I. Epidemiology
1. Thyroid cancer accounts for 0.2%-1% of malignant tumors in human body.
2. Thyroid cancer accounts for 3.06% of head and neck malignant tumors.
It is the fastest growing solid malignant tumor in the past 20 years, with an annual growth rate of about 6.2%.
4.More women than men, generally 2 to 4:1.
The age of onset is generally 21-40 years old, with the majority of middle-aged people around 40 years old. The latest data shows that thyroid cancer ranks 5th among female malignant tumors.
Diagnosis
1. Clinical manifestations: Most of them have no clinical symptoms when the tumor is small.
Anterior neck mass: local pressure
Symptoms of invasion of surrounding structures: hoarseness, difficulty in breathing, difficulty in swallowing, etc.
2.Auxiliary examination
Laboratory tests: no specific hematological diagnostic indexes for the time being
Imaging examination: ultrasound, fine needle/coarse needle aspiration biopsy, CT/MRI, nuclear scan, etc. Among them, ultrasound is the most popular, sensitive and the best examination means.
Pathological classification of thyroid cancer
1. Differentiated thyroid cancer: including papillary thyroid cancer and follicular cancer
Papillary thyroid cancer: 70%-80%;
Follicular thyroid cancer: 5%-20%;
2. Medullary thyroid carcinoma: 5%-10%;
3.Undifferentiated carcinoma: accounting for about 5%.
IV. Treatment of differentiated thyroid cancer
Trilogy of treatment: “surgery + radioactive iodine-131 + thyroxine drugs”.
The prognosis is good and the quality of life is high, the 10-year survival rate can be as high as 90%.
V. Situation of iodine-131 treatment for differentiated thyroid cancer
1.Distant metastases of lung, bone and other organs are known to exist;
2. Intraoperatively, the tumor breaks through the thyroid envelope and invades the subcutaneous soft tissue, larynx, trachea, esophagus, laryngeal nerve, prevertebral fascia or encircles the carotid artery and mediastinal vessels (regardless of the size of the tumor);
3.The primary tumor is more than 4 cm in diameter;
4. Although the tumor does not break through the thyroid envelope and is between 1-4 cm in diameter, there is a proven risk of lymph node metastasis or other intermediate or high risk of recurrence and death. Specifically, surgical pathology suggests microscopic tumor invasion of soft tissues around the thyroid gland, highly invasive histological manifestations (such as hypercellular, columnar cell, insular cell, diffuse sclerosis, hypofractionated carcinoma, follicular carcinoma, eosinophilic carcinoma, etc.) or vascular invasion, incomplete tumor resection, and hypothyroglobulinemia (Tg).
VI. Toxic effects of iodine-131 therapy
High safety. Early-onset and late-onset reactions mainly include salivary gland damage, nasolacrimal duct obstruction, and second tumor (long-term follow-up confirms that it does not increase the risk of second tumor). A few female patients may experience menopause or decreased menstrual flow for 4-10 months without long-term infertility, and pregnancy after 1 year of iodine-131 treatment is still recommended. Male patients do not suffer from permanent infertility after a single iodine-131 treatment and are recommended to delay childbirth for 6 months-1 year.