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Take 12 doubts about thyroid cancer

Take 12 doubts about thyroid cancer

Thyroid cancer can be considered the most common in the head and neck region and mainly affects women. In Brazil, it corresponded to 1.3% of all cases of cancer enrolled in INCA from 1994 to 1998 and 6.4% of all head and neck cancers. Here are some key questions about thyroid cancer:

What is the thyroid?

The thyroid is one of the most important glands in our body. It regulates the production of hormones that interfere with the functioning of various organs of the human body, such as the heart, kidneys, intestines and, in the case of women, regulate the menstrual cycle.

What are the types of thyroid cancer?

According to endocrinologist Fabiano Tegão Nave, of the OrthoHormone clinic in São Paulo, there are three types of thyroid cancer. (papillary and follicular), moderately differentiated (medullary) and undifferentiated (anaplastic) carcinomas.

- Papillary: is the most common and less aggressive - corresponds to about 80-85% of cases Thyroid cancer.

- Follicular: it is also less aggressive and corresponds to about 15% of the cases.

- Medullary: a slightly more aggressive type of cancer, which corresponds to about 3-5%

- Anaplastic: a very aggressive and rare form that usually affects the elderly over 70 years of age. It corresponds to about 1% of thyroid cancers and is usually fatal.

What are the risk factors for thyroid cancer?

According to head and neck surgeon Dorival de Carlucci, Hospital São Luiz, São Paulo, the best known risk factor is exposure to radiation. "For example, with the Fukushima nuclear accident in Japan, the incidence of this cancer has increased a lot, just as happened in Chernobyl and Goiânia, in the radiological accident," he says. People who work with radiation or patients who perform many tests involving radioactive substances should also be aware.

Painless nodules may be a sign of thyroid cancer - Getty Images

Is it possible to prevent thyroid cancer?

Unfortunately, it is not possible to prevent this type of cancer. "The most to be done is the early diagnosis," says Carlucci.

What are the symptoms of this cancer?

The main sign is the appearance of a painless lump in the thyroid. "This is why it is part of the clinical examination to test this region to identify possible nodules," explains the endocrinologist Pedro Saddi of Unifesp.

How is thyroid cancer detected?

Ultrasonography confirms the presence of the nodule. "Today, the ultrasound is increasingly powerful, it detects smaller and smaller lumps and still tells the amount, if it is solid, etc.," explains the surgeon at São Luiz Hospital. "These are necessary clues for correct detection However, to determine whether it is benign or malignant, the patient should undergo a biopsy. "The diagnosis of cancer is made with fine needle aspiration (FNA), which consists of the introduction of a fine needle in the lump and aspiration of the contents of it. The material will be referred to a pathologist, who will analyze the cells harvested and differentiate whether the lump is malignant or not, "explains the endocrinologist Fabiano Nave.

What are the treatments for this type of cancer?

The treatment has three stages: surgical removal, called thyroidectomy, remaining thyroid ablation, and suppressive hormone therapy.

Surgery: With the detection of cancer, doctors perform thyroidectomy, that is, remove the thyroid.

Ablation of the remaining thyroid: Unlike other cancers, external radiation therapy does not work in thyroid cancer, so the patient ingests radioactive iodine, which will destroy the thyroid cells that remain after surgery. very delicate. Therefore, it is not always possible to completely withdraw the thyroid gland. Here comes radioactive iodine, "says Carlucci's Dorival.

Ultrasound Detects Thyroid Cancer - Getty Images

According to the surgeon, the thyroid needs iodine to function. In this procedure, the patient stays for a period of 20 to 30 days without receiving iodine and, when received, the substance comes in radioactive form. The remaining thyroid cells will feed on this iodine which, because it is radioactive, will destroy them. "It is indicated only for cases of papillary and follicular cancers, less aggressive because it does not work with the medullary and "In such cases, treatment with iodine should be discussed with the doctor in charge of the case," he says. .

Suppressive hormonal therapy: As the treatment completely removes the thyroid, the patient develops hypothyroidism. As this gland produces hormones essential for the maintenance of life, it becomes necessary to replace this lack artificially. "The hormone replacement is done with the synthetic thyroid hormone T4 (levothyroxine), taken once a day, in a fast," says Fabiano Nave.

In Brazil, the most common is that the gland is completely withdrawn, Dorival de Carlucci, the cancer manifests on both sides in 50 to 60% of cases.

Carlucci's Dorival surgeon explains that this therapy, while restoring the hormones, prevents the growth of a possible tumor that has weathered This is because hormone replacement causes the pituitary - the area of ​​the brain that controls the gland - to think that the thyroid is working and, therefore, will not stimulate its functioning. With this, two problems are solved: hypothyroidism and the risk of feeding possible tumors. This treatment should be done for at least five years.

Is it always necessary to remove the thyroid gland completely?

In Brazil, the most common is to completely remove the gland, because according to Dorival de Carlucci, the cancer is manifested on both sides in 50 to 60% of cases. "The thyroid is similar to a butterfly. In some cases, it is as if the cancer has occurred on both wings. However, in some parts of the world, it is recommended to remove only one side of the wing in patients considered low risk, that is, under 45 years old, have single tumors, no other nodules in the gland and whose nodule is less than two centimeters ", points out the surgeon.

It is true that the treatment of this cancer leaves the "When performed by a specialist surgeon, the risk of more serious complications resulting from this surgery, such as permanent hoarseness, is less than 1% of the cases," says Abrão Cury, supervisor of the Clinic Doctor of HCor, in São Paulo. This is because, according to Carlucci's Dorival, behind the thyroid, well supported, there is a nerve, responsible for moving the vocal folds.

Ultrasound also serves to accompany patient after healing. is necessary enough to separate the gland from the nerve, but this is not always possible because in some cases the cancer may leak the thyroid and reach the nerve.In this situation, it is obligatory to cut the nerve, then the patient is hoarse " , says the surgeon at São Luiz Hospital

What is done after cancer treatment?

After the end of treatment, the patient should be followed with some frequency. "He should do imaging tests periodically, such as neck ultrasound and lung radiography every six months or a year," says Carlucci's Dorival. This is because, according to the surgeon, the region of the neck and lungs and bones are the most frequent with regard to cancer metastasis. In addition, thyroglobulin, a substance produced by the thyroid, is periodically dosed. "If the thyroglobulin goes up in the blood, it is a sign of metastasis in some part of the body," he added.What are the people most affected?

Women ages 30 to 40 usually have more thyroid nodules. "In order to make sense of it, 40% of women have any type of nodule in the gland." Of these, 8% have cancer, "says surgeon Dorival de Carlucci.

What are the chances of a cure?

According to Dorival de Carlucci, from São Luiz Hospital, 3% of patients with thyroid cancer end up undergoing the process of metastasis.


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