Source: Yangtze Evening News
On the physical examination list, "nodule" is a high-frequency word, of which thyroid nodules are not uncommon. Many patients will "cluck" in the heart of thyroid nodules, will their nodules be thyroid cancer? What if thyroid cancer is diagnosed? In the first phase of the "Yifu Health Micro-Classroom" of Yifu Hospital affiliated to Nanjing Medical University, we invited Zhu Feng, director of the Department of General Surgery, to understand the surgical treatment of thyroid nodules and thyroid cancer.
Intern Yu Yuening Correspondent Nie Jing Li Haoyang Yangzi Evening News/Purple Cow News Reporter Yang Yan
In thyroid nodules, the proportion of "cancer" is only 3%-5% Director Zhu Feng said that the incidence of thyroid nodules has indeed increased in recent years. The incidence of thyroid nodules is related to genetic factors, environmental factors, etc., and is also related to the more common coverage of thyroid examination in routine physical examination. "But finding thyroid nodules doesn't require blind worry." Director Zhu Feng said that the proportion of thyroid nodules that are cancerous is only about 3%-5%. "We can judge whether the thyroid nodule is cancer through ultrasonography, and the doctor will pay attention to whether the shape of the nodule is regular, whether there is an envelope, whether the envelope is complete, whether the boundary is smooth, whether there is calcification, whether the blood flow is rich, etc., and give a comprehensive judgment."
Director Zhu Feng told the Yangtze Evening News reporter that the inspection report obtained by the public will be marked as several types of nodules, in general, the first, second and third types of nodules are basically benign, but the proportion of malignant in the three types of nodules is about 5%. "If it is four types of nodules, it must be divided into A, B, and C. If the level reaches 4C, the probability of malignancy reaches 95%, and five or six types of nodules can basically be determined to be cancer. Compared with other cancers, thyroid cancer is not so "fierce", still more "home", less willing to "run out", so even if the staging is later, the case of metastasis to other organs is relatively small. "But that doesn't mean it can be taken lightly." Director Zhu Feng said that papillary cancer and follicular cancer account for 95% of thyroid cancer, and the malignancy of these two types of cancer is relatively low, so most thyroid cancer patients have a good treatment effect. But there are also two types of thyroid cancer, myeloid carcinoma and undifferentiated carcinoma, with relatively high malignant degrees. Especially for undifferentiated cancer, bloody metastasis will occur soon after the cancer occurs, and the survival time of patients is only about half a year. Whether thyroid nodules should be treated or not, they must first look at pathological examination to determine good and malignant. Malignant thyroid cancer is preferred for resection, and if it is benign, it can be continued for observation. If the nodule is benign, but the volume is large, pressing on the trachea, esophagus, or the nodule is located in front of the neck and trachea, which has a great impact on the appearance, it is also necessary to consider removal.
Detour through the armpit to remove the tumor, "cosmetic surgery" neck without scars "Most of the current thyroid cancers are early cancers and microcarcinomas found in the physical examination, and there are not many lymph node metastases, only need to do the resection of the lesion plus the central area lymph node dissection." Director Zhu Feng said that in the case of early stage of thyroid cancer and the "scale" of surgery, there are two options for surgery, one is the traditional open surgery, opening an incision in the neck and going straight to the "destination"; the other is "cosmetic surgery", which requires a "detour", through the chest, through the mouth or armpits, using instruments to reach the lesion, do excision and lymph node dissection. Director Zhu Feng said that "cosmetic surgery" is suitable for thyroid cancer patients who have early stages and have not developed lymph node metastasis. "Cosmetic surgery" is not a complete minimally invasive procedure, and the trauma is even greater than directly in the neck opening, but it is still very meaningful. "We often meet patients who only think about how to cut the tumor clean after diagnosis, but return to daily life after surgery, always thinking about how to cover up the eye-catching scars on the neck." Patients with thyroid tumors have a long survival period, and scar problems will continue to plague patients. Solving the scars hidden in the lesions, there is also a long-term "care" for the patient's psychology, which is the meaning of "cosmetic surgery". "There are three 'entrances' in the chest, mouth and armpits, and the passage through the armpits is the most." Opening through the natural folds of the armpits and pulling the muscles up with a pull hook can "open up" a surgical pathway without the need for carbon dioxide inflation, complete dorsiolusectomy and lymph node dissection under endoscopy, and avoid related complications. The endoscope can enlarge the surgical field of vision by 5-10 times, open the fine structures that cannot be seen by surgery, and can be seen very clearly after magnification, the nerves and parathyroid glands can be dissected, with less bleeding, fine surgery, and good postoperative effect. If the patient has more lymph node metastases, it is not recommended to do "cosmetic surgery", but it is also possible to use combined surgery to combine the oral and transthoracic surgical pathways to achieve the purpose of removing the tumor and clearing the lymph nodes, while also hiding scars.
The pathogenesis factors are complex, don't just blame the iodized salt Director Zhu Feng said that the exact cause of thyroid nodules is unclear, most of them are closely related to genetics, environment, diet, work pressure and other factors, and the incidence of thyroid gland in women is also higher than that of men. Many people are concerned about the diet, in recent years thyroid dysfunction, thyroid nodules and even cancer has increased, some people turned their suspicious eyes to "iodized salt". Director Zhu Feng said that most of China's areas belong to iodine deficiency areas, and salt iodine supplementation is a national policy. At present, there is no evidence that salt iodization is associated with the high incidence of thyroid disease, and the occurrence of thyroid cancer may have a certain relationship with each person's own metabolism of iodine, but there is no clear relationship with iodine in food. The incidence of thyroid cancer is increasing in major countries around the world, regardless of whether iodine intake increases, stabilizes or decreases. Especially people with pregnant women, nursing women, infants and young children, etc., can not only eat non-iodized salt. To prevent thyroid cancer, comprehensive intervention is needed. For example, the thyroid gland is sensitive to rays, and the occurrence of some thyroid cancers is related to the radiation received in childhood, so it is necessary to pay attention to daily protection and reduce unnecessary exposure. A scientific diet, reducing work stress, and trying to maintain a calm mood can also help prevent various cancers, including thyroid cancer. During the physical examination, it is found that the thyroid gland has nodules, so it is necessary to keep an eye on it and follow up regularly. If there is a family history of thyroid disease, it is more important to pay attention to the annual physical examination, detect abnormal conditions early, and intervene at the right time to avoid delaying treatment.