Thyroid cancer, although less common compared to other types of cancer, has seen an increase in its diagnosis due to the use of thyroid examinations, especially through ultrasound, and fine-needle aspiration biopsies of suspicious thyroid nodules performed by experienced professionals in recent years.
Thyroid cancers are three times more frequent in women compared to men. Factors known to increase the likelihood of thyroid cancer include a family history of thyroid cancer, exposure to neck radiation, and the presence of a solitary and cold nodule.
Papillary thyroid cancer is the most common type of thyroid cancer.
It is a slow-growing cancer, and even if it metastasizes, the survival rate is typically high, which is why it is classified as a well-differentiated thyroid cancer.
When diagnosed in the early stages, there is a good chance of successful treatment. Papillary thyroid cancers can spread to the lymph nodes in the neck if not caught early, and in such cases, neck dissection, which involves removing the lymph nodes in the neck, is often performed in conjunction with thyroid surgery.
Subsequently, the patient can be treated with radioactive iodine therapy (radioactive iodine treatment) to achieve a complete recovery.
Papillary thyroid cancer can be detected by the patient or during a doctor's examination as a nodule in the thyroid gland, or it can be found in routine check-ups when a neck ultrasound is performed specifically for the thyroid. Nodules of small size that cannot be felt during a physical examination can also be discovered during these screenings.
When suspicious ultrasound and examination findings are present in these nodules, a fine-needle aspiration biopsy is performed on the patient. If the diagnosis is considered to be thyroid cancer, the treatment plan, including surgery and subsequent radioactive iodine therapy (radioactive iodine treatment),depends on the size of the nodule and whether it has spread to the lymph nodes in the neck. In some cases, the lymph nodes in the neck can enlarge enough to be palpable, and if there is suspicion on neck ultrasound, a fine-needle aspiration biopsy is performed on these lymph nodes, and the pathological diagnosis can be consistent with papillary thyroid cancer.
In such cases, the patient is evaluated through neck ultrasound focused on the thyroid gland and neck lymph nodes, and the surgical and subsequent treatments are planned accordingly.
Another sign of papillary thyroid cancer is when the cancer grows to compress the nerve that controls the vocal cords, leading to symptoms like hoarseness. It can also cause difficulty swallowing as it grows backward and presses on the esophagus. In such cases, a doctor should be consulted, and a fine-needle aspiration biopsy is performed on the suspected nodule using thyroid ultrasound or advanced imaging methods to diagnose papillary thyroid cancer. Afterward, the treatment plan, including surgery and therapy, is organized.
Papillary thyroid cancer, like other cancers, has a tendency to spread (metastasize) if not diagnosed and treated promptly. The most common site of metastasis is the cervical lymph nodes, which are lymph nodes in the neck. Papillary thyroid cancers can also metastasize to distant organs. Approximately 8-10% of cancer patients with papillary thyroid cancer develop distant organ metastasis, and about half of these metastases occur in the lungs.
The majority of cancers that occur in the thyroid gland do not produce noticeable symptoms. Most of these patients are diagnosed after a suspicious nodule is identified during a neck ultrasound performed during routine check-ups, followed by a fine-needle aspiration biopsy. In recent times, the widespread use of ultrasound for the thyroid has led to the earlier detection of thyroid cancers, and surgical procedures have been facilitated with the use of new devices.
After a diagnosis of papillary thyroid cancer, a neck ultrasound is always performed to check for any potential spread to the lymph nodes in the neck. Then, a surgical plan is developed for the patient. The type of surgery to be performed varies depending on the size of the thyroid cancer and whether it has spread to the lymph nodes in the neck.
Papillary thyroid cancer surgery typically takes about 1.5 to 2 hours, and the patient is usually discharged the following day. After discharge, patients can take a shower 1 or 2 days later, and there is no need for suture removal as absorbable sutures are typically used. This treatment allows for a quick return to social life. The administration of radioactive iodine therapy (radioactive iodine treatment) is also planned based on the size of the nodule and the extent of lymph node involvement in the neck, and the patient is referred to the Nuclear Medicine department for this treatment.
Papillary thyroid cancer surgery is performed in an operating room under general anesthesia. The majority of surgeons specializing in thyroid surgery use magnifying glasses called loops to enhance precision during the operation. Nerve monitoring is employed to minimize the risk of nerve damage during the surgery.
After the papillary thyroid cancer surgery, patients are typically discharged the day following the operation. A detailed post-discharge plan is provided, which includes information on when the patient can take a shower, when they can return to their normal daily life, any travel restrictions, medication instructions, potential need for radioactive iodine therapy, wound care, suture removal, and dietary recommendations.
The majority of thyroid cancers are well-differentiated tumors originating from follicular cells, including papillary, follicular, and Hürthle cell cancers.
Medullary cancers make up about 5% of thyroid cancers. Anaplastic cancers are rare but aggressive tumors.
Thyroid cancer is one of the most common endocrine cancers. Among thyroid cancers, papillary cancer is the most frequently diagnosed. The prognosis is generally favorable, especially when diagnosed early, as surgical removal is often sufficient for treatment.
In the treatment of thyroid cancer, a total or partial thyroidectomy (removal of the entire or part of the thyroid gland) is usually performed. In some cases, a neck lymph node dissection may be necessary. After surgery, radioactive iodine therapy is often planned as a follow-up treatment.
The diagnosis of thyroid cancer involves a thorough assessment of the patient's medical history, thyroid hormone levels, physical examination, and various diagnostic tests. This may include a thyroid ultrasound, scintigraphy, and needle biopsy.
Key aspects of the patient's history, such as family history of thyroid cancer, radiation exposure to the neck, geographic location, and medication use, should be evaluated. Symptoms like difficulty breathing, voice changes, and difficulty swallowing should also be inquired about. A physical examination, including an evaluation of neck lymph nodes, is essential. All of these evaluations are crucial for assessing the likelihood of cancer and confirming the diagnosis.
In cases with high suspicion of thyroid cancer, factors such as a family history of thyroid cancer, hoarseness, difficulty swallowing, a history of radiation exposure, the presence of neck lymph nodes, solitary solid or cold immobile thyroid nodules that have rapidly grown, as well as new nodule development in individuals under 20 or over 60, may indicate a higher risk of thyroid cancer.
Thyroid ultrasound is the most commonly used method for diagnosing thyroid diseases. It allows for distinguishing between solid and cystic components of thyroid nodules, measuring their size, and providing guidance for needle biopsy. Thyroid needle biopsies are highly accurate. If the biopsy yields insufficient material, a repeat biopsy may be required. It's essential to have experienced medical professionals perform biopsies.
When a thyroid biopsy is assessed as suspicious or malignant, surgical intervention is warranted. In cases of abnormal thyroid hormone levels, whether high or low, treatment should be administered to normalize these levels before surgical procedures are considered. After hormonal levels have been corrected, surgery can be performed.
In the surgical treatment of benign thyroid lesions, if the lesion is confined to one lobe, unilateral lobectomy (unilateral total thyroidectomy) is often sufficient.
For thyroid gland cancer, the standard surgical procedure is total thyroidectomy, which involves the removal of the entire thyroid gland. This procedure should be performed by experienced surgeons to minimize the risk of complications. With the use of new technological devices in recent years, the potential risks and complications have been significantly reduced.
The length of hospital stay is typically around 1 day, thanks to innovations like intraoperative nerve monitoring and modern surgical tools, which help reduce surgical time and the occurrence of complications. After surgery, patients will need to take thyroid medication regularly, and the dosages are adjusted through follow-up appointments. Patients are usually discharged from the hospital the day after surgery, resume normal eating, take showers as early as the day after discharge, and don't need to have their stitches removed because aesthetic and absorbable sutures are often used for the incision.
Cancers in the head and neck region, such as thyroid cancer, often spread to the lymph nodes in the neck. In such cases, in addition to removing the affected organ, the lymph nodes affected by cancer also need to be removed. For this purpose, a incision is made on the side of the neck, extending upwards from the thyroid site, towards the side where the lymph nodes will be removed. In this surgery, sometimes, along with the lymph nodes, muscles and vascular structures may also need to be removed.
Neck dissection can vary in its surgical approach based on the type and location of cancer, the stage of cancer, the patient's condition, and the involvement of lymph nodes. It can be performed either concurrently with the surgery of the affected organ or in a separate session.
The purpose of removing lymph nodes is to prevent the spread of cancer to this area or to ensure the cleansing of lymph nodes in the affected region where the cancer has spread
Nerve monitoring is a medical technique used during surgical procedures to easily identify and protect the nerves that lead to the vocal cords. It is performed by placing an electrode around the patient's neck after they are under anesthesia, through a tube placed in the throat. This electrode is connected to a monitoring system. During the surgery, a pen-like device is used to stimulate the nerve leading to the vocal cords. The monitoring system then verifies that this is indeed the nerve, and it ensures the nerve's protection throughout the surgery. This helps prevent nerve damage during the operation and avoids harm to the patient's vocal cords, both during the surgery and in the postoperative period.
Thyroglossal cysts are the most common congenital (present at birth) cysts found in the neck. They typically occur in the midline of the neck and result from the remnants of the thyroid gland's path of descent during fetal development. While these cysts are most commonly identified in childhood, they can also be seen in later years.
They often appear as small, mobile lumps in the midline of the neck, and if they become infected, they can cause pain, redness, and swelling. Diagnosis is usually made based on the patient's history, physical examination, and ultrasound. In cases of infection, antibiotic treatment is administered before planning surgical removal.
The surgical procedure for removing a thyroglossal duct cyst is relatively straightforward. The patient is admitted to the hospital, and the surgery is typically performed on the same day. After the surgery, the patient can start eating within 3-4 hours, and they are usually discharged the next day. There is no need for further wound care at home, and the patient can take a bath one day after discharge. A follow-up examination is scheduled about a week later. From the patient's perspective, this surgery is comfortable and uncomplicated.
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Prof. Dr. Sezai AydınGeneral Surgery Turkey
PROF. DR. SEZAI AYDIN
