Treatment of Thyroid Gland Cancer in Turkey

Thyroid Cancer Overview

Thyroid cancer is a tumor originating from the thyroid gland, a butterfly-shaped gland located at the base of the neck, just below the Adam's apple. The thyroid gland produces hormones that regulate heart rate, blood pressure, body temperature, and weight.

In its early stages, thyroid cancer may not cause noticeable symptoms. However, as it grows, it can lead to signs and symptoms such as neck swelling, changes in voice, and difficulty swallowing.

There are various types of thyroid cancer, with most growing slowly. Nonetheless, some types can be highly aggressive. Many cases of thyroid cancer can be successfully treated, but there is a rising trend in thyroid cancer incidence. Improved imaging technologies contribute to the detection of small thyroid cancers during diagnostic procedures like computed tomography (CT) scans and magnetic resonance imaging (MRI) conducted for other medical conditions. Typically, thyroid cancers discovered incidentally through such methods are small and respond well to treatment.

Types of Thyroid Cancer

1_ Well-Differentiated Thyroid Cancers:

• Begin in cells that produce and store thyroid hormones, known as follicular cells.
• Display a resemblance to healthy cells under a microscope.

2_ Papillary Thyroid Cancer:

• The most common type, often occurring in individuals aged 30 to 50.
• Most cases are small and respond well to treatment.

3_ Follicular Thyroid Cancer:

• A rare type that usually affects individuals over 50.
• Typically does not spread to lymph nodes but may spread to other locations.

4_ Hürthle Cell Thyroid Cancer:

• Formerly classified under follicular thyroid cancer, now recognized as a distinct type.
• Often highly aggressive, capable of spreading to neck structures and other areas.

5_ Poorly Differentiated Thyroid Cancer:

• A rare and more aggressive type compared to other well-differentiated types.
• Often unresponsive to standard treatments.

6_ Medullary Thyroid Cancer:

• Originates in C cells responsible for producing calcitonin.
• Associated with the RET gene, and familial cases increase the risk of thyroid cancer.

7_ Anaplastic Thyroid Cancer:

• A rare, rapidly growing cancer that is challenging to treat.
• Primarily affects individuals over 60 and can cause severe symptoms like rapidly worsening neck swelling, leading to breathing and swallowing difficulties.

Causes of Thyroid Cancer

Thyroid cancer begins when changes occur in the DNA of thyroid gland cells. The DNA, containing instructions that guide the cell in its function, undergoes changes, known as mutations by doctors. These mutations direct the cells to grow and divide abnormally. While these cells continue to grow, normal cells die naturally, resulting in the formation of a mass known as a tumor.

The tumor may grow, invading the surrounding tissues, and it can also spread to the lymph nodes in the neck. In some cases, cancer cells may spread to multiple areas in the body, such as the lungs and bones.

The specific reason for these DNA changes that lead to thyroid cancer is not known.

Diagnosis of Thyroid Cancer in Turkey

The diagnosis of thyroid cancer in Turkey involves various tests and procedures:

1_Physical Examination: The doctor will conduct a physical examination, palpating the neck to detect any changes in the thyroid gland, such as the presence of masses or nodules. The doctor may also inquire about risk factors, including previous exposure to radiation and a family history of thyroid cancer.

2_Blood Tests: Blood tests are performed to examine the function of the thyroid gland. These tests measure the levels of thyroid-stimulating hormone (TSH) and hormones produced by the thyroid gland in the blood, providing insights into the thyroid gland's health.

3_Ultrasound Imaging: Ultrasound, which utilizes high-frequency sound waves, is used to produce images of body organs. To visualize the thyroid gland, a transducer is placed beneath the neck. The appearance of a thyroid nodule in ultrasound images helps determine its likelihood of being cancerous. Indicators of a potentially cancerous nodule include small calcifications within the nodule and irregular borders. If the likelihood of a cancerous nodule is high, additional tests are necessary to confirm the diagnosis and determine the type of thyroid cancer.

4_Fine Needle Aspiration (FNA) Biopsy: During an FNA biopsy, a long, thin needle is inserted through the skin into the thyroid nodule. Ultrasound is often used to guide the needle accurately. The doctor uses the needle to remove some cells from the thyroid gland, and the sample is sent to the laboratory for analysis. A pathologist examines the tissue sample under a microscope to determine whether cancer is present. Results may not be definitive for some types of thyroid cancer, especially papillary thyroid cancer and Hürthle cell cancer. Additional testing or surgery to remove the thyroid nodule may be recommended.

5_Radioactive Iodine Scan: A radioactive iodine scan uses a radioactive form of iodine and a special camera to detect cancer cells in the thyroid gland. This test is often performed after surgery to find any remaining cancer cells, especially for well-differentiated and follicular thyroid cancers.

6_Other Imaging Tests: Additional imaging tests may be conducted to assess the extent of cancer spread beyond the thyroid gland. These tests may include ultrasound imaging, computed tomography (CT) scans, and magnetic resonance imaging (MRI).

7_Genetic Testing: Some types of medullary thyroid cancer result from inherited genes passed from parents to children. If medullary thyroid cancer is diagnosed, genetic testing may be recommended to understand the risk of other types of cancer and the impact of the inherited gene on children.

Staging Thyroid Cancer

Healthcare teams use information from tests and procedures to determine the stage of thyroid cancer and its extent of spread. The stage of cancer helps predict the prognosis and identify the most likely effective treatment.

Cancer stages are referred to by numbers from 1 to 4. A lower number usually indicates that the cancer is more likely to respond to treatment and has not spread beyond the thyroid gland. A higher number indicates a more advanced diagnosis, and the cancer may have spread beyond the thyroid gland to other parts of the body.

Different types of thyroid cancer have different stage groupings. For example, there are distinct stage groupings for medullary thyroid cancer and anaplastic thyroid cancer. Differentiated thyroid cancers, including papillary, follicular, Hürthle cell, and poorly differentiated types, share a set of stage groupings. The stage may also vary with age in the case of differentiated thyroid cancers.

Thyroid Cancer Treatment in Turkey

Thyroid cancer poses a significant health challenge, and Turkey adopts advanced and effective treatment methods to address it. The choice of treatment depends on the type of cancer, its stage, the patient's overall health, and personal preferences, with various techniques used to ensure the effectiveness of the treatment.

1. Surgery:

• Thyroidectomy: Involves the removal of most or all of the thyroid gland using precise surgical procedures. The surgeon often leaves a thin margin of healthy tissue around the adjacent parathyroid glands to avoid damaging them, as they help regulate calcium levels in the blood.
• Lobectomy: Involves the removal of part of the thyroid gland, recommended for cases of slow-growing cancer in a specific part of the gland.

2. Lymph Node Dissection:

• This procedure is performed if there are indications of cancer cells spreading to the lymph nodes in the neck.

3. Blood Tests:

• Tests are conducted to verify the removal of cancer cells, including thyroid globulin, calcitonin, and thyroglobulin antibodies.

4. Hormone Therapy:

• Hormone therapy is used to replace thyroid hormones after surgery and aims to prevent the growth of cancer cells.

5. Radioactive Iodine:

• This treatment is effective in eliminating remaining cancer cells and is primarily used in cases of differentiated thyroid gland cancer.

6. Alcohol Ablation:

• Alcohol is used to shrink small tumors in the thyroid gland, providing a practical option for treating small areas that may not allow for surgery.