Update: October 2018
Рак thyroid gland – злокачественное новообразование,
developing from follicular, medullary or papillary
Рост частоты установления диагноза — рак thyroid gland за
the last 15 years was 6%. According to experts, this
associated with the widespread introduction of ultrasonic methods
diagnostics, capable of detecting the presence of
malignant lesions that previously remained
ATыявить признаки рака щитовидки на ранних этапах можно с помощью
self-diagnosis – the so-called “Thyroid self-examination
glands. ” Self examination of the neck often helps to identify
swelling and enlargement of individual structures, indicating goiter,
доброкачественные опухоли или рак thyroid gland.
The following disease statistics are expected for the US in 2014
- About 63 thousand newly diagnosed cases of cancer 48 thousand –
women and 15 thousand – men
- 1800 – 1850 cancer deaths 1050 – women and
800 – men
Рак thyroid gland, симптомы которого позволяют быстро
determine the presence of a pathological process, usually diagnosed
in adults at an earlier age than malignant tumors
other organs. 65% of the total number of confirmed cases
found in patients younger than 55 years. Withблизительно 2% раковых
опухолей thyroid gland возникают у детей и подростков.
AT последние десятилетия заболеваемость раком thyroid gland
increased significantly, making it the fastest growing
malignant cancer in the United States. However,
mortality remains stably low compared to
To conditions that increase the risk of cancer
заболеваний thyroid gland, относятся:
- Sex and age (in women, the disease develops three times
more often. Also, in women, cancer is detected at an earlier age (40-50
years) than men (60-70));
- Insufficient consumption of products containing iodine (in regions
lack of iodine in food is more often noted
развитие фолликулярного thyroid cancer. Iodine deficiency
increases the risk of papillary carcinoma, especially in people
exposed to radiation);
- Radiation (exposure to radioactive radiation – confirmed
risk factor. Radiation therapy в области головы и шеи, проводимая в
childhood, significantly increases the chance of illness in
the future. Radioactive effects also include
diagnostic procedures – x-ray or computed tomography.
Withменение данных методов в детском возрасте должно осуществляться
only for clear indications and in small doses, if other ways
Studies have shown that after the accident atomic
power plant in Chernobyl, there was a sharp increase in frequency
заболеваемости раком thyroid gland в 10-ки раз. With этом люди с
sufficient intake of iodine in the body had less risk
diseases. ATоздействие радиации на взрослый организм несет
much lower risk than in childhood.
- Hereditary diseases (sometimes marked family
susceptibility to cancer. However, в общей
morbidity, they are isolated and do not have
sufficient basis for confirmation).
ATсе эти факторы приводят к конечной причине перерождения
glandular cells into cancer – the patient’s DNA mutations. AT случае
burdened heredity man acquires mutated gene
still at conception. AT остальных случаях мутация происходит под
exposure to various factors described above.
Types of tumors
Большинство раковых опухолей thyroid gland являются
differentiated, that is, consist of almost unchanged
фолликулярных клеток body.
Папиллярная карцинома составляет примерно 80% всех
злокачественных опухолей thyroid gland. itт вид отличается
медленным ростом и поражением только 1 доли body. Despite
quite slow growth, the tumor quite often spreads
on the cervical lymph nodes. Papillary cancer характеризуется низкой
летальностью и благоприятным прогнозом treatment.
Фолликулярная карцинома – вторая по частоте выявления
форма рака thyroid gland (10%). Frequency of its occurrence
significantly higher in countries with insufficient levels of iodine in food.
Such tumors usually do not spread to the lymph nodes, but may
penetrate other organs, including the lungs and bone system.
Forecast фолликулярной карциномы не так благоприятен, как
papillary, although in most cases, treatment allows
полностью избавиться от diseases.
Медуллярная карцинома в структуре раковых заболеваний
thyroid gland составляет приблизительно 6%. It develops from
glandular cells that produce the hormone calcitonin, which controls
blood calcium levels. The presence of a tumor may indicate
high content of calcitonin and special protein –
carcinoembryotic antigen. This type of cancer metastasizes in
lymph nodes, lungs, liver and others organs. Often this happens still
until a tumor is detected. Due to the impossibility of diagnosis and treatment
this type of cancer with radioactive iodine at the moment
the forecast remains unfavorable.
Анапластическая карцинома – редкая форма рака,
about 2-4% of cases. This is an undifferentiated form.
cancer, since the type of tumor cells cannot be accurately determined.
It is believed that this cancer develops from existing papillary or
medullary carcinomas. Symptoms of anaplastic thyroid cancer
glands are more rapid development, accelerated growth
tumors and early metastasis to the cervical lymph nodes and distant
organs, which leads to significant difficulties in the treatment.
Symptoms of thyroid cancer are:
- Feeling of increased education in the neck (usually with one
sides, often with rapid growth)
- Swelling of the neck in the gland area
- Pain in the gland sometimes extending upwards
- Hoarseness and other persistent changes in voice
- Difficulty swallowing
- Respiratory failure – shortness of breath, choking, cough
- Persistent cough, not associated with catarrhal diseases
(thyroid cancer stage 4 in 61% of cases metastasizes in
The pain that occurs when swallowing, excessively stimulates the work
glands in the throat producing viscous mucus. Because of this arises
feeling of “cotton ball in the throat.”
Rebirth of glandular cells leads to a decrease in volume
healthy tissue of the body and reduce the amount of hormones produced,
resulting in the development of hypothyroidism. Signs of this
- Apathy, lethargy, drowsiness
- Tingling in limbs
- Hair loss (causes), rough voice
With the development of follicular cancer of the thyroid gland, on the contrary,
the body is stimulated, leading to hyperthyroidism.
Due to hyperproduction of pathological pathological hormones
following symptoms appear in the cells:
- Feeling hot, excessive sweating (causes)
- Insomnia, chronic fatigue
- Slimming, loss of appetite
Differentiated forms in patients under 45 years of age
Young people are less likely to die
this form of cancer. The division into stages in the described age
group is as follows:
- Stage 1 – the tumor has any size, but it does not
подвергается распаду и не метастазирует в отдаленные organs.
Distribution in the nearest lymph nodes is possible;
- Stage 2 – a tumor of any size, which at the same time has
metastases in distant parts of the body.
Differentiated forms in patients after 45 years
- Stage 1 is characterized by limited tumor growth (up to 2 cm),
not having metastases in the lymph nodes and other organs;
- Stage 2 – a tumor with a diameter of 2 to 4 cm, not going beyond
the limits of the body. Lymph node metastases and other organs
- Withзнаками 3 стадии is an увеличение размера опухоли > 4
cm or go beyond the boundaries of the body without spreading to the lymph nodes and
other parts of the body or the presence of a tumor of any size that has
metastases in the nearest cervical lymph nodes, but without decay and
metastasis to other organs;
- Stage 4A – a tumor of any size with foci outside
body. Perhaps the presence of metastases in the surrounding lymph nodes
(neck, chest), but without distant secondary foci;
- Stage 4B – a tumor of any size, characterized by
germination deep into the neck in the direction of the spine, or in
nearby large blood vessels. Possible metastasis in
lymph nodes, but there are no distant metastases;
- Stage 4C means the presence of metastases in other organs. With
this tumor can be of any size and not even go beyond
glands or metastasize to lymph nodes.
All detected anaplastic forms are considered to be cancer 4
degree that characterizes the unfavorable prognosis of the disease.
- 4A stage – the tumor is located within the thyroid gland.
There are no distant metastases, but foci in the nearest
- Stage 4B is characterized by tumor germination beyond
organ without the formation of distant metastases;
- Stage 4C reflects the presence of distant tumor metastases. With
this primary focus may be within the gland and not have
lymph node metastases.
The choice of treatment method depends on the form of cancer and the stage of development.
tumors. Treatment рака thyroid gland осуществляется одним или
a combination of the following two methods:
- Treatment радиоактивным йодом;
- Radiation therapy;
- Hormone therapy;
- Selective therapy (targeted, targeted).
Thyroid oncology is usually treatable, especially
if the tumor has not yet metastasized. In a situation
when it is impossible to completely cure cancer, treatment
aims to remove or destroy most cancer cells and
suspension of their further growth and metastasis. AT
neglected cases, palliative care is performed to
eliminate the dangerous symptoms of cancer (pain, respiratory failure,
Operation to date is the main treatment
thyroid cancer. The exceptions are some
Lobectomy is an operation involving the removal of 1 lobe
thyroid gland. This method is used to treat cancer.
small size, not penetrated beyond the tissues of the gland. AT ряде
cases such an operation is performed for diagnostic purposes, if
biopsy did not provide a reliable result.
The advantage of the operation is the lack of need to receive
hormonal drugs in the future, as a result of treatment
the healthy part of the gland remains.
Thyroectomy is an operation during which a complete
удаление thyroid gland. This is the most common method.
surgical treatment. There are total and subtotal
thyroidectomy. The latter implies incomplete tissue removal.
glands due to the characteristics of tumor growth or anatomical
After removal of the thyroid gland, the patient is prescribed
hormonal drugs daily (thyroid hormone
Removal of lymph nodes is usually performed simultaneously with
main operation. Of particular importance is the removal of cervical lymph nodes
has in the treatment of medullary cancer, as well as anaplastic
Complications and side effects of surgical treatment include:
- ATременная или постоянная осиплость голоса, а также его
- Damage to the parathyroid glands;
- Bleeding or the formation of a large hematoma in the area
- Wound infection
Treatment радиоактивным йодом
With попадании в организм радиоактивного йода (Йод-131) он почти
в полном объеме накапливается в клетках thyroid gland. On this
based this method of treatment. After ingestion in the form of a capsule
the drug is absorbed from the intestine into the blood and absorbed by the cells
glands. Under the influence of radiation, glandular cells (cancer and
healthy) are destroyed, it does not have a negative impact
на все остальные organs.
This method can be used to destroy the tissues of the thyroid.
glands remaining after surgical treatment. Treatment
radioactive iodine is also effective against lymph node metastases
and other organs.
The described method provides a significant increase
survival of patients with papillary and follicular thyroid cancer
glands that have passed in stage 4 (with metastasis). AT то же
time, the advantages of the method remain questionable in the early
stages when tumor removal can be effectively carried out
In order to get more efficacy from the treatment
radioactive iodine, it is necessary to achieve a high concentration
thyroid stimulating hormone in the patient’s blood. It promotes aggregation
iodine glandular cells. If before it was produced
surgery to remove the thyroid gland, raise the level
thyroid stimulating hormone is possible by limiting daily hormone intake
thyroid in a few weeks. Alternative
way – the introduction of the drug Tyrogen, which is
a solution of thyroid stimulating hormone. It is administered once a day in
for 2 days. On the third day, the introduction of radioactive
Complications of the method depend on the received dose of radiation:
- Отек в области neck;
- Dry mouth;
- Nausea and vomiting;
- Swelling and compaction of the salivary glands;
- Change in taste;
- Dry eye (see dry eye syndrome).
Constant intake of thyroid hormone tablets
serves two purposes:
- Maintain the normal functioning of the body;
- Stopping the growth of cancer cells remaining after surgery
Since after thyroidectomy the body is not able to
to produce thyroid hormones, the patient needs
carry out hormone replacement therapy. it
helps prevent the recurrence of cancer. Usually doctors
recommend taking hormones in doses exceeding daily
Complications and side effects: arrhythmias, osteoporosis (see symptoms
and causes of osteoporosis, treatment of osteoporosis).
Radiation therapy подразумевает применение высокоинтенсивного
radiation for cancer cells. Before irradiation
fine and fine tuning is made for irradiation only
pathological focus without damaging healthy tissue. Usually
This method is not used to treat cancers,
accumulating iodine, as a more effective treatment
is a therapy with radioactive iodine. Thus, ray
therapy is used to treat anaplastic forms
злокачественной опухоли thyroid gland.
With разрастании опухоли за пределы thyroid gland лучевая
therapy reduces the risk of re-development of the tumor after
surgical treatment and slow the growth of metastases in other
The course of treatment takes place within a few weeks, 5 days in
a week Before starting treatment, a medical professional will produce
accurate measurements of the anatomical structures of each individual patient,
determine the desired angle of exposure and set the required dose
radiation. The radiation session lasts a few minutes and is an
Side effects of radiation therapy:
- Damage to surrounding tissues;
- Discoloration of the skin;
- Dry mouth;
AT данное время продолжается разработка новых лекарственных
funds whose action is aimed at eliminating only
altered cancer cells. AT отличие от стандартной
chemotherapy, during which all the fast-growing
cells, these drugs are more selective and
affect only cancer cells.
Preparations for selective treatment of medullary cancer
Treatment данного вида рака представляет больший интерес, так как
standard hormone therapy as well as radioactive treatment
iodine in this case remain ineffective.
ATандетаниб (Vandetanib) – это препарат для избирательной
therapy that promotes the cessation of tumor growth for 6
месяцев с начала treatment. Along with not enough
data on the survival rate of patients taking this drug
compared to other groups.
Cabozantinib (Cabozantinib) is another drug for
избирательной терапии медуллярного thyroid cancer. Term
limiting the growth of a cancer when taking the drug is 7
Selective therapy папиллярного и фолликулярного рака
Необходимость препаратов для лечения данных типов рака is an
less pronounced, as in these cases successfully applied
surgical methods and therapy with radioactive iodine. For drugs
for selective therapy include:
- Sorafenib (sorafenib);
- Sunitinib (sunitinib);
- Pazopanib (pazopanib);
- ATандетаниб (vandetanib).
The effectiveness of treatment and the quality of further life depend on
type and stage of the disease. For 2010, survival statistics were
represented by the following numbers.
|Five-year survival of patients||Stage 1||Stage 2||Stage 3||Stage 4|
|Papillary cancer||almost 100 percent survival||almost 100 percent survival||93%||51%|
|Follicular cancer||about 100%||about 100%||71%||50%|
|Medullary cancer||about 100%||98%||81%||28%|
Five-year anaplastic (undifferentiated) survival
карцином thyroid gland, большинство из которых к моменту
detection reached stage 4, is about 7%.
Автор: Коробов Никита Александрович врач-анестезиолог