In the last 10 years, the detection rate for thyroid cancer in Russia has increased by one third, and mortality from this disease has been reduced by almost half within a year of diagnosis (based on 2021 data). The increased availability of ultrasound machines and the development of the primary endocrinological link played in favor of patients in our country, – says the Deputy Chief Physician for Coordination of the Oncological Service of the State Scientific Center of the National Research Center for Endocrinology of the Ministry of Health of Russia , surgeon and oncologist Petr Nikiforovich. On World Cancer Day, the doctor explained whether it is possible to suspect thyroid cancer on its own, what is the complexity of the diagnosis and what is important for the cure.
Often neoplasms in the thyroid gland are very small nodules from 1 mm to 3-4 cm, says the oncologist. It is extremely rare for tumors to grow to a size where a person can feel them on their own. Change in the shape of the neck, asymmetry, difficulty swallowing – in most cases, these symptoms are associated with the so-called goiter, that is, with the growth of the thyroid nodes. But only 4% of these nodes can turn into cancer. Also, if the nodule is large, this does not mean at all that it is malignant.
WHY IT IS HARD TO GET A DIAGNOSIS
For the diagnosis to be correct, the qualifications of the specialist to whom the person goes for the first appointment, as well as the doctor who performs the ultrasound, are important. Here it is necessary to assess not only the state of the thyroid gland, but also the lymph nodes, both around the thyroid gland and in the lateral parts of the neck. This is the main place where metastases can be.
– There are many ultrasound devices in the country, and there are also many specialists who do this research. There are no difficulties here, the thyroid gland is not located so deep. But not all specialists can correctly interpret the results of the study, correctly characterize all formations in the thyroid gland and changes in the lymph nodes, determine the indications for a puncture or observation biopsy, says Petr Nikiforovich.
It is definitely worth contacting the large federal and regional centers for a “second opinion” to confirm the diagnosis, as the description of ultrasound results from one doctor to another can vary greatly. It happens that when reviewing the ultrasound, the diagnosis can be changed again, both in the direction of “good-quality education”, and in the opposite direction. However, with cancer of the thyroid gland, the diagnosis of cancer is not a sentence. In 85% of cases, the so-called highly differentiated thyroid cancer occurs, in which the prognosis for cure and continuation of life is quite favorable.
WHAT IS INNOVATIVE IN THE TREATMENT OF THYROID CANCER?
The general trend in recent years is that the aggressiveness of surgical treatment is decreasing, and there are also fewer indications for surgery. If earlier the thyroid gland (two lobes of the thyroid gland) was completely removed, regardless of the size of the tumor, now operations are approached with more caution, trying to preserve the portion of the thyroid gland in which there is no cancer. Thus, the subsequent intake of hormones throughout life can be avoided. A moderate approach during the operation makes it possible to preserve the function of the recurrent laryngeal nerve, the person will be able to speak, which means that it will be easier to live after the operation.
WHO IS MOST VULNERABLE TO THYROID CANCER?
Most of the time, thyroid diseases occur in women, but thyroid cancer is a problem for both women and men alike.
Those who received radiation exposure to the neck and chest in their youth or childhood are at risk of developing cancer. For example, it could be multiple procedures for pediatric oncology, redundant radiological diagnostics. People who work in industries with higher risk of radiation are also vulnerable.
QUESTION EDGE
Is it possible to beat cancer once and for all?
– Now we move towards a greater differentiation of cancer variants and a deeper understanding that some of its types can be observed without resorting to surgery. But there are types of cancer in which surgery must be radical. If 15 years ago the surgeon was the main GP in oncology, now the patient is treated by an interdisciplinary team: in addition to surgeons and chemotherapists, radiotherapists, geneticists, pathologists and radiologists are involved. In addition to classical methods of treatment (surgery, radiotherapy and chemotherapy), “targeted” drugs are used. The recent use of immunological therapy, radionuclide therapy of peptide receptors prolongs a person’s life, its quality is preserved for years, even with the most unfavorable diagnosis, emphasizes the oncologist, surgeon Pyotr Nikiforovich.
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HOW TO DETECT CANCER AT THE EARLY STAGE
Every resident of Russia has the right to a preventive medical examination, which includes oncoscreening according to the risks of developing cancer depending on sex and age.
For the exam you need:
1. Have a compulsory health insurance policy.
2. Attach to the clinic.
What studies are carried out according to sex and age?
Women
PAP test (liquid-based cytology). Age: after 18 years – every three years. 18, 21, 24, 27, 30,33,36,39,42, 45, 48, 51, 54, 57, 60, 63 years old.
Mammography. Age: after 40 years – every two years. 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72, 74 years old.
Men
Determination of prostate specific antigen (PSA) in blood. Age: 45, 50, 55, 60, 64.
General investigations:
Fecal test for occult blood. Age: 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 65 (and older).
gastroscopy. Age: 45.
If there are medical indications, the doctor may prescribe additional tests:
gastroscopy
sigmoidoscopy
colonoscopy
dermoscopy
X-ray or computed tomography of the lungs (CT).
