Jimu news reporter Yan Wen
Correspondent Luo Junhua Wang Fang
"Thyroid nodules don't have to be anxious, and less than 2 percent really need treatment." Although the incidence of thyroid cancer has increased threefold in the past 15 years, the mortality rate has not increased. In general, thyroid cancer is a relatively inert tumor, but the degree of standardized treatment determines the survival and quality of life of patients after surgery. A few days ago, during the National Cancer Prevention and Control Week (April 15 to 21), Zhu Youhua, director of the Department of Head and Neck-Thyroid Surgery of Hubei Provincial Cancer Hospital and chief expert of thyroid cancer, said in an interview with Jimu News.
It is reported that thyroid cancer is the fastest growing malignant tumor in recent years, and it is also the closest cancer to young people! How should we respond to the increasing rate of thyroid nodule detection and the fastest growing incidence of malignancy? Yesterday, this newspaper specially invited Zhu Youhua, chief expert of thyroid cancer in Hubei Provincial Cancer Hospital, to be a guest of the "Lecture Hall of Famous Doctors of Chutian" to provide early diagnosis and early treatment of thyroid cancer for the general public.
【Expert Business Card】
Name: Zhu Youhua
Position: Chief Physician, Director of Head and Neck-Thyroid Surgery Department of Hubei Provincial Cancer Hospital, Chief Expert of Thyroid Cancer. He is a member of the Head and Neck Tumor Professional Committee of the Chinese Anti-Cancer Association and the chairman of the Thyroid Cancer Professional Committee of the Hubei Anti-Cancer Association. Visiting Scholar, MD Anderson Cancer Center, USA.
Specialty: Good at the diagnosis, treatment and functional repair of intractable diseases of the head and neck and thyroid gland.
Specialist clinic hours: Every Tuesday morning
There is no need to panic when nodules are detected, and less than 2% of them need to be treated.
Talking about the pathogenesis characteristics of thyroid cancer, Zhu Youhua, director of the Head and Neck Surgery Department of Hubei Provincial Cancer Hospital and chief expert of thyroid cancer, introduced that the incidence of thyroid cancer has increased, in addition to the growth of the disease itself, the main reason is that people's health awareness is stronger, and the examination methods during physical examination are more advanced, like 1 mm of lumps can be exposed in the prototype under high-resolution color ultrasound. At the same time, the pathogenesis of thyroid tumors is characterized by young adults aged 20-40 as the "main force", and women are much higher than men, with a ratio of about 3:1.
Thyroid cancer is closely related to exposure to radioactive substances, obesity, and mental stress, and these pathogenic factors should be avoided. Thyroid cancer is familial, and the prevalence of immediate family members is 2-3 times higher than that of the general population.
"Despite the high incidence of nodules, from the physical examination data, the detection rate of nodules is as high as 20% to 70%, but there is no need to panic and worry too much." Zhu Youhua pointed out that most thyroid nodules are benign, and less than 2% of them may need treatment. It can be said that more than 95% of thyroid nodules are benign, even if it is a malignant tumor of the thyroid gland, more than 90% of it belongs to highly differentiated thyroid cancer, it is low degree of malignancy, better biological behavior, more inert, slow progression, low mortality, often called 'lazy cancer', but this does not mean that thyroid cancer can not be taken seriously. Cancer is cancer, will not be because of wearing the mask of kindness will no longer become dangerous, even if the highly differentiated thyroid cancer, there are lymph nodes and distant metastasis very early, not to mention the high degree of malignancy of medullary thyroid cancer and undifferentiated carcinoma. Therefore, thyroid cancer must not be taken too lightly and ignore treatment. Try to achieve early detection, early diagnosis, and early treatment.
High-resolution color ultrasound, the most "reliable" means of detection
"High-resolution ultrasound and experienced ultrasound physicians are critical during the detection and diagnosis of thyroid nodules." Zhu Youhua suggested that after finding thyroid nodules, it is best to go to a specialist hospital to find a specialist doctor to do it again with high-resolution color ultrasound, so as to facilitate the accurate classification of thyroid nodules. The purpose of classification is to characterize nodules to guide follow-up protocols and treatment strategies in the later stages. "The conclusions given by experienced doctors are often basically consistent with the postoperative conclusions. Therefore, the experience of the B ultrasound doctor is very important. Zhu Youhua said.
In general, thyroid nodules are divided into 6 grades, and at 4A, there is a 5%-10% possibility of thyroid cancer; 4B is 10%-20%; 4C is 20%-50%; and at 5A, it is higher than 50%.
"In the outpatient clinic, we can almost always receive very anxious patients, and I can't wait to come once a week, every month, which makes us cry and laugh." Zhu Youhua said that people's panic about nodules can be understood, and it is also necessary to find nodules for regular review, but the frequency is not necessarily so high.
In general, nodules of class 3 or below, if it is convenient, once every six months, or once in a year, you can also check too diligently. Nodules above level 4 are recommended for puncture biopsy, because even if only 5% of them are likely to be cancerous, doctors do not want to let it go.
If the diagnosis is not cancerous, and the size of the nodule is less than 2 centimeters, there is no special discomfort, the doctor will recommend to continue to observe, without special treatment.
Surgical techniques are demanding, and treatment specifications are important
"The surgical incision for thyroid tumors may not look like much, but it is a great test of the surgeon's skills." In response to the idea that many people think that the malignancy rate of thyroid tumors is not high, and surgery is only a "small operation", Director Zhu Youhua pointed out that thyroid tumors are not the same as other tumors, and patients are often very young, and have higher requirements for postoperative quality of life. Moreover, the thyroid gland is close to the trachea, esophagus, large blood vessels in the neck, recurrent laryngeal nerves, and parathyroid glands, etc., and the location is narrow, and once surgery is to be performed, it is difficult. "Thyroid tumors are also showing a younger trend, and the youngest patient last year was only six and a half years old. After the operation is done, it is also necessary to consider the future growth, marriage, and childbirth of the child, so the protection of various functions and nerves is crucial. ”
Therefore, the surgical standardization of thyroid tumors is very exquisite, not only to remove the primary lesion and lymph nodes that may metastasize, but also to protect the normal function as much as possible. For example, if the parathyroid glands and recurrent laryngeal nerve are not well protected, the patient's postoperative quality of life will be greatly affected, leaving sequelae such as hoarseness, calcium deficiency, cramps, singing high pitch and so on.
Traditionally, thyroid cancer surgery involves an incision in the neck so that even if the disease is cured, the patient may leave a scar on the neck. "For patients who have appearance requirements, if within the scope of the indications, we can perform endoscopic cosmetic surgery." Zhu Youhua said that at present, the overall 10-year survival of high-differentiation thyroid cancer surgery can reach more than 90%, and the survival of 20 years is more than 80%, and most patients are cured by one operation, but the degree of treatment norms determines the survival time and quality of life of patients after surgery. Regular review and follow-up of the postoperative "Golden Decade" is also important for the early detection of recurrence and metastasis.