Medullary thyroid cancer is a malignant nodular structure that arises from the degeneration of thyroid cells.
Medullary type of oncopathology is found only in 5-9% of all cases of thyroid cancer. Medullary cancer is considered more dangerous than the papillary and follicular form, because it is able to germinate through the thyroid capsule into the muscle tissue and trachea.
Histologically, the formation is a solid tumor consisting of a continuous cellular tissue. Cancer affects specific C-cells of the thyroid gland, which produce a hormone calcitonin that does not participate in any material exchange processes.
The disease is characterized by hot flashes and stools, skin flushing on the face, fever, etc.
Medullary cancer is most typical for patients after 40 and up to 50 years. Such oncoform has no sexual preferences, equally often affecting women and men.
In patients under 50 years of age, the predictions are relatively favorable, but in elderly patients this form of cancer proceeds extremely aggressively, affecting metastases inorganic structures. At children practically does not meet.
Causes of pathology
The causes of pathology are not defined definitively, however, it is known that with adverse heredity, medullary cancer is inherited in an autosomal dominant form.
Specialists distinguish several quite typical factors provoking the development of medullary oncopathology:
- Radiation therapy of other tumoral diseases;
- Adverse environmental conditions associated with increased ionizing radiation;
- Elderly age, which experts explain by the presence in the elderly of a greater number of somatic mutations;
- Harmful habits;
- Harmfulness of a professional nature, etc.
Propensity to pathologies of this nature is transmitted and hereditary, but sometimes medullary cancer is detected in individuals whose ancestors have never suffered such an oncology.
Symptoms of medullary thyroid cancer
Initially, the pathology develops latently and for the first time makes itself felt by the increase in the cervical lymph nodes and the appearance of densification in the glandular region, which does not cause any complaints and brings discomfort.
Clinical manifestations of the tumor are in external abnormalities and violations of hormonal status.
The development of medullary thyroid cancer is indicated by symptoms like:
- Respiratory difficulties and painful discomfort when ingested;
- Visually noticeable increase in lymph node cervical structures;
- Appearance of characteristic sypa and hoarseness in the voice;
- Failures in the digestive and intestinal activities such as diarrhea and bloating, flatulence, etc.;
- Intestinal cramping;
- Oncology and calcium-metabolic disturbances are typical for medullary type, which is manifested by weakness of ligaments, thinning of bone structures, changes in body proportions, etc.;
- Approximately half of patients have pheochromocytoma signs such as mental imbalance, hypertension, or headaches;
- Prolonged course of the tumor process over time causes frequent increases in blood pressure;
- Approximately 10-20% of patients develop hyperparathyroidism, which manifests itself asymptomatically with urolithiasis or hypercalcemia.
Virtually all medullary oncogenes cause lymphogenous and hematogenous metastasis. Remote metastasis in a third of cases is localized in the lung tissues, although it may occur in cerebrospinal, bone, renal or hepatic structures.
Classification of
The medullary type of thyroid cancer is classified into several forms:
- Family, hereditary form. A similar disease is not associated with other endocrine pathologies, is more often found in old age and is distinguished by a more peaceful course;
- Medullary oncology of thyroid in the form of a syndrome of endocrine neoplasia of multiple character 2B type - MEN-2B. Such a cancerous form is usually accompanied by pheochromocytoma, ocular pathologies, neurofibromatous lesions of the mucous membranes, intestinal diverticulosis and a characteristic physique;
- Medullary type of oncology, which is part of the syndrome of endocrine neoplastic processes, proceeding in 2A form - MEN-2A. For this form of medullary cancer, the presence of pheochromocytoma and hyperparathyroidism is typical;
- Sporadic form of medullary thyroid cancer. It is considered the most common, there is no family history, and the tumor usually has a one-sided nature.
Diagnosis
The procedure for determining the pathology and confirming the diagnosis is based on traditional studies:
- Laryngoscopy;
- Ultrasound diagnosis;
- Tomographic studies of thyroid gland by computer, magnetic resonance or positron emission;
- Blood test for the presence of oncomarkers like calcitonin;
- Biopsy fine needle aspiration;
- Histological examination, etc.
Timely diagnosis reveals effective therapy and increases the chances of a cure and a long life.
Treatment of medullary thyroid cancer
The most effective method of treating thyroid cancer is surgery, which involves complete removal of the tumor along with the gland and some lymph nodes.
In 4 stages of medullary cancer, removal of all oncology sites, including distant organs with metastases, is indicated.
After removal, several courses of systemic chemotherapy are conducted.
Irradiation with medullary oncology is justified only in such cases as preoperative necessity, postoperative destruction of cancer cells or as an element of palliative therapy in inoperable formations. But in general, irradiation with a similar oncotype does not always prove effective.
After the operation, to reduce the probability of metastasis, the patient is administered radioactive iodine. In the future, after the removal of the thyroid gland, the oncological patient will have to take life-long preparations on the basis of thyroid hormones.
Pazopanib and Caprelsa are used as effective chemotherapeutic anti-cancer drugs for medullary thyroid oncology. On the background of their reception, there are many side effects such as diarrhea and nausea, weight loss and headaches, pressure jumps and dizziness, excessive fatigue, etc.
Forecast
Forecasts for medullary thyroid types differ according to the specific form of the tumor.
The hereditary cancer cases proceed more safely, in 80% of such cases, if metastasis is localized in the cervical lymph nodes, there is a 5-year survival rate. When the tumor spreads to distant organs, the percentage of survival is markedly reduced.
In general, the medullary carcinoma of the thyroid gland is considered as an oncoform prognostically unfavorable. Regional metastasis is present in about 70% of cancer patients. About a third of patients have distant metastases, which exacerbates the picture of pathology and limits therapeutic possibilities. With distant metastasis, 5-year survival is about 20%.
To avoid recurrence, the patient must visit the endocrinologist every year.
If, at the end of therapy, the level of calcitonin is normal, this indicates a positive outcome of treatment, with an increased content of a similar hormone, the risk of recurrence is high. In such a situation, the patient is subjected to a more thorough examination to identify metastases that need to be removed.
Medullary thyroid cancer is quite aggressive, so the only correct approach to treatment is early diagnosis and radical removal of the affected organ.
The role of radiation therapy in the treatment of medullary and highly differentiated thyroid cancer, in this video: