Thyroid cancer is rare and low-risk cases have a good prognosis; The 10-year survival is around 99%. Most patients have a palpable swelling in the neck, and evaluation should be made with a combination of history, physical examination, thyroid ultrasonography and FNAB (fine needle aspiration biopsy). creates. It is the predominant thyroid cancer in children and individuals exposed to external radiation. Papillary carcinoma is more common in women with a female/male ratio of 2/1 and the average age of incidence is 30-40 years. Most patients are euthyroid and present with a slowly growing painless mass in the neck. Difficulty in swallowing, respiratory distress, and impaired voice are usually associated with locally advanced disease. Lymph node metastases are common, especially in children and young people, and may present with complaints. Lateral aberrant thyroid; almost always indicates a cervical lymph node involved with metastatic cancer. Suspicion of thyroid cancer often arises from the physical examination and history of the patients. Diagnosis is made by FNAB from thyroid mass or lymph node. Once thyroid cancer has been diagnosed with FNAB, it is recommended to evaluate contralateral lobe and central or lateral lymph node metastases with a full neck ultrasound. Distant metastases are not common at the time of diagnosis, but may develop in 20% of patients. The most common site of distant metastasis is the lungs, followed by bone, liver, and brain. In general, the prognosis in patients with papillary thyroid cancer is excellent, with 95% at 10-year survival. Many prognostic indicators, It is included in many staging systems that divide patients into low- or high-risk groups. Many data on which the staging systems are based are obtained according to the postoperative pathology report.
Treatment:
Treatment of thyroid cancer is primarily surgical. Total thyroidectomy is recommended for patients with tumors larger than 1 cm. This surgical method is such that the entire thyroid gland is removed from both lobes. If there is a suspicious lymph node in the preoperative ultrasonography, fine needle biopsy is performed. If there is a metastatic lymph node detected in the neck, lymph node dissection is added to total thyroidectomy according to the location of the metastatic lymph node. Even if there is no suspicious lymph node, if the cancer diameter is 4 cm or more, the lymph nodes in the central region should be cleaned during thyroidectomy as a precaution. In selected cases, unilateral lobectomy can be performed if the contralateral lobe is proven to be normal in tumors smaller than 1 cm in the low-risk group.
The patient should be evaluated with the pathology report and personal risk factors after surgery. In appropriate cases, “Radiactive Iodine Therapy” is given in addition to surgery.