Overview of differentiated thyroid carcinoma:
We all know that the best prognosis among thyroid carcinoma is differentiated thyroid carcinoma, including papillary carcinoma and follicular carcinoma. Although metastasis or recurrence can be treated, as long as the lesion can ingest iodine 131, there is a chance of cure.
Generally speaking, the 10-year overall survival rate of DTC patients after iodine 131 treatment was 92.38%, of which the 10-year survival rate of the cervical lymph node metastasis group was 98.09%, the pulmonary metastasis group was 87.50%, and the bone metastasis group was 80.41%. Therefore, the treatment of iodine 131 can significantly improve the patients' recurrence-free survival, progression-free survival and disease-free survival.
However, after differentiated atarcum occurs during the treatment process, the treatment effect is quite poor and the prognosis is very poor. According to statistics, during the treatment process, about 1/3 of recurrent and metastatic lesions have differentiation.
Below we understand the loss of differentiation of atar cancer from the following aspects:
- What exactly is the loss of differentiation of atar cancer?
- What factors can lead to loss of differentiation of atarcemia? How to treat
- after the loss of differentiation of methyl cancer?
- What is important is how to avoid the loss of differentiation of ana carcinoma?
What exactly is the loss of differentiation of atarcemia?
methyl carcinoma is abnormal differentiation refers to the degenerative changes in the morphology and function of differentiated thyroid cancer after treatment, including the use of iodine 131 treatment. A-cancer cells cannot correctly express TSH receptor , and cannot ingest iodine or have extremely reduced uptake. Because this type of methyl cancer cells are not sensitive to iodine, they cannot continue to use iodine 131 treatment. In layman's terms, it means that the original high-definition level of anaerobic cancer transforms into a tumor with a low-definition level of anaerobicity. The process of loss of differentiation is also a manifestation of increased malignancy of atherosclerosis.
What factors can lead to loss of differentiation of atarcemia?
According to relevant studies, the loss of differentiation of differentiated thyroid cancer may be related to the following situations:
1, treatment-related factors
Many thyroid cancers with good differentiation degrees are killed and inactivated after a certain dose of iodine 131 treatment or other radiation treatment. However, the metabolic process of some undestroyed thyroid cancer cells may be affected by radiation, and their radiation energy causes cancer cells to undergo "gene mutations". The more common is that the synthesis of thyroid globulin Tg and the dysfunction of cancer cells to metabolize iodine, thus losing their ability to absorb iodine. The final outcome is that cancer cells' intake of iodine-131 has decreased or even no iodine is taken at all.
2, age factor
Most studies have shown that the probability of loss of differentiation of metastases of ana carcinoma is related to the age of the patient, and the loss of differentiation rate gradually increases with age. This also shows that the longer the tumor course, the higher the tumor's differentiation rate, and the malignant tumor will also increase. Therefore, after discovering aramid cancer, it is necessary to treat it as soon as possible. If it is necessary to treat iodine, it will be done. Although iodine 131 treatment has radiation, it will also cause a small part of the harm to the body. However, from the perspective of benefits, most cancer iodine 131 treatment still outweigh the disadvantages.
3, Factors of the malignant tumor of the malignant tumor of the malignant tumor of the malignant cancer, some differentiated type of aphrodisiac carcinoma combined with a variety of pathological subtypes, such as papillary carcinoma combined with follicular subtypes, high-cell subtypes, solid subtypes, diffuse sclerosis subtypes, eosinophil subtypes, Warthin-like subtypes, clear cell subtypes, etc.
The expression and Tg synthesis of TSH receptors by different pathological subtypes are different, resulting in different uptake of iodine-131. When the iodine-131 treatment is performed, iodine 131 selectively eliminates cancer cells with strong iodine absorption capacity. The morphology and function of the remaining residual foci or metastatic cancer cells that are insensitive to iodine 131 may undergo significant mutations, and the ability to ingest iodine 131 is significantly reduced, resulting in the occurrence of loss of differentiation. How to treat
after the loss of differentiation of ?
study shows that the 10-year survival rate of lost differentiated atarctic lesions with distant metastasis is below 10%.Currently, the treatment for the loss of the differentiation of aphrodisiac carcinoma is the following types of
1, tretinoic acid
retinoic acid is a biologically active metabolite of vitamin A, which has the effect of inhibiting the proliferation of a variety of tumor cells and inducing cell differentiation. Studies have shown that the effective efficiency of retinoic acid in the treatment of differentiated aphrodisiac is 30%-40%. However, there are many side effects, and the adverse reactions gradually disappear after the suspension of retinoic acid. Since retinoic acid has an inducible differentiation effect on partially differentiated lesions, partially differentiated staphylococcus can be used optionally.
2, external radiation assisted treatment (radiotherapy)
differentiated atarcum is not sensitive to external radiation therapy and is not recommended as a routine use.
However, for distant metastasis that is visible to the naked eye and cannot be operated, or is located in a critical area that cannot be operated (such as spinal metastasis, central nervous system metastasis, certain mediastinal or submediastinal or pelvic metastasis, pelvic metastasis, etc.), when the tumor does not intake iodine 131 or iodine 131 has poor treatment effect and is iodine-refractory, when the tumor does not have iodine 131 or iodine 131 treatment, external radiation therapy or imaging-guided radiotherapy can be considered at the same time as TSH inhibition treatment, mainly for local palliative treatment.
3. Chemotherapy (chemotherapy)
Chemotherapy is still an attempt to treat after other treatments are ineffective, as palliative treatment. Currently, the only chemotherapy drug approved by the United States FDA for the treatment of metastasis of phat cancer is doxorubicin (dorubicin). However, due to its poor efficacy, it is gradually replaced by targeted drugs.
4, targeted therapy
Studies have shown that in order to break through the differentiation treatment of atarctic cancer, tumor-targeted drugs may be the key. Although many studies have conducted multiple clinical studies on sorafenib, sunitinib, vandetinib and axitinib, no case has achieved complete remission, and the partial remission rate has reached 50%, making it difficult to maintain long-term use. At present, the targeted drug sorafenib has been approved by the FDA, becoming the first targeted drug to be used to treat thyroid cancer. How to avoid the loss of differentiation of
?
1. Once diagnosed with A-carcinoma, actively regulate treatment, including surgery, iodine 131 and TSH inhibition treatment.
2. For aphrodisiac cancer with iodine 131 treatment indications, iodine treatment should be more active. In order to prevent the loss of differentiation of iodine 131 from metastatic or residual lesions, it is considered that the dose of clearing aceta should be as large as possible so that the lesions that can be killed by iodine 131 should be killed as much as possible to avoid insufficient dose.
3. Regular review, including neck color ultrasound, iodine 131 whole body imaging, Tg, TGab, and chest CT and bone scans if necessary.
4. Take medicine regularly. Uagra is crucial in TSH inhibition treatment. Many patients may not be treated with iodine 131, but they must not be taken with UALE.
Therefore, as long as the differentiated atarcum is diagnosed, it is recommended to standardize treatment as early as possible, and strive to achieve clinical cure before the loss of differentiation.
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