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Thyroid Cancer

There are over 33,000 new cases of thyroid cancer each year in the World. Generally Females are more likely to have thyroid cancer.

Thyroid cancer can occur in any age group, although it is most common after the age of 30 and its fierceness increases significantly in older patients. The majority of patients present with a nodule on their thyroid, which typically does not cause symptoms.

Occasionally, symptoms such as roughness, neck pain, and enlarged lymph nodes do occur. Although as much as 10 % of the population will have thyroid nodules, the vast majority are benign. Only approximately 5% of all thyroid nodules are malignant. A nodule which is cold on scan (shown in photo outlined in red and yellow) is more likely to be malignant, nevertheless, the majority of these are benign as well.

A lot of information about thyroid nodules and the potential of these nodules to be malignant is contained on 3 pages about nodules:

Types of Thyroid Cancer

There are four types of thyroid cancer some of which are much more common than others.

Thyroid Cancer Type and Incidence

Papillary and mixed papillary/follicular

Papillary and follicular thyroid cancer , or carcinoma, account for about 83% of all thyroid malignancies. Some are pure papillary, some are purely follicular in nature, and some are mixed, that is, both types of cancer cells may be present in the same tumor. The important thing to understand is that 1) the typical forms of these cancers are quite curable in a very large percentage of cases and, 2) they behave in somewhat dissimilar ways, and affect slightly different age groups, though there are often exceptions to the rule.

Follicular and Hurthle cell

Follicular carcinoma is considered more aggressive than papillary carcinoma. It occurs in a slightly older age group than papillary and is also less common in children. In contrast to papillary cancer, it occurs only rarely after radiation therapy. Mortality is related to the degree of vascular attack. Age is a very important factor in terms of prognosis. Patients over 40 have a more aggressive disease and typically the tumour does not concentrate iodine as well as in younger patients. Vascular invasion is characteristic for follicular carcinoma and therefore distant metastasis is more common. Distant metastasis may occur in a small primary. Lung, bone, brain, liver, bladder, and skin are potential sites of distant spread. Lymph node involvement is far less common than in papillary carcinoma (8-13%).

Medullary

Unlike papillary and follicular thyroid cancers which arise from thyroid hormone producing cells, medullary cancer of the thyroid comes from the parafollicular cells (also called C cells) of the thyroid. These C cells make a different hormone called calcitonin . This cancer has a much lower cure rate than does the "well differentiated" thyroid cancers (papillary and follicular), but cure rates are higher than they are for anaplastic thyroid cancer. Overall 10 year survival rates are 90% when all the disease is confined to the thyroid gland, 70% with spread to cervical lymph nodes, and 20 when spread to distant sites is present.

Anaplastic

This cancer has a very low cure rate with the very best treatments allowing only 10 % of patients to be alive 3 years after it is diagnosed. They often arise within a more differentiated thyroid cancer or even within a goiter. Like papillary cancer, anaplastic cancer may arise many years (~20) following radiation exposure. Cervical metastasis (spread to lymph nodes in the neck) are present in the vast majority (over 90%) of cases at the time of diagnosis. The presence of lymph node metastasis in these cervical areas causes a higher recurrence rate and is predictive of a high mortality rate. The most common way this cancer becomes evident is by the patient or his/her family member noticing a growing neck mass.

 

 

 

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