Papillary carcinoma of the thyroid (PTC)
More than 80 percent of thyroid cancer patients will develop papillary-type cancer, three times as common in women as men.
You can find below:
- 1. What are the signs of the disease.
- 2. Genes in papillary thyroid cancer.
- 3. Diagnosis of the diseases.
- 4. Treatment of papillary thyroid carcinoma.
Thyroid (also known as the thyroid gland) is located in the lower part of the neck and produces hormones that influence body temperature regulation, metabolic processes, and new cell differentiation. New patients that are diagnosed each year with four major types of thyroid cancers. The most common of them (more than 80%) is papillary thyroid carcinoma. These tumors are three times more common in women than in men, and are usually diagnosed in a young population aged 30-40.
In the past the doctor would feel the neck and discover only large lumps. Today ultrasound and CT neck and chest can found mostly small nodes, some of which will not cause problems without treatment. The problem is that we do not know which tumors may grow and cause health problems, whereas tumors are “sub-clinical” and do not require treatment. Therefore, in cases where small tumors appear to be non-dangerous, our doctors try to perform the minimal treatment – the removal of half of the node, and in more advanced cases the tumor will be treated both in surgery and complementary treatment.
It is important to note that thyroid cancer is different from other cancers, in most cases the disease is not life-threatening, and after proper treatment you can come back to normal life, usually taking one pill a day of thyroid hormone.
1. What are the signs of the papillary thyroid carcinoma?
A cancerous tumor in the thyroid gland tends to develop in a subtle and slow manner. A warning be lit with the appearance of a lump in the neck or the development of other symptoms, such as hoarseness, swollen lymph nodes in the neck, difficulty swallowing or breathing, pain in the throat or neck that is not cold.
2. Genes in papillary thyroid carcinoma
Few chromosomal rearrangements were detected in papillary thyroid carcinoma. RET fusion proteins (RET / PTC family) seem to play an oncogenic role in about 20% of papillary thyroid carcinomas. In addition, NTRK1 and the MET proto-oncogene can be over-expressed and / or enhanced. Studies data also suggests that physiological growth regulators of thyrocytes, such as interleukin-1 and interleukin-8 or insulin-like growth factor-1, transforming growth factor-beta, epidermal growth factor may play a role in the pathogenesis of this cancer.
BRAF mutation in the gene is characteristic of papillary thyroid carcinoma as well. The BRAF V600E mutation is associated with aggressive clinical and pathological characteristics of papillary carcinoma of the thyroid gland, including metastases to the lymph nodes, thyroid invasion, lack of response to radioactive iodine treatment and recurrence of the disease.
Radiation exposure (from radiation therapy) may cause papillary thyroid cancer based on gene expression patterns involving seven genes (SFRP1, MMP1, ESM1, KRTAP2-1, COL13A1, BAALC, PAGE1).
3. Diagnosis of papillary thyroid carcinoma.
The medical examination begins with an ultrasound, when a problem with the gland is suspected. It is important to know that thyroid links are very common and about 95% of cases are benign (non-cancerous). Therefore, only if the ultrasound test identifies suspicious factors a biopsy should be performed by means of a fine needle aspiration (FNA). It is recommended that you do not pry in lumps smaller than 1 cm, since they are usually of no health importance.
The biopsy result may be benign, suspicious of cancer or cancer. For cases where the pathology result is not unequivocal, new molecular tests are being developed to help determine if these are benign or cancerous lumps.
4. Treatment of papillary thyroid carcinoma.
When the biopsy results confirm the suspicion of a papillary cancer, individual risk is assessed. The treatment is adapted to it, considering the extent of the disease, age, and the concomitant diseases. The main components of papillary treatment include surgery, radioactive iodine therapy, Thyroid Stimulating Hormone (TSH) and, if necessary, systemic therapies. These treatments are managed by a our israel multidisciplinary team consisting of an expert endocrinologist, a thyroid surgeon, a nuclear medicine physician. Patients with advanced disease should be consulted by an israel oncologist – an expert on head and neck tumors.
Tanks to the most effective and targeted treatment, most patients with papillary disease recover from the disease (survival rate of 95% after 5 years, 87% after 20 years). Even if the disease returns with new tumors in the lymph nodes or the gland (occurring in 15% to 30% of the cases diagnosed), there is an effective treatment for the disease.
Surgery for papillary thyroid cancer (partial or total thyroidectomy)
Surgery is done under complete anesthesia. The tumor is excised with the entire thyroid gland or half of it, depending on the spread of the tumor. After complete resection of the tumor treatment with calcium and active vitamin D will be given, which will be gradually reduced for several days according to calcium tests in the blood. After complete removal of the thyroid gland, thyroid hormone therapy should be started (Eltroxine, Eutirox or Synthroid).
Thyroid hormone pills provide the body with the missing glandular hormones and ensure excellent quality of life even without the existence of thyroid gland in the body. The doctor determines the dose of thyroid hormone therapy according to the desired TSH target (a hormone that stimulates the growth of thyroid cells for growth and activity). Therefore, after thyroid cancer is removed, the aspiration is that the TSH level is low. The greater the dose of pills, the lower the level of TSH. Many patients return to work about two weeks after surgery.
Risk of recurrence after the surgery: The initial risk assessment after surgery predicts the likelihood of relapse. This assessment is based mainly on the pathological report that indicates the degree of risk: size, type of tumor, vascular infiltration, extrusion of the gland, number and size of lymph nodes, etc. It is very rare for a low risk patient to become a high risk patient during follow up. On the basis of an individual risk assessment, the doctor decides whether complementary treatment should be needed for surgery using radioactive iodine (ablation) and also determines the frequency of the necessary medical follow-up.
Radioactive iodine treatment for papillary thyroid cancer
Thyroid cells are the only cells in the body that are sensitive to iodine. After ingestion of iodine, about 99% of the body’s material is absorbed by the thyroid gland and the rest of the material is excreted in the urine. Like normal thyroid cells, papillary cells also tend to absorb iodine from the bloodstream, so radioactive iodine can be used to destroy residual cells left in the body after surgery and to follow the patient after initial treatment.
The treatment of radioactive iodine excels its ability to focus on the thyroid gland and in a small number of side effects. The treatment is given by taking a pill and then the patient must remain isolated for three or seven days (depending on the dose taken) to prevent further exposure to radioactive radiation from the body. The side effects of radioactive iodine therapy (nausea, loss of appetite, dry mouth, salivary glands) are not common, but each patient should consider the expected benefits of treatment compared to possible side effects.
After the initial treatment phase of the disease, which includes the surgery and, if necessary, radioactive iodine, the doctor adjusts the daily dose of thyroid hormones necessary for the patient. The patient continues to perform a long-term follow-up at the endocrinologist. Neck ultrasound and blood tests should be performed as well.
Precision treatment of papillary thyroid cancer
The main emphasis of our doctors now is on personalized treatment – patients with small, non-hazardous lumps will be able to undergo small surgery, and in the future may also have a local burn, and patients with more advanced disease will undergo new techniques to prevent complications, receive radioactive iodine with a preparation that will improve its effectiveness and develop new drugs for advanced disease.
Thyroid cancer is a common cancer, but usually not dangerous. The current treatment is adapted to the degree of risk of the disease, ranging from luteal resection only to surgery combined with complementary treatments for radioactive iodine, TSH suppression and systemic treatments. Under this approach we achieve healing in most patients, while minimizing side effects and maintaining the quality of patients’ lives.