Thyroid cancer is seen quite frequently, and its incidence has been substantially increased in the last decade owing to the wide spread use of ultrasound and fine needle aspiration biopsy (FNAB). Thyroid cancer is 2.5 times more common in females and it is more frequently seen in patients who received radiotherapy to the neck and in those whose family member(s) have thyroid cancer.
There are 4 types of thyroid cancer.The most common types are papillary cancer (75-80%) and follicular cancer. These are very slow-growing tumors and survival is very long even in patients who have developed metastases. For this reason, papillary and follicular cancers are also called "well-differentiated" cancers. Since the survival is extremely long especially in papillary cancer, it is currently questioned whether or not aggressive treatments such as thyroidectomy is really necessary in this patient group. In general, 20 years survival is 98-99% in papillary cancer and 80-90% in follicular cancer.
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How is diagnosis made?
Thyroid cancers generally do not cause any complaints. They are mostly diagnosed incidentally during a neck ultrasound examination that is done for goiter or for reasons other than the thyroid. Owing to the wide spread use of ultrasound, most thyroid cancers are diagnosed at an early stage. Although the vast majority of thyroid nodules are benign, some ultrasound features increase the likelyhood of malignancy (cancer). These include large (>1cm) size, irregular contours, hypoechoic (dark) appearance, increased vascularity, perpendicular orientation to the skin and presence of calcifications. If the ultrasound appearance of the nodule(s) suggest malignancy a fine needle aspiration biopsy (FNAB) should be performed. This procedure is done under local anesthesia with ultrasound guidance and typically lasts for several minutes. FNAB is quite accurate and can successfully make the diagnosis in more than 70% of the cases. However, in about 15% of FNABs, the result is nondiagnostic, which means that the amount of cells aspirated is not enough to make a diagnosis. In another 15% (avarage) of FNABs, the result is indeterminate, which means the pathologist can not make the diagnosis confidently although the amount of aspirated cells is enough. In this 30% patient group, where FNAB is not successful, it is a common practice to repeat the biopsy. However, not uncommonly, the second FNAB is not able to provide the diagnosis. For this reason, some centers including ours, prefer to do a trucut biopsy additionally besides the FNAB in the second biopsy procedure. In this way, the pathologist can make the diagnosis much more accurately and confidently. What's more, if the result is cancer, trucut biopsy allows to determine the subtype of cancer, which is important for both treatment and prognosis.
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If the thyroid nodule(s) prove to be cancer in biopsy, the classic treatment is total thyroidectomy with or without radioactive iodine (RAI). If the tumor is a small (<1cm) papillary cancer, some centers prefer to remove only the part of the thyroid where the cancer is located. In such cases, some centers have also used percutaneous ablation and reported excellent short term results. However, the long term results of percutaneous ablation in small papillary cancers are currently not well-known. Therefore, we prefer to perform percutaneous ablation
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If the cancer recurs in the neck after the operation, surgery may still be repeated. Alternatively, percutaneous ablation (laser, radiofrequency, microwave, alcohol) can be performed for the recurrent cancer foci. Many studies in the literature report good local control rates with ablation in recurrent thyroid cancers.
Low risk papillary carcinoma
Nearly 3/4 of thyroid cancers are papillary carcinoma, and their majority are low risk tumors. Low risk papillary cancer (also called papillary microcarcinoma) is defined as a small (<1-1.5cm) tumor, that is confined to the thyroid and not metastasized to the neck lymph nodes. In such cases, survival rates are as high as 98% in 20 years. Today, with the increased use of ultrasound and FNAB, low risk papillary microcarcinomas are diagnosed more and more frequently, and it is believed that these tumors currently constitute about 80-85% of all papillary cancer diagnoses.
Despite their very good prognosis, papillary microcarcinomas are treated as aggressively as other thyroid cancers. In these patients, the standart of care is still total thyroidectomy plus RAI. However, numerous studies have shown that hemithyroidectomy (partial removal of the thyroid) is sufficient and RAI does not have any benefit in such patients. Some authors even recommend no treatment for these tumors. In a study from Japan, 1465 low risk papillary carcinomas were followed up for 5 years without any treatment and only 5% of these tumors showed enlargement and only 2% developed lymph node metastases.
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Another treatment that is recommended for low risk papillary carcinomas is percutaneous ablation. This method is preferrred increasingly by patients and some doctors because:
It does not have the risks of surgery.
It can kill the tumor tissue completely, and
It provides a much more attractive alternative to the "no treatment strategy".
Many studies have shown that laser, radiofrequency and microwave are very successful in the treatment of low risk papillary carcinomas. Therefore, although the long term results are not very well-known, percutaneous ablation is an important treatment option in patients who is not fit for or do not desire surgery.
Thyroid cancer metastases
Thyroid cancers can metastasize to neck lymph nodes, lungs and bones. In these patients, classic treatments are surgery (if possible) and RAI. Recently, some studies have reported very good local control rates with percutaneous ablation in the treatment of recurrent lymph node metastases after surgery. Similarly, some authors also reported that distant metastases of thyroid cancers to the lungs, liver and bone can also be successfully treated with percutaneous ablation or embolization.
In our patient with papillary cancer liver metastases, the masses were treated with chemoembolization followed by microwave ablation. The 9 months control CT showed complete destruction of all liver metastases. During the 3 years follow-up, no new metastases developed and the patient is currently tumor free.
Papillary microcarcinomas (<1cm in size, no capsule invasion, no lymph node metastasis) can be safely and effectively treated with percutaneous radiofrequency, microwave or cryoablation.
You can get information on our treatments via phone and e-mail as well as by filling and sending the consultation form below. Please send the reports of your thyroid ultrasound, hormones, scintigraphy and biopsy (if available) via e mail () or whats up ( +90-534-551 0 551). Remember to write clearly your e mail address and phone number so that we can return to you as soon as possible.