Thyroid Cancer – Causes, Symptoms and Treatment
Thyroid cancer is a malignant tumor of the thyroid gland. It is the most common cancer of the endocrine system and, when detected early, is usually highly treatable with excellent long-term outcomes.
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Thyroid cancer is a malignant tumor of the thyroid gland. It is the most common cancer of the endocrine system and, when detected early, is usually highly treatable with excellent long-term outcomes.
What Is Thyroid Cancer?
Thyroid cancer is a malignant (cancerous) tumor originating in the thyroid gland, a butterfly-shaped gland located in the front of the neck. The thyroid produces hormones that regulate metabolism, heart function, and many other vital body processes. Thyroid cancer is the most common malignancy of the endocrine (hormone-producing) system. In most cases – particularly the well-differentiated forms – the prognosis is very favorable.
Types of Thyroid Cancer
There are four main types, differing in their tissue of origin, growth behavior, and prognosis:
- Papillary thyroid carcinoma: Accounts for approximately 70–80% of cases. It grows slowly, tends to spread to regional lymph nodes, and has an excellent long-term prognosis.
- Follicular thyroid carcinoma: Represents about 10–15% of cases. It tends to spread through the bloodstream (hematogenous metastasis), for example to the lungs or bones.
- Medullary thyroid carcinoma: Arises from parafollicular C-cells, which produce the hormone calcitonin. It can occur sporadically or as part of a hereditary syndrome (MEN 2).
- Anaplastic thyroid carcinoma: The rarest but most aggressive form. It grows very rapidly and carries a poor prognosis.
Causes and Risk Factors
The exact cause of thyroid cancer is often unclear. The following factors are known to increase the risk:
- Radiation exposure: Particularly radiation to the head and neck area during childhood is a significant risk factor.
- Genetic predisposition: Family history and specific gene mutations (e.g., RET proto-oncogene in medullary carcinoma) are well established.
- Iodine deficiency: Associated with an increased risk of follicular carcinoma.
- Sex and age: Women are affected approximately three times more often than men; the peak incidence is between ages 40 and 60.
- Pre-existing thyroid conditions: Benign thyroid nodules (adenomas) or goiter may increase risk.
Symptoms
In early stages, thyroid cancer often causes no or only nonspecific symptoms. Possible signs include:
- A palpable, painless lump in the neck
- Hoarseness or voice changes (due to involvement of the recurrent laryngeal nerve)
- Difficulty swallowing or a feeling of pressure in the throat
- Enlarged lymph nodes in the neck
- Persistent cough without an obvious cause
If thyroid cancer is suspected, a doctor should be consulted promptly.
Diagnosis
Diagnosis is confirmed through a combination of examinations:
- Thyroid ultrasound: The primary imaging method to assess nodules (echogenicity, size, vascularity).
- Fine needle aspiration biopsy (FNAB): Extraction of cells from a nodule for microscopic examination.
- Blood tests: Measurement of TSH, calcitonin (if medullary carcinoma is suspected), and thyroglobulin.
- Scintigraphy: A nuclear medicine scan to assess the functional activity of thyroid nodules.
- CT, MRI, or PET-CT: Used for staging and to detect metastases.
Treatment
Surgery (Thyroidectomy)
Surgical removal of the thyroid gland (thyroidectomy) is the primary treatment. Depending on the extent of the tumor, the thyroid is removed completely or partially. Affected lymph nodes are also removed surgically.
Radioiodine Therapy
Following surgery for differentiated carcinomas (papillary, follicular), radioiodine therapy (131I) is commonly administered. Remaining thyroid tissue and any iodine-absorbing metastases are selectively destroyed.
Hormone Therapy (TSH Suppression)
After surgery, patients receive lifelong levothyroxine (thyroid hormone) to replace the body's hormone production. At the same time, secretion of TSH (thyroid-stimulating hormone) is suppressed, as TSH can promote tumor cell growth.
Additional Treatment Options
- External beam radiation therapy: Used for locally advanced tumors or anaplastic carcinoma.
- Targeted therapies: Tyrosine kinase inhibitors (e.g., sorafenib, lenvatinib) are used for advanced, radioiodine-refractory carcinomas.
- Chemotherapy: Plays a minor role in thyroid cancer overall, but may be considered in anaplastic carcinoma.
Follow-Up and Prognosis
Regular follow-up examinations are essential to detect recurrences early. These include blood tests (thyroglobulin as a tumor marker), ultrasound, and where indicated, whole-body scintigraphy. The prognosis for papillary and follicular carcinoma is excellent – the 10-year survival rate exceeds 90%. Anaplastic carcinoma, however, carries a very poor prognosis.
References
- Haugen BR et al. – 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016.
- World Health Organization (WHO) – Classification of Tumours: Endocrine and Neuroendocrine Tumours, 5th Edition, 2022.
- Schlumberger M et al. – Lenvatinib versus Placebo in Radioiodine-Refractory Thyroid Cancer. New England Journal of Medicine, 2015.
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