Thyroid Cancer Symptoms

introduction

Like any other organ in the body, cancer can also affect the thyroid gland. The type of malignant tumor depends on the tissue that degenerates as part of the disease. They can Thyroid epithelial cells (Thyrocytes), that Follicular epithelium (in which the thyroid hormones are stored) and the C cells - Cells that produce the hormone calcitonin - the starting point for thyroid malignancy.
On average, around 30,000 new cases occur each year. The majority of diseases (80%) consist of so-called follicular and papillary thyroid carcinomas, which develop from thyroid epithelial cells. The types of cancer just mentioned, as well as medullary thyroid carcinoma from C cells, are differentiated tumors - they have a low degree of malignancy (degree of malignancy of the tumor) and are therefore easy to treat.

In contrast to that anaplastic carcinoma, which is highly undifferentiated, grows very quickly and often does not allow a good forecast. There are gender-specific differences depending on the cell type. While most differentiated tumors occur three times more often in women, there is an even distribution in medullary and anaplastic forms.

causes

The causes for the development of thyroid cancer are in the majority of all cases unexplained. Ionizing radiation is said to increase the risk of developing a differentiated carcinoma of the papillary or follicular type. An iodine deficiency, which can trigger a goiter (enlarged thyroid), is apparently not a risk factor for tumor development. However, people in areas richer in iodine tend to have papillary thyroid cancer, which has a more favorable prognosis. The third differentiated tumor, C-cell carcinoma (medullary thyroid cancer), is due to genetic traits in a quarter of the diseases. Mutations on chromosome 11 are responsible for the tumor. In the rest of the cases, the cause is again unknown. Anaplastic thyroid carcinoma is the most dangerous tumor due to its undifferentiated nature. It develops extremely quickly from the Follicular epithelium, although no cause could be found here either.

Signs

The papillary thyroid cancer often comes as Micro carcinoma before, i.e. as a tumor smaller than one centimeter in size. Therefore it initially remains clinically silent and is not noticed by the patient. Even experienced doctors cannot feel such small structures during routine checks, for example.
Since the papillary carcinomas predominantly on lymphogenic route can spread as part of the disease Lymph node metastases that appear earlier than the primary tumor. Doing so is hardened on Lymph nodes in the neck region to pay attention that are not very movable. Distant metastases are more likely to occur follicular thyroid carcinoma because it scatters through the bloodstream.
Thus, metastases can affect the skeleton and the lung affected, the two most common sites of metastasis.

Other symptoms of papillary and follicular tumors are hard, palpable lumps in the thyroid gland or an apparent enlargement of the same. In the later course of the disease, if it is not discovered, the surrounding tissue - the muscles, the trachea and esophagus - will infiltrate. Nerves can also be damaged by the tumor.
Is the Recurrent laryngeal nerve affected, it comes to unilateral damage hoarseness, with bilateral infestation to hoarseness and shortness of breath. The reason for this is the task of the nerve: the innervation (nerve supply) of the inner larynx muscles, which move the vocal cords.

In addition to recurrent palsy (recurrent paralysis), this can Horner syndrome occur, which is caused by the damage to the sympathetic-controlled eye muscles. This symptom complex includes the Miosis (Reduction of the pupil), the Ptosis (Eyelid lowering) and, depending on the scientific view, the (pseudo-)Enophthalmus (Protrusion of the eye).

Medullary thyroid carcinoma is also often discovered late because it can initially develop without symptoms. A conspicuous finding during an examination followed by a biopsy of a lymph node or distant metastasis often leads to the initial diagnosis. Can he tumor not successfully treated or if it is not noticed, it can become relevant increase of Calcitonin level come. This hormone is produced by the C cells and, in the case of malignant degeneration, more is released.
It lowers the blood levels of calcium by reducing its excretion through the body kidney increases, decreases absorption in the intestine and reduces the activity of cells that break down bone substance (osteoclasts). The consequences of an increased calcitonin level can include flushing (reddening of the skin due to increased blood flow, see p. Flush syndrome), Diarrhea and dizziness be. A slight calcium deficiency (hypocalcemia) can also occur, which is shown by an increased excitability of the skeletal muscles - Muscle twitching or cramps can occur.

Due to the rapid development of anaplastic carcinoma, the disease manifests itself relatively quickly. There is a swelling of the neck on one side difficulties swallowing and increasing hoarseness is accompanied.
A sudden one Swelling of the neck must always be examined as quickly as possible, as other dangerous diseases (allergic reaction) can also be the cause.

Hair loss

In rare cases, the thyroid hormones can be influenced by malignant tumor diseases. Underactive, reduced hormone production, as well as overactive, increased hormone production, can affect hair growth and its structure. The thyroid hormones have important roles in controlling the Growth and the development of the human body. An underactive condition can cause hair to lose strength and diameter. The density can also be lost - the hair looks dull and brittle. This makes them lighter. This also happens with an overactive function, whereby growth can be accelerated here first. As a result, the hair enters its resting phase faster - it does not become as long, is thinner and more brittle.

Thyroid cancer can be with the help of a Radioiodine therapy be treated afterwards. This usually follows surgical removal of the thyroid gland, but it is also used for severe hyperthyroidism. In radio-iodine therapy, the patient is given radioactive iodine. This is stored in the thyroid, which is responsible for the body's iodine balance and which iodine needs to build up hormones. The radioactive substance destroys the tissue into which it is ingested. This can result in a therapy-related hypothyroidism, which can result in listlessness and weight gain, but also in the hair loss described above.

blood values

The diagnosis of papillary or follicular thyroid carcinoma is often made by removing tiny amounts of tissue from the suspicious structures. These are examined microscopically and diagnosed in the laboratory. The blood values ​​play a subordinate role in diagnostics, as they are normal in most cases of the disease and only rarely show increased thyroid hormone production. In some cases the thyroglobulin (TG = carrier substance of the thyroid hormones in the blood), which is produced and stored in the thyroid cells, is increased. It is usually found in small amounts in the blood - an increase indicates a problem with the thyroid gland.

Medullary thyroid carcinoma is also primarily treated with the help of a histological examination detected. Since the cancer consists of C cells, an abnormal blood test can be observed. C cells produce calcitonin, a calcium metabolism hormone that can be measured in the blood. The proliferation of cells in the context of cancer leads to a multiple to a thousandfold increase in the calcitonin level in the blood. At the same time, the tumor marker CEA (carcinoembryonic antigen) increases, which is increased in the context of many different malignant tumor diseases.

In the case of anaplastic thyroid carcinoma, the clinical abnormalities are the only decisive factor. The thyroid hormones appear completely normal in the blood count and are therefore of no diagnostic help.

Chance of recovery

The chances of a cure are highest in papillary and follicular thyroid cancer. In over 80% of all diseases of a papillary thyroid carcinoma, the tumor can be cured, which is linked to the 10-year survival rate. This form of malignant tumor diseases of the thyroid gland therefore has the best prognostic prospects. The prognosis of follicular thyroid carcinoma is somewhat worse, with a 60 to 70% chance of recovery.

A C-cell carcinoma or medullary thyroid cancer can result from the genetic basis be dependent. There is a family formin which the predisposition to develop a thyroid tumor is inherited. In the case of a familial predisposition, the chances of recovery with regard to the 10-year survival rate are 50 to 70% better than with the "wild form", which arises without a genetic cause. If it can be determined that the hereditary disposition is to blame for the disease, counseling of the entire family should be sought in order to determine measures for early detection initiate and improve the prognosis of the disease in other cases in the family.

Anaplastic thyroid carcinoma has the worst prognosis and thus the lowest chances of recovery. Due to the dedifferentiated cells, the tumor grows extremely quickly and is difficult to attack by therapeutic measures. Because this form of cancer is difficult to cure, less than 10% survive the next 5 years even if treatment is initiated. Due to the highly aggressive nature of the tumor, half of all patients have died of the disease 6 months after the diagnosis was made.

Read more about this under Life expectancy in thyroid cancer.