The incidence of thyroid tumors has been on a straight upward trend this year. As for Shanghai, the incidence of thyroid cancer ranks fourth among women and eighth among men. The general public is increasingly vigilant about thyroid cancer. What is the reason for the increase in the incidence of thyroid cancer in recent years? There are mainly these aspects:
First, due to the improvement of the social security system and the enhancement of people's physical examination awareness, many small lesions can be discovered very early;
Second, the development of modern medicine, especially the rapid advancement of ultrasound diagnostic equipment, high-frequency probes are widely used in clinical practice, nodules as small as 2 mm can also be discovered in time, the diagnosis level of ultrasound doctors is also improving, and they can make more accurate judgments on the properties of tumors.
In the neck ultrasound, is it a benign nodule or cancer?
If everyone goes for a neck ultrasound examination, nearly 70% of people will be detected with thyroid nodules, but will so many nodules need to be surgically removed? Obviously it is not necessary, because most of these nodules are benign, and only 10% to 15% are malignant.
In the thyroid ultrasound report we see, there is usually a TI-RADS rating. If the rating is 4 or higher, it will be taken seriously. For example, if the b-ultrasound single shows a grading of 4a, it is necessary to perform thyroid cytology puncture, and then pathological diagnosis after puncture, which is the "gold standard" for thyroid cancer diagnosis. We have found in clinical practice that a considerable number of patients suffer from thyroid cancers are micro-cancers. What is micro cancer? It means that the maximum diameter of its primary lesions does not exceed 1 cm. The large number of discoveries of micro-thyroid cancers are actually due to the improvement of diagnostic technology. Some patients will suggest that such a small nodule must be surgically removed? Nowadays, we recommend surgical resection once the thyroid tumor is confirmed to be malignant.
Lymph node metastasis means advanced thyroid cancer?
Some patients have found metastatic lymph nodes on the neck when they are diagnosed. When they hear the word "metastasis", patients will ask: Does this mean that they are in the late stage? Does it mean that it cannot be removed surgically? In fact, this is not the case. Thyroid cancer, especially papillary thyroid cancer, is a tumor that likes to undergo lymph node metastasis. Its metastasis does not mean that it has reached its late stage. Through reasonable treatment, most patients can survive for a long time.
In clinical practice, differentiated thyroid cancer, papillary thyroid carcinoma and follicular thyroid carcinoma, no matter which stage the patient is in clinical trials, through standardized and reasonable treatment, the 10-year survival rate has reached 91.7%. Even if lymph node metastasis occurs, there is nothing to be scary.
Does iodine 131 isotope treatment still need to be treated after surgery?
Some patients came to the hospital and were indeed in the late stage. If they only undergo surgery, they cannot achieve clinical cure and need to undergo postoperative iodine 131 isotope treatment. There is a prerequisite for the treatment of iodine 131 isotope, which is to remove the patient's thyroid gland.
What kind of patients need to undergo iodine 131 isotope treatment?
①Both lesions of the thyroid gland are accompanied by bilateral lymph node metastasis;
②Distant metastasis is found in clinical practice, and the most common ones are lung metastasis, bone metastasis, etc.
③ Although there has not been distant metastasis yet, it can be foreseen that the probability of lymph node metastasis in the neck is relatively high. In order to facilitate future follow-up, some patients need to undergo methyl iodine 131 treatment after surgery. The so-called clearing of the nail means using a small dose of iodine 131 to clear all the remaining thyroid glands in the neck.
How should patients with thyroid cancer follow up?
As we said before, most patients with thyroid cancer can achieve long-term survival, but long-term survival does not mean no recurrence and metastasis. Therefore, the "follow-up" matter must not be ignored.What tests do we need to do during the follow-up visit?
① Because patients have to take thyroxine tablets for a long time after the operation, they need to frequently test the function of the thyroid gland to understand whether the dosage of the drug is appropriate.
② Neck ultrasound should also be performed during follow-up, with the purpose of knowing whether there is recurrence of tumors in the neck and the appearance of suspicious lymph nodes;
③ Since thyroid cancer "likes" to transfer to the chest, it takes a related examination once a year.
patients were discharged from the hospital after surgery and followed up every 3 months. If the condition does not develop in the second year, they can be followed up once every six months, strictly follow the doctor's advice and long-term follow-up, which is very important for patients with thyroid cancer.
Professor Wu Yi is a professor of head and neck surgery at the Affiliated Cancer Hospital of Fudan University, and director of the Center for Diagnosis and Treatment of Thyroid Tumors of Fudan University. He has been engaged in clinical and basic research on head and neck oncology surgery for a long time, and is especially good at the diagnosis and treatment of thyroid tumors, salivary gland tumors, oral tumors, soft tissue tumors of the neck and metastatic cancers with unknown primary foci.
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