancer. Gland Surg [online]. 2015, vol. 4, no. 1, s. 44-51, dostupné také z <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321056/?tool=pubmed>. ISSN 2227-684X.
Anaplastic carcinoma of the thyroid gland is rare (1-5% of thyroid carcinomas). It usually affects people over 60-70 years of age. This type of tumor is characterized by rapid growth of the tumor node, invasion of the environment and mechanical syndrome (from oppression). It creates early distant metastases (nodes, lungs, liver, CNS).
Therapy
- Radical surgery (total thyroidectomy),
- palliation – cytostatics + external irradiation.
- often treatment only symptomatic.
Prognosis
- Unfavorable, median survival 5 months[1].
Medullary thyroid carcinoma
Medullary thyroid carcinoma originates from parafollicular, also called C-cells, of the thyroid gland. In four clinical forms:
- sporadic (70-80% medullary ca, most aggressive)
- familial (AD inherited)
- MEN 2A and MEN 2B syndromes (together with pheochromocytoma, neurofibromas, parathyroid adenomas, ...)
Clinical picture + diagnostics
- Similar to differentiated thyroid cancer,
- secretes calcitonin ( marker),
- is more aggressive than differentiated carcinoma, at the time of diagnosis Molecular mechanisms of metastasis in more than 50% of cases,
- in medullary thyroid carcinoma in connection with MEN 2A and MEN 2B syndromes, vanillic acid is measured,
- 50% of medullary ca produces CEA (carcinoembryonic antigen).
Therapy
Total thyroidectomy, external radiation (C cells do not accumulate iodine), chemotherapy.
Forecast
Despite the aggressiveness, the prognosis is favorable - 75% of patients survive for 15 years.
Links
Related Articles
Used literature
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Source
> Medullary thyroid carcinoma originates from parafollicular C-cells of the thyroid gland. In four clinical forms:
- sporadic (70-80% of medullary carcinoma, the most aggressive)
- familial (AD hereditary)
- MEN 2A and MEN 2B syndromes (together with pheochromocytoma, neurofibromas, parathyroid adenomas,...)
Clinical picture + diagnostics
- Similar to |differentiated thyroid carcinoma,
- secretes the calcitonin (marker),
- is more aggressive than differentiated carcinoma, at the time of diagnosis there are metastases in more than 50% of cases,
- in medullary thyroid carcinoma in connection with MEN 2A and MEN 2B syndromes vanillic acid is measured,
- 50% of medullary ca produces CEA (carcinoembryonic antigen).
Therapy
Total thyroidectomy, external irradiation (C cells do not accumulate iodine), chemotherapy.
Prognosis
Despite the aggressiveness, the prognosis is favorable - 75% of patients survive 15 years.
TNM classification
TNM of thyroid tumors
| TX | cannot be evaluated |
| T0 | not found |
| T1 | less than 2 cm |
| T2 | more than 4 cm |
| T3 | over 4 cm or minimal spread outside the thyroid gland |
| T4 | grows outside the thyroid gland |
| NX | cannot be evaluated |
| N0 | without finding |
| N1 | with a finding |
| N1a | only nearby nodes on the tumor side |
| N1b | finding on the other side or more distant |
| MX | cannot be determined |
| M0 | are not present |
| M1 | are present |
Links
References
- DÍTĚ, P., et al. Vnitřní lékařství. 2. edition. Prague : Galén, 2007. ISBN 978-80-7262-496-6.
- KLENER, P, et al. Vnitřní lékařství. 3. edition. Prague : Galén, 2006. ISBN 80-7262-430-X.
- BENEŠ, Jiří. Studying materials [online]. ©2007. [cit. 2014]. <http://jirben.wz.cz>.
References
- ↑ KEUTGEN, Xavier M – SADOWSKI, Samira M – KEBEBEW, Electron. Management of anaplastic thyroid cancer. Gland Surg [online]. 2015, y. 4, no. 1, p. 44-51, Available from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321056/?tool=pubmed>. ISSN 2227-684X.
Kategorie:Vnitřní lékařství Kategorie:Endokrinologie Kategorie:Onkologie Kategorie:Otorhinolaryngologie Kategorie:Chirurgie Kategorie:Patologie
