Follicular thyroid cancer (FTC)
According to statistics, follicular thyroid cancer (FTC) occurs in 15% of cases and is the second most common type among thyroid cancers. Follicular tumors are formed from follicular cell lined by cuboidal epithelial cell and have the ability to metastasize. Although this type of carcinoma rarely spreads to the nearest lymph nodes, it also more often metastasizes to the lungs and bones.
This tumor is characterized by a slow development, and it is most often diagnosed in patients between 40 and 60 years old. At the age of 45 follicular thyroid cancer has a worse prognosis and it is more aggressive than in the young patients.
Facts and characteristics
- Follicular thyroid cancer has higher rates among females than among males.
- Its rates is higher in regions with an increased radioactive background – nuclear test sites, storage facilities, etc.
- In older age it is more aggressive.
- Follicular carcinoma metastasizes more often to the bones and lungs than other thyroid carcinomas.
- At initial treatment 11% of patients have metastases in the mediastinum area.
- A large percentage of cancer cure (in children with small sized tumors – 95%), but it decreases with age.
Diagnosis of Follicular thyroid Carcinoma
Diagnosis of a follicular thyroid tumor is difficult on the basis of a cytological biopsy (fine needle cytology) or on sonographic images, and there is no way to find the difference between a benign and a malignant disease. Therefore, a surgical operation should be performed in order to obtain a sufficient amount of tissue for histopathological examination. It will define the type of invasive follicular carcinoma – capsular or vascular.
How is a follicular thyroid cancer treated?
Conservative surgical treatment of follicular thyroid cancer
With a good prognosis of the disease, when the tumor diameter does not exceed more than 1 cm in patients under 40 years of age – hemiroidectomy and istimpectomy is performed. If follicular carcinoma or metastasis has been diagnosed or the histopathological examination revealed a cancer spreading, partial or total thyrodectomy is performed.
After surgery patients are prescribed replacement therapy or drugs with thyroid hormone, which must be taken for life. This is necessary for:
- filling the lack of thyroid hormone levels in the body;
- reducing the level of thyroid stimulating hormone in the pituitary gland, which is proven to be the recurrence cause of follicular carcinoma.
Treatment of follicular thyroid cancer by iodine i-131 isotope
Thyroid cells have a unique ability to absorb and accumulate iodine, therefore radioactive iodine is often used for treatment. Isotope I-131 has a toxic effect on tumor cells of follicular carcinoma, it stops their growth and eliminate them.
The need in such type of treatment occurs only when carcinoma invasion is in the vessels or lymph nodes of the thyroid and other body areas, as well as based on the patient’s age and the clinical picture. This therapy is chosen individually by the physician.
Treatment with radioactive iodine is an effective type of chemotherapy for follicular carcinoma with few side effects. Before it starts people usually follow a low iodine diet for 1-2 weeks before starting therapy to increase the level of thyroid stimulating hormone. At this time they refuse a replacement therapy, or take Thyrogen drug. After surgery iodine is usually given after 6 weeks (dates may vary) and, if necessary, the course is repeated every 6 months.
Projections for follicular thyroid cancer. Annual Medical Examination
Life expectancy for this disease depends on:
- age – the prognosis is better in young people compared with patients after 45 years;
- tumor size;
- distant metastases;
- invasion type – vascular or capsular;
For patients with follicular thyroid cancer it is necessary to undergo a chest radiography every year.
After total thyrodectomy you also need to check regularly the level of thyroglobulin (Tg) in the blood. It can be used as a tumor marker in personalized (targeted) medicine. Values higher than 10 ng / ml indicate a disease recurrence even with a negative PET-CT result.