Most common endocrine gland cancer which is generally considered as a disease of the developed world. Incidence of this disease is increasing throughout the world and the most common reason cited for this is overdiagnosis due to availability of better diagnostic facilities like Ultrasound, CT, MRI and recently PET CT. More and more thyroid lesions are incidentally found in these studies done for other indications which otherwise may not have been detected.
Incidence is also rising in India and more so in South India. It comprises <1% of total cancer cases in India.
Patients are the mostly asymptomatic and commonest presentation of this disease is swelling in the neck. Though sometimes patient may present with a change in voice or difficulty in swallowing and/or respiration if there is a large swelling causing compression
Younger population and female sex (approx 3-4:1) is more prone to the disease. Other risk factors include Radiation exposure (Therapeutic, diagnostic or Occupational), Family history, Obesity, Smoking Etc.
Thyroid cancer is a heterogeneous group because of different cells of origin in the same gland and primarily can be categorised into:
1. Papillary or Mixed papillary or follicular thyroid cancer (Most common type, approx 85%)
2. Follicular or Hurthle cell thyroid cancer (approx 10%)
3. Medullary thyroid cancer(approx 3%)
4. Anaplastic or Undifferentiated thyroid cancer (<1%)
Not only these types differ in the cell of origin but each has a different prognosis depending upon the stage of the disease with Anaplastic carcinoma having the worst prognosis
The simplest way of the Diagnosis is an Ultrasound and a guided FNAC or Biopsy.
Other ways of diagnosis and differentiation can be tumour markers and specialised tests like MRI.
As most of the thyroid cancers are iodine avid, we generally do not prescribe a CT scan with contrast as the contrast contains iodine and can interfere with the treatment. Once we confirm the diagnosis and stage the disease treatment is planned.
Thyroid cancers have a better prognosis as compared to other types of cancers with the possibility of cure and longevity.
Surgical Removal of the Gland (may be hemi or Total) with or without the Lymph nodes in the neck offers the only possibility of a cure for papillary, follicular and other differentiated cancers and Patient may also need post-operative Radioactive iodine therapy depending upon the stage and extent of the disease
No role of chemotherapy or Radiotherapy in the management of Thyroid cancers except in palliative management of Anaplastic or Undifferentiated thyroid cancer
For Medullary cancers, Surgery offers the only form of cure and some patient might benefit from Targetted Therapy. Surgery can be performed by open or Endoscopic method and most recently Robotic surgery is coming up in a big way for thyroid surgeries as an oncological safe method
We at Manipal Hospitals, Dwarka have all the diagnostic and therapeutic facilities in the house for the management of all type of Thyroid cancers.
Consultant - Surgical Oncology, Oncology Sciences
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