Thyroid Cancer in iran

Thyroid Cancer

Females are more likely to have thyroid cancer at a ratio of 3:1. Thyroid cancer can occur in any age group, although it is most common after age 30, and its aggressiveness increases significantly in older patients. Approximately 1.2 percent of all men and women will be diagnosed with thyroid cancer during the course of their lifetime.

Thyroid Cancer Symptoms

Thyroid cancer frequently presents without any symptom whatsoever. When a symptom does present, the most common symptom is a lump in the neck. Less commonly, patients may have symptoms including hoarseness or change in voice. Symptoms of pain are very uncommon except in inflammatory conditions of the thyroid and the rarer of thyroid cancers called medullary thyroid cancer.
Although as many as 75% of the population will have thyroid nodules, the vast majority are benign. Young people usually don't have thyroid nodules. However, children and adolescents with thyroid nodules are most commonly benign, but the overall risk of thyroid cancer is markedly higher than in the adult population. As people age, they are more likely to develop a thyroid nodule. By the time we are 80 years of age, 90% of us will have at least one thyroid nodule.
Fewer than 1% of all thyroid nodules are malignant (cancerous). Thyroid nodules are most commonly identified due to routine physical examination or x-ray studies obtained for other reasons. The below MRI study was obtained for a patient complaining of neck pain following a motor vehicle accident. The red arrow points to a right thyroid mass (the right and left sides are reversed in x-rays) which was confirmed to be papillary thyroid cancer by ultrasound-guided needle biopsy.

Types of Thyroid Cancer

• Papillary and/or mixed papillary/follicular thyroid cancer: ~ 85%
• Follicular and/or Hurthle cell thyroid cancer: ~ 10%
• Medullary thyroid cancer: ~ 3%
• Anaplastic thyroid cancer: ~ 1%

Papillary Thyroid Cancer

Papillary thyroid cancer (also sometimes called papillary thyroid carcinoma) is the most common type of thyroid cancer. You may have even heard your doctor talk about metastatic papillary thyroid cancer ("metastatic" means that it has spread beyond your thyroid gland). This article will focus on papillary thyroid cancer basics, including papillary thyroid cancer symptoms, treatments, and prognosis.
Most commonly, papillary thyroid cancers are totally asymptomatic. However, the most common symptom is a mass in the neck. Papillary carcinoma typically arises as a solid, irregular or cystic mass that comes from otherwise normal thyroid tissue. This type of cancer has a high cure rate—10-year survival rates for all patients with papillary thyroid cancer estimated at over 90%. Cervical metastasis (spread to lymph nodes in the neck) are present in 50% of small papillary carcinomas and in more than 75% of the larger papillary thyroid carcinomas.
The presence of lymph node metastasis in the neck area typically has a more frequent recurrence rate but not a higher mortality rate. Distant spread of papillary thyroid cancer is called metastasis. Distant metastasis of papillary thyroid cancer is uncommon, but when it does occur, it may spread to the lungs, liver, and bone. Papillary thyroid cancers that invade the surrounding tissues next to the thyroid gland have a much worse prognosis because of a high local recurrence rate. But what do doctors look for in diagnosing papillary thyroid cancer?

Characteristics of Papillary Thyroid Cancer

• Peak onset ages are 30 to 50 years old.
• Papillary thyroid cancer is more common in females than in males by a 3:1 ratio.
• The prognosis is directly related to tumor size. Less than 1.5 cm [1/2 inch] is a good prognosis.
• The prognosis is also directly related to age. Patients under 55 years of age do much better than patients who are over 55 years of age.
• The prognosis is directly related to gender. Women have a much better prognosis than do similarly aged men.
• This cancer accounts for 85% of thyroid cancers due to radiation exposure.
• In more than 50% of cases, it spreads to lymph nodes of the neck.
• Distant spread (to lungs, liver or bones) is uncommon.

Thyroid Cancer: Follicular Cancer

Follicular thyroid cancer is the second most common type of thyroid cancer (papillary thyroid cancer is the most common thyroid cancer). This article will focus on the symptoms, diagnosis, and treatments for follicular thyroid cancer.
About 15% of all thyroid cancer cases are follicular thyroid cancer.1 Follicular carcinoma is considered more malignant (aggressive) than papillary carcinoma.
But what are some common follicular thyroid cancer symptoms, and how is follicular thyroid cancer diagnosed? Follicular thyroid cancer occurs in a slightly older age group than papillary thyroid cancer 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 invasion. Age is a very important factor in terms of prognosis. Patients older than 40 years old have a more aggressive disease and typically the tumor does not concentrate iodine as well as in younger patients. Vascular invasion is characteristic for follicular carcinoma and therefore distant metastasis is more common.
With follicular thyroid cancer, lung, bone, brain, liver, bladder, and skin are potential sites of distant spread. Lymph node involvement is far less common than in papillary carcinoma.

Characteristics of Follicular Thyroid Cancer

• Peak onset of follicular thyroid cancer is between ages 40 and 60 years old.
• Follicular thyroid cancer is more common in females than males by 3:1 ratio.
• The prognosis directly related to tumor size (less than 1.0 cm [3/8 inch] is a good prognosis).
• This cancer is rarely associated with radiation exposure.
• Cancer that spreads to lymph nodes is uncommon (~10%) in follicular thyroid cancer.
• Invasion into vascular structures (veins and arteries) within the thyroid gland is common.
• Distant spread (to lungs or bones) is uncommon, but it is more common than with papillary cancer.
• Overall cure rate is high (near 95% for small lesions in young patients), but this decreases with age.

Medullary Thyroid Cancer: Distinctive Symptoms Early in the course of medullary thyroid cancer, there are usually no symptoms. It almost never causes hyperthyroidism (increased thyroid function) or hypothyroidism (decreased thyroid function). It doesn't make people feel tired or any different.
As such, the early detection of sporadic (non-hereditary) medullary thyroid cancer typically is found by the patient or someone else noticing an unusual lump in the neck or throat, or by a doctor feeling a lump or nodule when examining a patient's thyroid gland. Because sporadic early medullary thyroid cancer doesn’t present with any symptoms, it is difficult to assess how long the tumor has been growing.
Although rare among thyroid cancers, medullary thyroid tumors may be tender to the touch and can even be painful either where they originated in the thyroid or where they spread to in the lymph nodes of the neck. But, almost all cancers that spread to the neck lymph nodes do not produce any noticeable discomfort.
Medullary thyroid cancer produces many proteins and sheds other substances that may lead to another common symptom of advanced medullary thyroid cancer—diarrhea. Diarrhea might arise from an interaction of several factors including increased calcitonin, prostaglandins, and the presence of several other substances. This diarrhea can be managed either by surgical removal of the tumor (and any involved lymph nodes) and/or appropriate medications.

Thyroid Cancer: Anaplastic Cancer

Anaplastic thyroid cancer is the least common type of thyroid cancer.

Characteristics of Anaplastic Thyroid Cancer

• Peak onset of anaplastic thyroid cancer is age 65 years old and older.
• It's very rare in young patients.
• It's more common in males than females by a 2:1 ratio.
• It typically presents as a rapidly growing neck mass.
• It can occur many years after radiation exposure.
• The spread to lymph nodes of the neck is present in more than 90% of cases.
• The distant spread (to lungs or bones) is very common even when it's first diagnosed.
• The overall cure rate is very low.
• It typically requires a very aggressive treatment plan with surgery, radiation, and sometimes even chemotherapy.
• It often requires a tracheostomy to maintain the patient's airway.
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