This article totals 1720 words
Read for about 5 minutes
In the big family of thyroid cancer, if ranked according to the degree of malignancy and the poor prognosis, the most common differentiated papillary carcinoma can only be regarded as harmless "little brother" compared with its "big brother" undifferentiated cancer and "second brother" myeloid carcinoma.
The three brothers of undifferentiated carcinoma, medullary carcinoma and differentiated papillary carcinoma can be described as a "disparity in strength" - the eldest brother undifferentiated cancer is a fierce person who can break the wrist with a well-known villain with a very high degree of malignancy such as lung cell carcinoma and glial cell carcinoma; the second brother myeloid carcinoma is also a "thug" whose growth rate, invasiveness, and malignancy are at the forefront of all cancers; only the younger brother is a "lazy cancer" that is felt that there will be no progress every day, and compared with the two of them, it is almost like a "good student".
<h1 class="pgc-h-arrow-right" data-track="70" > two faces of myeloid carcinoma</h1>
Medullary carcinoma is not only the second oldest, it also has two faces.
When it was still small, it behaved very similarly to his "brother's" tiny papillary carcinoma under the color ultrasound, and some of the color ultrasound images of myeloid cancer were similar to benign adenomas. When it grows to a larger body size, it will appear as a well-defined round or oval low echo clumps, with coarse calcifications inside and an aspect ratio greater than one.
This leads to two problems, one of which is that some medullary carcinomas are misdiagnosed as micropammonal carcinomas, or even benign adenomas, until the intraoperative pathology is discovered as medullary carcinoma
(Of course, the marketing numbers that tell you that micro-cancers don't care won't mention this stubble.)
The second is because medullary carcinoma progresses rapidly and is aggressive, so when it is large enough to show its own characteristics, color ultrasound suggests suspected medullary cancer, it often has extensive lymphatic metastasis.
The prognosis will naturally be relatively poor, and the scope of surgery will be wider than that of general thyroid surgery, and it is basically necessary to perform additional central cervical lymph node dissection, and even unilateral and bilateral lateral cervical lymph node dissection.
Pulpoid carcinoma under ultrasound: Can you figure out where it is?
Therefore, the detection of medullary cancer needs to start from many aspects.
Color ultrasound can help us do a preliminary screening, calcitonin is a specific indicator of medullary carcinoma, generally speaking, combining these two tests can confirm the diagnosis of medullary cancer. In addition, genetic testing is required for a friend with a family history of myeloid carcinoma or a direct family member of a friend who has a history of medullary cancer, and if a mutation in the RET gene is found, preventive thyroidectomy is performed at different times depending on the site.
Mothers with medullary carcinoma should pay special attention to this, such as M918T, which may require surgery at the age of one year, and do not delay the timing of surgery.
<h1 class="pgc-h-arrow-right" data-track="71" > staging of medullary thyroid carcinoma</h1>
According to the criteria proposed by the American Cancer Consortium (AJCC) in 2017, the TNM stages for medullary carcinoma are as follows:
Quiz:
According to the table above, if Xiaohong's medullary pathology report is T4aN1aM0, can A friends tell what her cancer is? Tell the little i in the message~
<h1 class="pgc-h-arrow-right" data-track="72" > treatment of medullary thyroid cancer</h1>
For medullary carcinoma, the clinical proposition is generally total excision, and overall it is more radical than the surgical strategy of differentiated thyroid cancer.
Advocate "one-time emptying" - the scope of surgery is as large as possible, as clean as possible, often accompanied by a thorough, careful and extensive cleaning of the lymph nodes in the central area, lateral area and even to the upper mediastinum on one or both sides.
Schematic diagram of cervical lymph node partitioning
As for the specific range selection, it is necessary for the doctor to implement it in each case, and evaluate it according to the lymph node metastases and calcitonin levels.
For example, according to the recommendation of the 2015 ATA, if the preoperative calcitonin in patients with medullary carcinoma is greater than 200 pg/ml, central lymph node dissection plus cervical area dissection on the affected side is required.
Of course, such surgery may damage the surrounding laryngeal nerves, paranormal glands and muscles, but it must not be "choked".
Medullary carcinoma is insensitive to iodine therapy, the effect of chemoradiation is limited, targeted therapy is expensive, and can only be used as a supplemental treatment for advanced patients. All we can rely on is one and only one surgical resection sufficiently thorough. If you reduce the scope of surgery because of fear of side effects, or even simply abandon the operation, it will not be worth the further development of cancer.
<h1 class="pgc-h-arrow-right" data-track="83" > Xiao i said:</h1>
After reading this article, A friends must be very curious about the indicator of "calcitonin", it is indeed an important indicator related to the diagnosis, treatment and prognosis of medullary cancer, about its things, please allow Xiao i to sell a close, the next issue of the medullary carcinoma surgery when the time to tell the A friends ~
The pictures in this article are from the Network, if there is infringement, please contact in time.
bibliography
Sun Wei,He Liang,Zhang Hao. American Joint Cancer Commission Thyroid Cancer Staging System (Eighth Edition) Update Interpretation. Chinese Journal of Practical Surgery,2017,3(37):255-258
GAO Ming, YU Yang, ZHAO Jing. Hereditary thyroid cancer[J]. Surgery-Theory & Practice, 2012, 017(001):7-10.
Gao Ming, Ge Minghua, editors-in-chief. Thyroid Oncology[M], Beijing: People's Medical Publishing House, 2018:242.