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Thyroid Cancer
Is thyroid cancer without lymph node metastasis considered early stage?
Thyroid cancer, if it has not metastasized to lymph nodes, generally falls under early-stage. Once thyroid cancer is diagnosed, surgical removal is the primary treatment choice. Postoperative treatments vary depending on the different pathological types of thyroid cancer. For the most common type, papillary carcinoma, if the surgery is radically curative, further treatment may not be necessary, and merely supplementing thyroid hormones suffices. In cases such as follicular carcinoma, undifferentiated carcinoma, or medullary carcinoma, even after surgically radical removal, postoperative treatment often requires further radiotherapy or treatment with Iodine-131, depending on the surgical pathology results. (The use of medications should be carried out under the guidance of a professional doctor.)
Characteristics of thyroid cancer lymph node enlargement
Thyroid cancer is a type of malignant tumor. However, if it is detected early, diagnosed early, and treated early, it generally has a relatively good prognosis compared to other malignant tumors. Once a patient is afflicted with this disease, it is crucial to seek treatment promptly. Without treatment, thyroid cancer can spread to lymph nodes. Initially, the cancerous lymph nodes may invade surrounding blood vessels and nerves, leading to symptoms such as hoarseness. If it compresses the throat area, it can cause discomfort in the throat accompanied by breathing difficulties and coughing while drinking. If the optimal time for treatment is missed, cancer cells can spread, potentially moving not only to the lungs but also to the respiratory system and bones, among other distant sites.
How is thyroid cancer diagnosed?
The first point is the diagnostic process for differentiated thyroid cancer. Initially, most patients may not have symptoms, while a minority might show symptoms due to invasion of surrounding organs. Ultrasound examination is the preferred method for diagnosing thyroid nodules. Ultrasound can clarify the number, nature, and location of thyroid nodules, as well as provide information on whether there are abnormally enlarged lymph nodes in the neck. It has a relatively high accuracy in identifying the nature of thyroid nodules. Currently, the most accurate test for determining the nature of thyroid nodules remains the fine needle aspiration cytology, which has a diagnostic sensitivity of 83-92% and specificity of 80-92%, but it is not 100% conclusive. The second point is about the diagnosis of medullary thyroid cancer. Besides the tests common for thyroid cancers, additional tests for medullary thyroid cancer can include fine needle aspiration, ultrasound, and some serological tests, such as calcitonin and carcinoembryonic antigen tests.
What are the clinical manifestations of thyroid cancer?
For patients with thyroid cancer, the most common clinical manifestation is thyroid nodules, and most patients do not have obvious clinical symptoms, only being incidentally discovered during physical examinations. In rare cases, patients may seek medical attention due to enlarged cervical lymph nodes. As the condition progresses, the neck mass gradually enlarges, becomes firmer, and its mobility decreases during swallowing. In some rapid developments, it may invade surrounding tissues, leading to late-stage symptoms such as hoarseness, difficulty breathing, and difficulty swallowing. When the cervical sympathetic nerve is compressed, it can cause pain in the ears, occipital region, and shoulders. In the case of medullary carcinoma, which can produce serotonin and calcitonin, patients may sometimes experience symptoms such as diarrhea, palpitations, facial flushing, or decreased blood calcium levels.
Can people with normal thyroid function get thyroid cancer?
Thyroid function and thyroid cancer are not necessarily related. It is possible to have thyroid cancer even when thyroid function is normal. Clinically, thyroid cancer is usually detected by color ultrasound. Clinicians will classify thyroid nodules based on their size, texture, growth direction, presence of blood flow signals, clarity of boundaries, infiltration of surrounding tissues, and enlargement of nearby lymph nodes. Nodules classified as categories one to three generally have a benign tendency, and regular follow-up appointments are sufficient. If the nodules are classified as categories four to five, they are suggestive of malignancy, and it is recommended to perform thyroid fine needle aspiration or surgery to determine the pathological type of the nodules.
Symptoms of thyroid cancer
The symptoms of thyroid cancer, the first point is the clinical manifestations of differentiated thyroid cancer. Most differentiated thyroid cancers are asymptomatic, with only occasional palpable nodules of varying sizes and textures, which can sometimes be detected in routine physical and imaging examinations. A few advanced thyroid cancers may produce noticeable symptoms due to large nodules or invasion of surrounding organs, such as compression of the trachea causing breathing difficulties, difficulty swallowing due to pressure on the esophagus, and hoarseness due to compression of the recurrent laryngeal nerve. The second point concerns the specific clinical manifestations of medullary thyroid carcinoma. The specific symptoms of medullary thyroid cancer include persistent watery diarrhea, not accompanied by severe malabsorption in the large intestine, often with facial flushing, some endocrine syndromes, and some associated conditions such as pheochromocytoma, multiple mucosal neuromas, and parathyroid adenomas.
Causes of Thyroid Cancer
Regarding the causes of thyroid cancer, they are similar to most malignant tumors. The etiology of thyroid cancer is currently unclear, but some factors have been found to be associated with the onset of thyroid cancer. The first factor is neck radiation; the thyroid is an endocrine organ that is sensitive to radiation, so radiation exposure may cause carcinogenic changes in thyroid cancer cells. The second factor is genetics; some thyroid cancers have a clear genetic predisposition, the most typical being medullary thyroid cancer, with about 25% of patients showing familial clustering, known as familial medullary thyroid cancer. The third factor is that the rapid increase in the incidence of thyroid cancer also has some reasons, with one recognized reason being advancements in early diagnostic methods, allowing for the easy detection of numerous early lesions. The fourth is iodine intake, which has been shown to be related to some benign diseases of the thyroid, but its relationship with thyroid cancer itself needs further study.
Will thyroid cancer spread if surgery is not performed immediately after a biopsy?
Thyroid cancer, after undergoing a fine needle biopsy, may spread if surgery cannot be performed immediately, which is a risk of the thyroid cancer biopsy. Fine needle biopsy of the thyroid is a method for obtaining histopathological results and is a gold standard for the clinical diagnosis of thyroid cancer. A biopsy is an invasive examination that causes some degree of harm to the body, hence, informed consent must be obtained from the patient before proceeding. After the biopsy, complications such as local bleeding, swelling, pain, and infection may occur, and the spread of cancer cells at the biopsy site is a significant adverse effect. Therefore, for most thyroid cancer patients, it is advisable to arrange surgery as soon as possible after a biopsy to prevent the disease from spreading.
Thyroid cancer ultrasound manifestations
The characteristics of ultrasonography for thyroid cancer include the tumor being a solid hypoechoic mass with unclear boundaries, uneven internal echoes, abundant internal blood flow, and the presence of sandy calcifications and longitudinal growth, among others. Currently, ultrasonography is the preferred method for examining thyroid nodules. It can clearly identify the number, nature, and location of thyroid nodules, as well as whether there are any abnormally enlarged lymph nodes in the neck. Ultrasonography is highly accurate in differentiating the nature of thyroid nodules, with experienced ultrasonographers reaching an accuracy rate of over 80%. However, the highest accuracy in differentiating the nature of thyroid nodules is still achieved with fine-needle aspiration cytology.