Overview.
A rare and highly malignant form of thyroid cancer, most of which are asymptomatic in the early stages and can be detected as a goiter on physical examination. The cause of the disease is unknown, and may be related to genetics, radiation, inflammation, hormones, iodine abnormalities, and other factors. Treatment may include surgery, radiation, and chemotherapy.
Definition
Undifferentiated thyroid cancer is a highly aggressive malignant tumor composed of undifferentiated follicular cells of the thyroid gland. It is the most malignant of the thyroid cancers and has a very poor prognosis, with rapid progression of the disease and a high tendency to involve neighboring structures.
Epidemiology
Incidence
Undifferentiated thyroid cancer accounts for 1%~3% of thyroid cancer.
According to the data from the National Tumor Registry, thyroid cancer in China continues to grow at an annual rate of 20%. The incidence rate of thyroid cancer in women in urban areas of China ranks 4th among all malignant tumors in women.
Prevalent Crowd
It is mostly found in elderly people around 70 years old. It is less common in males than in females, and the male-to-female ratio is 1:(1.33-2.33).
Anatomy
The thyroid gland is a reddish brown soft gland with a butterfly shape, consisting of the left and right lobes and the isthmus. About half of the conical lobes are present, mostly arising from the isthmus.
The lateral lobes are located on either side of the larynx and trachea, with their upper poles rising mostly above the cricoid cartilage, the lower poles located in the 5th to 6th tracheal cartilage rings, and the isthmus located anterior to the 2nd to 4th tracheal cartilage rings.
Peripheral structures of the thyroid gland
On the dorsal surface of the lateral lobes are the parathyroid glands, which produce hormones with important functions in regulating calcium and phosphorus metabolism.
The medial aspect of the glandular lobe is adjacent to the larynx, trachea, hypopharynx, and esophagus, and the lateral aspect is adjacent to the common carotid artery.
The recurrent laryngeal nerve runs in the tracheoesophageal groove on the posterior medial side of the glandular lobe.
Etiology
Pathogenic factors
The etiology of undifferentiated carcinoma of the thyroid gland has not been clearly defined, and it is generally believed that its development is related to the following factors.
Radiation
Radiation exposure is the only clear cause of cancer.
The thyroid gland is more sensitive to radiation, and radiation exposure can cause cancerous transformation of thyroid cells, especially patients who have received a large dose of neck irradiation in their childhood are more likely to lead to the development of thyroid cancer.
Hereditary factors
25% of patients show family aggregation, called familial undifferentiated thyroid cancer.
Sex hormones
The incidence is approximately three times higher in women than in men. Sex hormones may play a role in etiology.
Some studies have found the presence of estrogen receptor (ER) and progesterone receptor (PR) in thyroid tissues, and the positive expression rate of estrogen receptor and progesterone receptor in thyroid cancer is higher than that in normal thyroid tissues and benign thyroid lesions, therefore, it is thought that estrogen receptor and progesterone receptor may be an important factor influencing the incidence of thyroid cancer in women.
Benign thyroid lesions
Some benign hyperplastic diseases of the thyroid gland, such as nodular goiter, can become cancerous after long-term development, especially after old age; Hashimoto’s thyroiditis can also be combined with the occurrence of papillary thyroid cancer.
The malignancy of thyroid adenomas is related to the type of pathology, and embryonic and fetal follicular adenomas are more likely to become malignant.
Pathogenesis
The pathogenesis of undifferentiated carcinoma of the thyroid has not been clarified, and it is currently thought that it may be related to genetic alterations. The most common molecular feature of undifferentiated carcinoma is TP53 mutation.
Symptoms
Most present with a rapidly growing neck mass, followed by hoarseness, dyspnea, and dysphagia.
Main Symptoms
Nodule or lump in the neck
The onset of the disease is often preceded by a thyroid nodule.
Nodules may increase rapidly in a short period of time, and grow rapidly after the appearance of neck lumps, which are fixed within 1 to 2 weeks, and progress rapidly to form bilateral diffuse huge thyroid lumps with hard and fixed texture, unclear borders, and extensive invasion of neighboring tissues.
Increasing thyroid tumor can cause neck pain.
Hoarseness: when the tumor compresses or violates the recurrent laryngeal nerve, hoarseness may occur.
Dyspnea or hemoptysis: when the tumor invades the trachea, dyspnea or hemoptysis may occur.
Dysphagia: when the tumor compresses or infiltrates the esophagus, it may cause dysphagia.
Ear, occipital and shoulder pain: when the tumor invades the cervical plexus, pain in the ear, occipital and shoulder or other symptoms may occur.
Horner’s syndrome: sympathetic nerve compression causes Horner’s syndrome, which manifests as pupil shrinkage, eyelid ptosis, and eyeball inversion.
Other symptoms
Corresponding symptoms may appear when undifferentiated thyroid cancer is combined with abnormal thyroid function.
Hyperthyroidism: symptoms related to accelerated metabolism such as agitation, panic, excessive sweating, insomnia and weight loss may appear.
Hypothyroidism: it manifests as slowing down of metabolism and symptoms such as depression, fatigue, poor appetite, drowsiness and memory loss.
Metastasis
Undifferentiated thyroid cancer progresses rapidly, and cervical lymph node metastasis and distant metastasis can occur at early stage.
Cervical lymph node metastasis: manifested as painless nodes in the neck, which can be movable.
Liver metastasis: jaundice (yellowing of eyes, skin or urine), abdominal pain and other symptoms may appear.
Lung metastasis: symptoms such as hemoptysis and dyspnea may occur.
Bone metastasis: symptoms such as bone pain and bone destruction may occur.
Consultation
Department of Medicine
General Surgery
If nodules or space-occupying lesions in the thyroid gland are detected by ultrasound during a routine physical examination or other tests, please consult the general surgery department or the Department of Nail and Breast Surgery.
Preparation for medical treatment
Preparation for consultation: registration, preparation of documents, common problems
Tips for Consultation
Undifferentiated thyroid cancer has no specific symptoms in the early stage and is easy to be overlooked, so people with family history of thyroid cancer should have regular medical checkups.
Preparation List
Symptom list
Particular attention should be paid to the time of symptom onset, special manifestations, etc.
How long has the thyroid nodule been found?
Do you have a hoarse voice or difficulty breathing?
Do you have difficulty swallowing meals?
Is there any fatigue with unexplained weight loss?
Medical History Checklist
Is there a family history of malignant tumors such as thyroid cancer?
Are there any drug or food allergies?
Are there any other associated diseases such as nodular goiter, Hashimoto’s thyroiditis, etc.?
Checklist
Examination results in the past 6 months, which can be brought to the doctor
Specialized tests: Thyroid puncture biopsy, thyroid function tests, tumor markers.
Laboratory tests: blood routine, urine routine, stool routine, blood biochemistry test.
Imaging tests: thyroid ultrasound, CT examination, magnetic resonance imaging (MRI), PET-CT.
Diagnosis
Disease diagnosis
Medical history
History of head and neck radiation exposure or exposure to radioactive dust during childhood.
History of systemic radiation therapy.
Living in a low iodine area.
Family history of thyroid cancer.
There may also be no clear history of the above.
Clinical manifestations
Presence of a painless neck mass, most of which move up and down with swallowing.
A few have hoarseness, dysphagia and pressure sensation, and enlarged lymph nodes are palpable in those with cervical lymph node metastasis.
Imaging
Ultrasonography
Ultrasonography is the most common and preferred imaging method for the thyroid gland.
Function
Ultrasonography of the neck can confirm the presence or absence of thyroid nodules, and should determine the size, number, location, cysticity, shape, borders, calcification, blood supply, and relationship with the surrounding tissues.
The presence of abnormal lymph nodes in the neck, their location, size, morphology, blood flow and structural features can also be evaluated.
Signs of malignancy in thyroid nodules
Tiny calcifications, irregular margins, aspect ratio >1.
Solid hypoechoic nodules, halo defects, extrathyroidal invasion, accompanied by abnormal ultrasound signs of cervical lymph nodes, etc.
TI-RADS CLASSIFICATION: Sonographers generally use the Thyroid Imaging Reporting and Data System (TI-RADS) to assess the degree of malignancy of thyroid nodules.
TI-RADS Category 1: Negative, no abnormalities, malignancy rate 0.
TI-RADS category 2: Cystic, confirmed benign lesion, malignancy rate 0.
TI-RADS category 3: solid or cystic, probable benign lesion, malignancy rate <5%.
TI-RADS category 4
4a: 1 suspicious ultrasound manifestation, malignancy rate 5% to 10%.
4b: 2 suspicious ultrasound manifestations with a malignancy rate of 10% to 50%.
4c: 3 or more suspicious ultrasound manifestations; malignancy rate 50% to 85%.
TI-RADS category 5: more than 4 signs of malignancy, especially with microcalcifications and microfolliculations; malignancy rate of 85% or more.
TI-RADS category 6: pathologically confirmed malignant lesions.
Electronic computed tomography (CT)
Cervical CT and common tracheal compression, or anterior-posterior diameter narrowing or left-right diameter narrowing, or tracheal compression displacement, biased to one side, prevertebral soft tissue thickening, indicating that the tumor encompasses the trachea and esophagus from the esophagus posterior to the prevertebral spine. There is often cervical lymph node metastasis, and sometimes the cervical metastatic lymph nodes are fused with the primary foci of the thyroid gland.
Enhanced CT scan can help doctors determine the extent of the thyroid tumor, blood supply, relationship with important surrounding structures (such as trachea, esophagus, carotid artery) and the presence of lymph node metastasis.
For cases of thyroid reoperation, it is helpful to understand the residual thyroid gland, assess the relationship between the lesion and the surrounding tissues and evaluate the recurrence of the localized thyroid gland and neck.
Enhanced CT of the chest can also detect the presence of lung metastases at an early stage.
Magnetic Resonance Imaging (MRI)
It can evaluate the benign and malignant nature of nodules. However, it is not sensitive to calcification, takes a long time to examine, and is easily affected by breathing and swallowing movements, so it is currently not used much in imaging the thyroid.
Positron emission computed tomography (PET-CT)
Useful for pre-treatment staging and to look for metastases when elevated calcitonin is present after surgery.
This test is expensive and is generally not recommended as a routine test for thyroid cancer diagnosis.
Laboratory Tests
Routine tests
Routine laboratory tests include routine blood tests, liver and kidney functions. Routine tests help to understand the patient’s general condition and whether appropriate treatment measures are appropriate.
Patients who need invasive tests or surgical treatments also need to undergo tests such as coagulation function.
Some patients require serum calcium/phosphorus, 24-hour urine calcium/phosphorus, and bone conversion biochemical markers, which help doctors assess thyroid function.
Thyroid Hormone Tests
These include blood measurements of thyroxine (T4), triiodothyronine (T3), free T4 (FT4), and free T3 (FT3), as well as thyroid-stimulating hormone (TSH).
TSH testing is an important initial screening test to clarify thyroid function and is commonly used clinically as the primary basis for determining thyroid dysfunction.
Serum TSH levels should be measured in all patients with thyroid nodules, especially those with highly suspected or confirmed thyroid cancer.
A reduced serum TSH level is one of the important indications when thyroid nuclear imaging is needed for the differential diagnosis of benign or malignant thyroid nodules.
Thyroid autoantibody test
Test items: Autoantibodies related to autoimmune thyroid disease mainly include anti-thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb) and thyroid stimulating hormone receptor antibody (TRAb).
Significance of the test
In patients with papillary thyroid cancer, TgAb is an important ancillary test for serum thyroglobulin (Tg).
The appearance of TPOAb usually precedes thyroid dysfunction and is involved in the tissue destruction process in the pathogenesis of Hashimoto’s thyroiditis and atrophic thyroiditis, causing clinical symptoms of hypothyroidism.
A positive TRAb test result indicates the presence of autoantibodies against the TSH receptor.
Thyroid Cancer Tumor Marker Test
Test Items: Thyroglobulin (Tg), etc.
Significance: Tg is a specific protein produced by the thyroid gland, which in some cases can help identify whether the patient has residual tumor or recurrence or metastasis, and it is of some significance to help the doctor monitor the recurrence and metastasis of the patient after surgery.
Pathologic examination
Cytologic examination
Methods of examination: Thyroid fine needle aspiration examination, which is categorized into the following 2 types of sampling methods.
Palpation-guided fine-needle aspiration: only applicable to palpable solid nodules, and the specimen is taken by the doctor by direct puncture.
Ultrasound-guided fine-needle aspiration: ultrasound-guided fine-needle aspiration is required for nonpalpable nodules, cystic solid nodules, or nodules that have previously undergone unsatisfactory fine-needle aspiration.
Significance: Fine needle aspiration utilizes a fine needle to puncture the thyroid nodule, from which cellular components are obtained to determine the nature of the target lesion through cytologic diagnosis, which helps to identify the benign or malignant nature of the thyroid nodule.
Interpretation of cytopathologic diagnostic reports: Thyroid cytopathologic diagnostic reports are made using the TBSRTC reporting system. In this reporting system, cytologic diagnosis is categorized into six levels.
Grade I, undiagnostic/unsatisfactory.
Grade II, benign.
Grade III, atypical cells of unknown significance/follicular lesions of unknown significance.
Grade IV, follicular tumor/suspicious follicular tumor.
Grade V, suspected malignancy.
Grade VI, malignant.
Risk of malignancy and clinical management: Patients with different cytologic diagnostic grades have different risks of malignancy and different clinical management measures.
Malignant risk and clinical management of thyroid TBSRTC by diagnostic grade
Diagnostic grade malignant risk clinical management
Unable to diagnose/unsatisfactory 5% to 10% Repeat fine-needle aspiration (ultrasound-guided)
Unable to diagnose/unsatisfactory
5% to 10%
Repeat fine needle aspiration (ultrasound-guided)
Benign 0～3% Follow-up
Benign
0～3%
Follow-up
Atypical cells of undetermined significance/follicular lesions of undetermined significance 10% to 30% Repeat fine-needle aspiration/molecular testing/surgery
Atypical cells of undetermined significance/follicular lesions of undetermined significance
10% to 30
Repeat fine needle aspiration/molecular testing/surgery
Follicular tumor/suspicious follicular tumor 25% to 40% Molecular testing/surgery
Follicular tumor/suspicious follicular tumor
25%～40
Molecular testing/surgery
Suspected malignancy 50%～75% Surgery
Suspected malignancy
50%～75
Surgery
Malignant 97%～99% Surgery
Malignant
97%～99
Surgery
Histologic examination
Pathologic diagnosis of the thyroid gland is carried out throughout the entire diagnostic and treatment process. Depending on the source of the specimen, it can be categorized into preoperative puncture pathologic diagnosis, intraoperative frozen pathologic diagnosis and postoperative paraffin pathologic diagnosis.
Preoperative puncture pathology diagnosis
Preoperative ultrasonic positioning of coarse needle puncture can collect tumor tissues for histopathological diagnosis, and the diagnosis can be clear in the case of sufficient specimens and typical morphology.
As fine needle aspiration has obvious advantages in diagnosis, histologic puncture is generally not routinely used, and can be used as a supplement in some cases of suspicious rare types.
Intraoperative frozen pathology diagnosis: characterization of thyroid nodules without preoperative puncture pathology diagnosis or unclear pathology diagnosis, and clarification of the presence or absence of lymph node metastasis, in order to decide on the surgical style of thyroidectomy or the scope of lymph node dissection.
Postoperative paraffin pathology diagnosis: it is for pathological examination of thyroid specimens removed after surgery, and generally the postoperative pathology report contains the following main contents.
Pathologic type: to determine which type of thyroid cancer is present.
Number of foci: to determine how many definite foci of cancer are present in the thyroid gland.
Thyroid peritoneum: to judge its involvement, which is related to clinical staging.
Vascular and nerve invasion.
Lymph nodes: lymph node metastasis and extraperitoneal invasion of lymph nodes, related to clinical staging.
pTNM staging: generally use the TNM staging jointly formulated by the American Cancer Consortium (AJCC) and the International Union Against Cancer (UICC).
Molecular biology examination
RET gene mutations are most common in patients with undifferentiated thyroid cancer.
With the advancement of precision medicine, genetic counseling and genetic testing can be carried out for high-risk groups of undifferentiated thyroid cancer in order to screen out RET gene mutations at an early stage for early intervention and treatment.
Other examinations
Preoperative and postoperative laryngoscopy can assess the activity of the vocal cords, clarify the damage of the recurrent laryngeal nerve, and provide the surgeon with surgical guidance.
Preoperative evaluation
Preoperative laryngoscopy is routinely performed to assess bilateral vocal cord activity.
If there are signs of reduced or even fixed vocal cord activity, the tumor is highly suspected of compressing or invading the recurrent laryngeal nerve, and appropriate surgical planning should be made before surgery, and tracheotomy or tracheostomy may be needed after surgery.
Postoperative evaluation: If the tumor is found to encroach on the recurrent laryngeal nerve during the operation, or if the recurrent laryngeal nerve test indicates that the function of the recurrent laryngeal nerve is affected, laryngoscopy is feasible to evaluate the recovery of the vocal cord movement after the operation.
Staging
The staging of undifferentiated thyroid cancer can help to reasonably formulate the treatment plan, correctly evaluate the curative effect and judge the prognosis.
TNM staging
The TNM staging method of undifferentiated thyroid cancer is the same as that of thyroid cancer, and the specific staging is as follows.
At present, TNM staging of thyroid cancer is a staging system jointly formulated by the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC), which is mainly based on the three elements of T, N and M. The TNM staging of thyroid cancer is based on the following three elements
T: represents the extent of the primary tumor, mainly referring to the size of the primary tumor foci and the degree of extravasation.
N: represents regional lymph node metastasis, including the number of metastases and regional extent.
M: represents the situation of distant metastasis, which mainly means that cancer cells are also present in other organs.
TNM will be appended with Arabic numerals from 1 to 4, etc. The larger the number, the more serious it is in general.
Clinical Staging
According to different TNM stages, the overall clinical stage (prognostic grouping) of the patient is finally determined, which is indicated by the Roman letters I, II, III and IV.
Undifferentiated thyroid cancer has the highest degree of malignancy among all types of thyroid cancer, progresses rapidly and is difficult to be detected early. Once diagnosed, most of them belong to stage IV, which can be subdivided into IVA, IVB and IVC.
Clinical staging TNM staging
Stage IVA T1-3a, N0, M0
Stage IVA
T1～3a、N0、M0
Stage IVB T1～3a, N1, M0, T3b～4, any N, M0
Phase IVB
T1～3a, N1, M0, T3b～4, any N, M0
Stage IVC any T, any N, M1
Stage IVC
Any T, any N, M1
Differential Diagnosis
Medullary thyroid carcinoma
Similarity: thyroid mass.
Differences: medullary carcinoma of the thyroid differs from undifferentiated carcinoma of the thyroid as follows.
Medullary carcinoma has inconspicuous interstitial degeneration, few nuclear schizonts, few necrotic foci, and amyloid in the interstitium; whereas, undifferentiated thyroid carcinoma tumor cells are often diffusely distributed, with many nuclear schizonts, more pronounced nuclear anomalies, obvious interstitial degeneration, and common necrotic foci.
Immunohistochemistry showed medullary carcinoma was negative for Tg, positive for CEA and CT; undifferentiated carcinoma was positive for Tg, negative for CT, and CEA was often weakly positive or not expressed.
Primary lymphoma of thyroid
Similarity: thyroid mass.
Difference: can be differentiated by pathologic examination. Primary lymphoma of the thyroid gland has diffuse tumor cells, heterogeneous nuclear staining, and characteristic “lymphoepitheliopathy” under light microscopy.
Treatment
Principles of treatment
Comprehensive treatment is the main treatment modality, and the treatment should be individualized according to the patient’s specific situation.
Surgical treatment
If the tumor is small when the patient presents with undifferentiated thyroid cancer, surgery may be possible.
Most patients with undifferentiated thyroid cancer have a large neck mass at the time of consultation and the disease progresses rapidly, so there may be no chance of surgery.
When the tumor compresses the trachea and causes respiratory difficulties, tracheotomy is performed after tumor reduction as much as possible. However, this tracheotomy is difficult and risky.
Radiation therapy
Radiation therapy is external radiation therapy.
For undifferentiated thyroid cancer, if there is residual or extensive lymph node metastasis after surgery, extensive postoperative radiation therapy should be given in time to minimize the local recurrence rate and improve the prognosis.
It can play a role as part of preoperative and postoperative comprehensive treatment. Radiotherapy alone can also be used, and high-dose radiotherapy (up to 60 Gy is recommended) is possible.
Complications of external beam radiation
Acute complications include pharyngitis, mucositis, dry mouth, altered taste, dysphagia, painful swallowing, radiation dermatitis, etc. Reactions above grade 3 are rare, with pharyngitis being the most common (<10%), and the rest of the reactions <5%.
Late complications: these include skin muscle fibrosis, esophageal tracheal stenosis, pharyngeal stenosis leading to dysphagia, internal carotid artery sclerosis, and second primary cancer.
Chemotherapy
Chemotherapy, or chemotherapy for short, is a treatment method that uses chemically synthesized drugs to kill tumor cells and inhibit their growth.
For stage IVA and stage IVB undifferentiated thyroid cancer, chemotherapy can be considered to be added on top of radiotherapy. Chemotherapy can be used simultaneously with radiotherapy, or can be given as an adjuvant after radiotherapy. The drugs used include paclitaxel, anthracycline and platinum.
Systemic chemotherapy may be considered for stage IVC undifferentiated thyroid cancer. Recommended regimens for stage IVC include paclitaxel plus platinum, doxorubicin plus doxorubicin, paclitaxel alone, and doxorubicin alone.
Biologic Therapy
Targeted therapy for undifferentiated thyroid cancer is advancing rapidly and has become a hot research topic in recent years. The clinical efficacy of some promising drugs such as Efatutazone and CA4P is under evaluation.
Immunotherapy for undifferentiated thyroid cancer is currently under investigation. Eligible patients may consider participating in clinical trials for better survival.
Other Treatments
Supportive therapy
Patients treated with radiation therapy require close airway monitoring. The airway can be narrowed for a variety of reasons, and in the absence of respiratory distress, a few can be relieved by moistening, antispasmodic or temporary application of short-acting steroids.
Most patients have a fair nutritional status and can be properly nourished orally without enteral nutrition. In contrast, enteral nutrition is advantageous in patients with esophageal obstruction or those who cannot tolerate transoral nutrition. Only very few patients need parenteral nutrition.
Treatment of metastatic lesions
There is little experience in the treatment of distant metastasis of undifferentiated thyroid cancer, and its treatment is mainly based on the treatment of distant metastasis of other malignant tumors.
Lung and mediastinal metastases: local treatment can be considered for limited and symptomatic lung and mediastinal metastases; systemic treatment is preferred for multiple and progressive lung and mediastinal metastases.
Bone metastasis: hormonal shock therapy and surgical decompression can be performed if symptoms of spinal cord compression appear. Radiotherapy can relieve the symptoms of bone pain caused by bone metastases. Bisphosphonates or disulfiram can also be used.
Brain metastasis: single brain metastasis can be treated with surgical resection or stereotactic radiosurgery; multiple brain metastasis can be treated with whole brain radiotherapy.
Liver metastasis: multiple liver metastases can be treated with hepatic artery embolization chemotherapy.
Chinese medicine treatment
Role
Chinese medicine can cooperate with surgery and radiotherapy, reduce the load of chemotherapy, radiotherapy and postoperative treatment, and play the role of adjuvant treatment and end-stage supportive therapy in reducing adverse reactions, improving physical strength, improving appetite, inhibiting tumor development and controlling the disease.
It can also be used as the main treatment for patients who do not accept surgery and radiotherapy.
Treatment Methods
Chinese medicine: including tonics, Chinese medicinal preparations and proprietary Chinese medicines. For those who are inherently weak or have damaged their vital energy after surgery, radiotherapy or chemotherapy, they can take tonics such as Eight Treasures Soup, Angelica Sinensis Blood Replenishing Soup, Ten Complete Tonic Soup, and Supplementing Zhongyiqi Soup with Additions and Subtractions.
Other traditional Chinese medical treatments: external compresses, acupuncture, etc.
Precautions
Traditional Chinese Medicine (TCM) treatments need to be carried out under the guidance of a professional TCM doctor.
Secret prescriptions, biased prescriptions, folk remedies and other methods of treatment have no scientific basis, the indications and effectiveness are not clear, and safety is difficult to guarantee, and are not recommended.
Prognosis
Prognostic factors
Prognostic factors refer to the factors that have an impact on the overall survival and quality of life of patients.
The survival rate of patients with undifferentiated thyroid cancer is related to the stage of the tumor, lymph node metastasis, treatment, and individual physical condition.
Survival rate
Undifferentiated carcinoma of the thyroid has the worst prognosis of all thyroid cancers.
The prognosis of undifferentiated thyroid cancer is very poor, with an average survival of 3-6 months and a 1-year survival rate of only 5%-15%.
Special reminder
The 1-year survival rate and other statistical data are only used for clinical research and do not represent the specific survival period of an individual. The individual survival period of a patient needs to be determined by combining various factors, and it is recommended to consult the physician.
Recurrence and Metastasis
About 50% of patients have distant metastasis at the time of consultation, 25% of patients develop distant metastasis during treatment or subsequent development of the disease, 80% metastasis to the lungs, 6% to 16% metastasis to the bone, 5% to 13% metastasis to the brain, abdominal metastasis such as the liver is rare.
Daily
Treatment-related care
Radiotherapy care
Before radiotherapy, patients need to remove metal objects from their bodies and wear loose, soft cotton clothes.
The skin will be dry and itchy during radiotherapy. Avoid strong hot or cold stimulation of the skin at the radiotherapy site, do not use hot water bags, and avoid direct sunlight. When molt and scabs appear, do not peel them off with your hands.
When cleaning the skin at the radiotherapy site, use a soft towel, the action should be gentle, avoid using irritating substances, such as soap, alcohol, etc..
Chemotherapy care
Leukopenia: Infection will be more likely to occur when white blood cells are reduced. During chemotherapy, pay attention to warmth and rest, avoid catching cold, and reduce close contact with the crowd to reduce the risk of infection.
Anorexia, nausea and vomiting: Eat small meals and eat easily digestible, light food. If necessary, consult your doctor if you need to take anti-emetic drugs.
Fever: For fever below 38℃, no antipyretic drugs can be used, drink plenty of warm boiled water and pay attention to rest; if the temperature exceeds 38℃ and there is obvious headache or general malaise, you should go to the hospital for a follow-up consultation in time.
Generalized fatigue: This kind of fatigue is often related to anemia, which requires sufficient rest and nutrition, and adequate intake of calories and proteins can help relieve the discomfort. If necessary, ask your doctor if you need to take medication to correct the anemia.
Hair loss: Hair loss may occur during chemotherapy and will grow back after the treatment is over, so don’t worry too much.
Life Management
Mindfulness and Emotional Adjustment
A good mood and mindset cannot be replaced by drugs.
After diagnosis, the patient may develop a sense of fear and may be afraid of pain, abandonment and death. Family members should pay attention to listen to the patient’s heart, improve the patient’s psychological tolerance and relieve anxiety symptoms.
Encourage the patient’s family to give support so that the patient can face the surgery and other treatments positively with a good mindset.
During the period between treatments and after treatment, family members are advised to encourage the patient to do work and household chores that are within his/her ability, so as to reintegrate into his/her social role.
Dietary regulation
Follow the diet prescribed by the doctor.
Post-operatively: a liquid diet is preferred, the temperature should not be too hot or too cold, and spicy and stimulating foods should be avoided to minimize stimulation of the surgical wound. During the recovery period after major surgery, it is advisable to eat more nutritious and easily digested and absorbed food.
Daily: Normal diet can be, there is no need to carve preferences or taboos of a certain food, the original normal dietary habits, life rules after recovery.